Childbirth and parenting preparation in antenatal classes
Introduction
Becoming a parent is a major life transition that can be confusing and overwhelming (Barimani et al., 2017, Deave et al., 2008, Fagerskiold, 2008, Leahy Warren, 2005, Nystrom and Ohrling, 2004, Premberg et al., 2008). Following childbirth, parents report physical and emotional changes (Fahey and Shenassa, 2013). Researchers describe physical complaints such as painful perineum, caesarean wound pain, breast problems, urinary incontinency, constipation, and back pain (Webb et al., 2008, Woolhouse et al., 2014, Yelland et al., 2009). Others describe emotional changes, such as postnatal fatigue (Taylor and Johnson, 2010, Taylor and Johnson, 2013), anxiety (Taylor and Johnson, 2013), and depression (Dennis and Dowswell, 2013, Schmied et al., 2013). Parents also reported sleep deprivation (Kurth et al., 2011) and changed relationships (Deave et al., 2008, Fagerskiold, 2008, Pinquart and Teubert, 2010, Premberg et al., 2008).
Antenatal education exists in most western countries to strengthen and support parents and thus help them deal with changes. This education has become an integrated part of health care services and is an essential antenatal care component. Antenatal education goals vary nationally and internationally, but according to Gagnon and Sandall (2007), a common goal is to prepare parents for childbirth and parenting.
Various names are assigned to this education (e.g., expectant parent classes; antenatal parenthood education; antenatal education; childbirth classes; and antenatal classes). This article uses the term antenatal classes and reports on findings that focus on subject matter/content in general antenatal classes.
Research on childbirth preparation in antenatal classes showed that the classes helped women prepare for childbirth (Fabian et al., 2005). But research mostly focused on varying obstetric outcomes after antenatal class participation (Artieta-Pinedo et al., 2010, Bergstrom et al., 2011, Brixval et al., 2016, Fabian et al., 2005). Several researchers reported that antenatal classes are not associated with benefits during childbirth, and when accounting for psycho-physical theory of childbirth and pain, the classes demonstrate no effect (Bergstrom et al., 2009, Svensson et al., 2009).
Researchers of parenting preparation in antenatal classes reported that the classes strengthened the parenting role (Ahlden et al., 2012, Asenhed et al., 2014, Barimani et al., 2017, Berlin et al., 2016, Schrader McMillan et al., 2009, Svensson et al., 2009). Others emphasized importance of discussions and of exchanging parenting-related information during social contact among parents (Asenhed et al., 2014, Berlin et al., 2016, Fabian et al., 2005, Murphy Tighe, 2010, Norling-Gustafsson et al., 2011, Svensson et al., 2006, Svensson et al., 2008).
In addition, the gender perspective is crucial in antenatal classes (Berlin et al., 2016); partners want to actively participate in the classes (Asenhed et al., 2014, Deave and Johnson, 2008, Entsieh and Hallstrom, 2016, Vikstrom and Barimani, 2016). That said, some researchers reported that parenting preparation wasn’t discussed in antenatal classes (Bergstrom et al., 2011, Berlin et al., 2016, Fabian et al., 2005, Schrader McMillan et al., 2009). According to two studies, a reason for this might be that midwives think parents are not too receptive to information about parenting. So self-confidence, parents’ emotional health, parenting skills, and the couple's relationship are among many factors that are not dealt with during antenatal classes (Renkert and Nutbeam, 2001, Wiener and Rogers, 2008). In addition, when asked in retrospect, parents were more satisfied with childbirth preparations and felt far less empowered regard parenthood preparations right after childbirth (Nelson, 2003, Nolan, 1997).
Researchers have paid little attention to antenatal class content, and during recent decades, antenatal education has become more challenging because parents come from different contexts (Forslund Frykedal et al., 2015) and get a lot of information from diverse sources such as parents, friends, magazines, and the web (Forslund Frykedal et al., 2015, Lima-Pereira et al., 2012).
Studies that investigated content mostly occurred retrospectively after childbirth, when parents realized that the classes did not address key issues. Consequently, a need exists for gaining information on issues that parents bring up during antenatal classes.
Section snippets
Aim
This study's overall aim was to identify course content that is presented by midwives and discussed by parents during antenatal classes – not prospectively or retrospectively. Its objectives were to describe topics (1) presented by midwives’ during antenatal classes and the amount of time spent on these topics and (2) raised and discussed by first-time parents and the amount of time spent on these topics.
Methods
This study implemented a qualitative design. Data were gathered using video or tape recordings and analysed using a three-pronged content analysis approach.
Analysis
Qualitative content analysis was applied using three approaches: conventional (codes are derived from data), summative (quantifying certain content or words in text), and directed (using preconceived categories) (Hsieh and Shannon, 2005, Krippendorff and Bock, 2009).
The videos and tapes were transcribed verbatim and compiled into one document. Table 2 displays the four data analysis phases – based on research objectives (items/statements).
To ensure reliability, each analysis phase was
Objective 1
Describe topics presented by midwives’ in antenatal classes. Table 3 displays these topics. Midwifes worked with a prepared lesson plan for the antenatal classes. The plan functioned as a map that they used to present childbirth and parenting topics.
Midwives spent 10 hours (67% of the entire antenatal course) conveying childbirth preparation information (on childbirth and pain relief). They spent 5 hours (33% of the antenatal course) conveying parenting preparation information (child-related
Discussion
This study varies from other antenatal education studies. It describes (i) content presented by midwives during antenatal classes and (ii) parents’ responses to the content and their questions and concerns during the classes – rather than prospectively describing content and retrospectively reporting parents’ questions, concerns, and opinions from interviews and surveys following classes and childbirth.
This study describes topics (1) presented by midwives’ during antenatal classes and the
Methodological considerations
The concepts credibility, dependability, and tranferability are used to describe varying trustworthiness factors (Graneheim and Lundman, 2004).
Conclusion
Childbirth preparation and pain relief topics took up more than half (67%) of the course time even though parents displayed equal interest in topics such as infant care, breastfeeding, and parenting. This finding suggests that (i) parents are receptive to parenting preparation information and (ii) a course-content shift in focus should occur from birth-related to parenting-related. In addition, classes should start in the second trimester – a proposal aligned with Svensson et al. (2006).
Often
Implications for practice
Based on our findings and conclusions, implications for practice are:
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Shift focus from birth-oriented to parenting-oriented
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Integrate the transition to parenthood topic into antenatal classes
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Offer classes in the second trimester – rather than the third
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Provide more time for parents to socialize with each other
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Allow time in the syllabus/lesson plan for parents to bring up new topics
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Investigate:
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ways in which antenatal course development and planning can improve
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measures for evaluating course
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Conflict of interest
No conflict of interest has been declared by the authors.
Ethical approval
A university research ethics board approved the study (2013/359-31).
Funding statement
This research was funded by the Swedish Research Council (grant # 721-2012-5473).
Clinical Trial Registry and Registration number
Not applicable.
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