14.3: Bradley Method

Learning Objectives

By the end of this section, you will be able to:

• Discuss the history of the Bradley Method
• Verbalize the importance of prenatal nutrition and exercise as part of the Bradley Method
• Summarize the importance of continuous labor support in the Bradley Method
• Compare and contrast the first and second stage of labor teaching that is provided to the birthing person and the labor support person in the Bradley Method

The Bradley Method is a classic form of childbirth education that has inspired countless families to consider unmedicated, low-intervention birth. Understanding the concepts of this approach to birth can help nurses be more prepared to support families choosing unmedicated birth or with a preference for low intervention in pregnancy, labor, and birth. As nurses support families who use this form of childbirth education, it will be important to include the patient’s support person because they have trained for the role extensively.

History

Dr. Robert A. Bradley developed the Bradley Method in 1947 and published his first book on the subject in 1965. Dr. Bradley grew up on a farm where birth was a normal event, and he became an obstetrician in the era of twilight births. At this time, laboring people would thrash in restraints from medication while forceps were used to deliver their newborns, a practice very different from how Bradley knew birth. His book Husband-Coached Childbirth taught people to support healthy pregnancies and birth without intervention or medication and taught partners to coach and support birthing persons (Bradley, 2008). The Bradley Method also teaches about the common discomforts of pregnancy and offers suggestions to help manage them. Birth support people, referred to as coaches in the Bradley Method, are taught how to better support the birthing person during pregnancy, labor, birth, and postpartum.

Benefits of the Bradley Method

The Bradley Method routinely covers more topics than other childbirth education options and is focused on preparing the couple for an unmedicated birth (Sioma-Markowska et al., 2016). This method provides education on pregnancy, labor, postpartum, and breast-feeding. A benefit of this method is the involvement of the partner in the supportive role. Paternal engagement in childbirth education is associated with more paternal involvement in the pregnancy, birth, and the postpartum period (Sioma-Markowska et al., 2016).

Shortcomings of the Bradley Method

A disadvantage of the Bradley Method is that it requires a 12-week commitment during pregnancy by the birthing person and their coach. Classes can sometimes be expensive. If a couple lives in a rural area, it could be difficult for them to find a certified Bradley instructor. This method is committed to providing factual, transparent information. At times this can cause fear and anxiety as couples learn about the risks of medication and interventions (Gurevich & Odunsi, 2021).

Bradley Method: Prenatal Nutrition and Exercise

Dr. Bradley noted that the healthier a pregnant person was, the more likely they were to have an uncomplicated birth. Because of this, the Bradley method incorporates diet and exercise recommendations into the teachings. This method teaches the importance of consuming protein and good fats during pregnancy, recommending intake of 100 g of protein a day. The intake of 100 g of protein requires the pregnant person to consume 4 cups of milk, 3 ounces of fish, 3 ounces of chicken or beef, and 4 eggs daily (BradleyBirth.com, n.d.).

Exercise during Pregnancy

The Bradley Method includes a strong emphasis on body movement and health in pregnancy, as illustrated in Figure 14.3. The recommendations include sitting on flat surfaces with legs folded to release the pelvic floor, as well as frequent squatting and pelvic rocking. All these exercises should be done early and often, then balanced by rest and relaxation of the muscles (Bradley, 2008).

Figure 14.3 Exercise during Pregnancy The Bradley Method encourages pregnant persons to exercise and stay healthy with a high-protein diet. (credit: “Incirlik keeps moms in shape with Pregnancy PT” by Senior Airman Anthony Sanchelli/Incirlik Air Base, Public Domain)

Foods Needed During Pregnancy

Dr. Bradley highly regarded the teachings of Dr. Brewer for pregnancy nutrition. Dr. Brewer suggested that a high-protein diet is the best diet for pregnancy, and this provides the basis for the nutritional teachings of the Bradley Method. Rigorous research did not support Brewer’s claim that this diet reduced preeclampsia (Zhu et al., 2022). However, research does show that high protein intake, high fruit and vegetable intake, and the Mediterranean diet can lower rates of preeclampsia (Makarem et al., 2022; Zhu et al., 2022).

Bradley Method: Continuous Labor Support

The Bradley Method recommends continuous labor support to improve the outcome and experience for the birthing person. Moving support people, especially partners, from the waiting room to the birthing room is, in large part, credited to the Bradley Method.

Support from the Nurse

Association of Women’s Health, Obstetric and Neonatal Nurses (AWHONN) staffing standards recommend a ratio of one to two patients per nurse and a 1:1 ratio with intermittent auscultation and advanced dilation in unmedicated labors (AWHONN, 2022). This staffing ratio can be very difficult to obtain, and many facilities fail to uphold these standards. The Bradley Method prepares the support person to provide continuous support, especially in the hospital, where continuous support from the nurse is often impossible.

Partners versus Other People as Supporters

Research shows that continuous labor support is associated with shorter labors, lower cortisol levels, and higher incidences of vaginal birth (Stjernholm et al., 2021). Partners can be great support persons because they are invested in the birth and know the laboring person intimately. At times, partners are not equipped for or capable of being the “coach,” and another support person can fill that role.

Doula as Continuous Labor Support

Doulas are trained and certified to attend births to support the laboring person. Some hospitals and birth centers employ doulas in addition to the nursing staff to care for their laboring patients. Independent doulas charge a fee that is typically dependent on the experience of the doula, meaning a very experienced doula would charge a higher fee. Cost can be a barrier to some families.

Figure 14.4 Doula Support The doula supports the laboring person as they are on their knees and using a birthing ball to support the upper body. (credit: Jefferson Rudy and Agência Senado/flickr, CC BY 2.0)

Bradley Method: What to Expect in the First Stage of Labor

Dr. Bradley wrote about the primal aspects of labor and how this mimics nature, where animals seek dark, quiet, secluded, safe areas to birth their young. His method recommends laboring in a dark, quiet, home-like environment with partner support, solitude, physical comfort, physical relaxation, controlled breathing, and rested/closed eyes (Bradley, 2008). To progress through labor, Bradley suggested that laboring persons include the techniques of movement between contractions, abdominal breathing, relaxation specifically of the jaw/throat, and the relaxation of all muscles not involved in birth that can be tense when under stress or strain (Bradley, revised 2008).

Bradley Method: Second Stage of Labor

Instinctual movements are also consistent with Bradley recommendations in the second stage. These include allowing for the spontaneous urge to push, squatting positions, and upright chair positions. Bradley also likens the act of pushing to that of moving the bowels when constipation is present. Bradley recommends treating the sensation of the fetal head as pressure instead of pain (Bradley, 2008).