Configuring childbirth education to survive in managed care.

Managed care plans, especially in capitated systems, have not recognized the value of childbirth education for facilitating the transition to parenthood, especially for first-time parents. Advanced practice nurses, who are the logical facilitators and teachers of such programs, have not always made cogent arguments for inclusion of childbirth education. Physicians have been embroiled in their own issues regarding managed care. The interaction of these three forces creates serious but not insurmountable constraints for providing comprehensive, cost-effective quality care for childbearing families.