What do mothers and fathers report when asked why they think the lamaze method of childbirth works?

So, you’ve had nine months to prepare.

You and your husband have faithfully attended childbirth education classes every Tuesday night for the past four weeks. You’ve listened to the lectures about physiology. You’ve watched the films. You’ve toured the hospital. You’ve learned imagery techniques and how to relax. You have practiced Lamaze breathing techniques until you’re blue in the face.

And now you’ve arrived at the hospital with extra pillows, Lamaze instruction sheets and a bagful of items designed to help you get through this. The contractions become rapid and. . . . Whoa! Bring on the fetal monitor, the intravenous drip, the drugs, maybe even the Cesarean. Suddenly, the experience that you and your husband planned for--calm, controlled, natural and free of much interference from medical personnel--has become something much different.

Did you fail childbirth education?

Or did the classes fail you?

It’s not uncommon for couples to ask themselves those questions these days.

As many childbirth educators acknowledge, the so-called “natural childbirth” movement, popularized by the Lamaze method in the 1950s, has fallen short of its goal. While women rarely give birth in the drugged, unconscious stupor that many did before 1950, few are achieving the original goals set by natural childbirth proponents: a birth free from medication and fear.

Moreover, although few recent studies or surveys have looked at satisfaction with and effectiveness of education programs, many women report that classes, often taught in hospitals, failed to supply them with the skills they needed for a prepared, calm, relatively painless childbirth.

“I remember thinking that the things that I heard in that hospital childbirth class were so irrelevant,” Mary Noonan, a Capistrano Beach mother, recalls of her first child’s birth.

Judy Cooper, a Los Angeles attorney, also attended such classes but recalls thinking that something big was missing.

“I think it was a little bit oversold,” she says of the childbirth techniques she was taught. “It didn’t give you the whole truth. Giving birth is very hard. It’s draining. It’s not a beautiful process. Everyone isn’t smiling and saying how wonderful things are. I experienced (childbirth) as painful and frightening.”

Many education groups are exploring ways to make their programs more effective. But experts point out that for some of today’s mothers, the goal has changed: More couples want minimum exertion with maximum comfort--including the use of medication, if needed.

While most people refer to childbirth classes as Lamaze or natural childbirth, a variety of methods are in use and many combine elements from various programs.

“Natural childbirth” is loosely defined as a method in which the mother prepares emotionally and physically for labor so that it is relaxed, relatively painless and requires little or no medication. While that concept is still considered the ideal, the term has been discarded by educators in favor of “prepared childbirth,” which ostensibly helps couples prepare for anything that could happen, including surgery and the use of medication. There are several methods or philosophies in practice around the country; Lamaze is just one of them.

Whatever you call it, childbirth education has ushered in many positive changes, educators say: Involvement of the father or other family members, movement toward more home and birthing-center deliveries, and the decline of some outdated medical procedures.

But studies show that a great many women still need drastic medical intervention during childbirth. Almost 24% of U.S. women have Cesareans, and more than half use some sort of medication during childbirth, many hospitals report.

Childbirth educators say several factors may contribute to prepared-birth shortcomings:

* Distortions in the popular Lamaze method, developed in Paris in the early 1950s.

* Inadequate teacher-training programs and teaching methods.

* Interference of medical technology.

* Unrealistic expectations from couples who want the perfect childbirth experience without much work, pain or preparation.

“One of the problems today, we have found, is that what passes for Lamaze is nothing close to what it should be,” says Flora Hommel, a Detroit woman who gave birth to her first child in Paris when Dr. Fernand Lamaze introduced his technique. She later studied with him and became one of the early Lamaze educators in the United States.

“As it became more and more popular, doctors and hospitals decided it was something that they wanted to get into,” says Hommel, who heads the Lamaze Birth Without Pain Education Assn. “There have been many modifications and distortions of the technique, but primarily distortions of the philosophy. We find there is so much distortion that no one really practices it anymore.

“That is why results are poor. And in our estimation, they are very poor.”

Hommel has divorced herself from the largest Lamaze teaching organization in the country--the American Society for Psychoprophylaxis in Obstetrics-Lamaze. But Joyce DiMarco, a Rancho Palos Verdes childbirth educator who is on the faculty of ASPO-Lamaze, suggests that differences in childbirth preparation philosophies are not that distinct: All the methods use such techniques as imagery, relaxation and controlled breathing.

But, she says, effectiveness varies greatly among instructors.

While many organizations train and certify teachers, no state or federal regulations govern birth educators. Couples attending classes rarely think to ask key questions, such as what are the instructor’s credentials and training, and what is the philosophy being taught, DiMarco says. Class size and length are also important.

“You have teachers who have been trained, teachers who have never been trained, and teachers (who) come from various philosophies,” she says.

But many educators say they design classes according to their beliefs about what works--or doesn’t.

Michelle Leclerc O’Neill, a Los Angeles nurse who holds a doctorate in psychoneuroimmunology, says distortion of the Lamaze method and the dissatisfaction expressed by many couples using the method led her to develop her own technique to improve Lamaze.

O’Neill’s method involves intense psychological preparation for childbirth and parenthood for both the mother and father; it includes the use of analytic dream work and self-hypnosis.

According to O’Neill, the Lamaze method and other childbirth preparation methods are doomed by the Western view of childbirth.

Instead of believing it is pain-free, joyous and natural, Americans generally grow up believing that childbirth is painful and unbearable. The birth itself becomes a medical emergency: The mother is in agony and cannot birth her baby, so doctors must intervene; the husband is a bumbling and helpless bystander.

O’Neill’s method stresses exploring one’s feelings about pregnancy and childbirth, motherhood, breast-feeding, marriage and career to pave the way for a relaxed experience. Unresolved anxiety in any area can be brought to the birth, causing physical tension, fear, loss of control and pain.

After three Cesarean sections, Judy Cooper asked O’Neill to help her prepare for the birth of her fourth child. Cooper hoped for a vaginal birth, which is rarely achieved after repeat Cesareans. After a 30-hour labor, and with the help of some medication, she delivered the baby without surgery.

“It gave me relaxation,” Cooper says of O’Neill’s method. “It helped me focus in a way I’d never been able to before in dealing with the fear.”

O’Neill criticizes hospitals that teach childbirth education classes but make little effort to evaluate their effectiveness and make improvements.

“The doctors know it doesn’t work,” she says. “But it’s beneficial to the hospital (to offer the classes). It looks good. But it doesn’t work.”

Her classes run about twice as long as the standard hospital-based program of four, two-hour sessions.

DiMarco says many ASPO-Lamaze instructors would prefer to teach small classes outside hospitals to avoid having to teach routine hospital childbirth procedures that the educator might not endorse. Her classes, which are private, run for six weeks and follow the ASPO-recommended size limit of less than 12 couples.

Rochelle Elliott, a longtime labor nurse for Cedars-Sinai Medical Center, says that while hospital-based classes are generally bigger than independent ones, hospital-based instruction--especially classes taught by labor and delivery nurses--gives couples a more accurate idea of the choices they may face in a hospital. Classes held independent of hospitals might emphasize the ideal birth while omitting information about what could happen, she says.

“I think people should be prepared for anything that can happen,” Elliott adds. “It’s not fair for a person to show up in labor and not know anything about what could happen.”

Hommel says many classes put too much emphasis on what will--or may--happen in the hospital. For example, she says, some hospitals routinely use labor-stimulating drugs, fetal monitors and intravenous drips that keep a woman confined to bed with less control over the birth process.

Physicians also draw some criticism when childbirth doesn’t turn out quite the way couples had prepared for it in classes.

Many obstetricians offer aggressive, high-tech medical equipment, services and medications out of fear that, if something goes wrong during the birth and the latest medical advancements are not in use, the mother will sue, Hommel says.

“Years ago, if a healthy patient showed something abnormal, you watched and waited and were conservative to avoid C-sections. Now, instead, the doctor thinks if he doesn’t do one and something goes wrong, he gets sued,” she says.

Elliott says physicians, nurses and couples give up on natural childbirth techniques more quickly than before:

“I think years ago couples tended to use the Lamaze techniques for a lot longer in labor and didn’t intend to use so much medication or whatever is available. At that time, medication was considered to be somewhat compromising to the baby.”

Now, however, several types of analgesics and anesthetics are considered relatively safe for use during labor. These include Demerol, a drug that takes some of the edge off pain, and the popular epidural anesthetic, which numbs the body from the waist down but can alter labor and render some natural-childbirth techniques ineffective.

But Gay Hall, a spokeswoman for the American College of Nurse-Midwives, says good classes prepare a couple to choose among a wide range of alternatives in birthing--including medication if they want or need it.

“As nurse-midwives, one of the things we believe in very strongly is patient choice,” she says.

Hall suggests, however, that couples may think they want a medication-free childbirth but have unrealistic expectations:

“Childbirth education very much reflects the nature of the population being taught. People have expectations that childbirth is painless and easily managed. And neither of those are true. I’m afraid that we have couples who would like a perfect childbirth experience. And that is just not achievable.”

Prepared birth techniques are effective only if they are taught well, practiced and used properly, DiMarco says.

But, she adds: “Women today expect no pain. They do not expect to put in time and energy and work on this. The goal is get me through this with no muss and no fuss. I don’t want my hair messed and my nails broken. There is a real different perception today than there used to be on what women want out of the birth experience.”