Elsevier

Midwifery

Volume 57, February 2018, Pages 1-7
Midwifery

Childbirth and parenting preparation in antenatal classes

https://doi.org/10.1016/j.midw.2017.10.021Get rights and content

Highlights

  • The midwifes targeted birth preparation more than parenting preparation.

  • Parents want a balance between birth preparation and parenting preparation.

  • Parents expressed concerns about what could happened once they are home.

  • All participants needed more time to discuss with other parents.

Abstract

Objectives

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.

Design

qualitative; data were gathered using video or tape recordings and analysed using a three-pronged content analysis approach, i.e., conventional, summative, and directed analyses.

Setting and participants

3 antenatal courses in 2 antenatal units in a large Swedish city; 3 midwives; and 34 course participants.

Findings

class content focused on childbirth preparation (67% of the entire antenatal course) and on parenting preparation (33%). Childbirth preparation facilitated parents’ understanding of the childbirth process, birthing milieu, the partner's role, what could go wrong during delivery, and pain relief advantages and disadvantages. Parenting preparation enabled parents to (i) plan for those first moments with the newborn; (ii) care for/physically handle the infant; (iii) manage breastfeeding; (iv) manage the period at home immediately after childbirth; and (v) maintain their relationship. During the classes, parents expressed concerns about what could happened to newborns. Parents’ questions to midwives and discussion topics among parents were evenly distributed between childbirth preparation (52%) and parenting preparation (48%).

Key conclusions

childbirth preparation and pain relief consumed 67% of course time. Parents particularly reflected on child issues, relationship, sex, and anxiety. Female and male participants actively listened to the midwives, appeared receptive to complex issues, and needed more time to ask questions. Parents appreciated the classes yet needed to more information for managing various post-childbirth situations.

Implications for practice

while midwifery services vary among hospitals, regions, and countries, midwives might equalise content focus, offer classes in the second trimester, provide more time for parents to talk to each other, allow time in the course plan for parents to bring up new topics, and investigate: (i) ways in which antenatal course development and planning can improve; (ii) measures for evaluating courses; (iii) facilitator training; and (iv) parent satisfaction surveys.

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:

  • Shift focus from birth-oriented to parenting-oriented

  • Integrate the transition to parenthood topic into antenatal classes

  • Offer classes in the second trimester – rather than the third

  • Provide more time for parents to socialize with each other

  • Allow time in the syllabus/lesson plan for parents to bring up new topics

  • Investigate:

    • ways in which antenatal course development and planning can improve

    • measures for evaluating course

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.

References (54)

  • J. Taylor et al.

    How women manage fatigue after childbirth

    Midwifery

    (2010)
  • J. Taylor et al.

    The role of anxiety and other factors in predicting postnatal fatigue: from birth to 6 months

    Midwifery

    (2013)
  • A. Vikstrom et al.

    Partners' perspective on care-system support before, during and after childbirth in relation to parenting roles

    Sexual&Reproductive Healthcare

    (2016)
  • H. Woolhouse et al.

    Physical health after childbirth and maternal depression in the first 12 months post partum: results of an Australian nulliparous pregnancy cohort study

    Midwifery

    (2014)
  • X. Yang et al.

    Predictors of breast feeding self-efficacy in the immediate postpartum period: a cross-sectional study

    Midwifery

    (2016)
  • J. Yelland et al.

    Enhancing early postnatal care: findings from a major reform of maternity care in three Australian hospitals

    Midwifery

    (2009)
  • I. Ahlden et al.

    Parents' expectations about participating in antenatal parenthood education classes

    Journal of Perinatal Education

    (2012)
  • I. Artieta-Pinedo et al.

    The benefits of antenatal education for the childbirth process in Spain

    Nursing Reserch

    (2010)
  • L. Asenhed et al.

    Becoming a father is an emotional roller coaster - an analysis of first-time fathers' blogs

    Journal of Clinical Nursing

    (2014)
  • M. Barimani et al.

    Facilitating and inhibiting factors in transition to parenthood - ways in which health professionals can support parents

    Scandinavian Journal of Caring Science

    (2017)
  • M. Bergstrom et al.

    Effects of natural childbirth preparation versus standard antenatal education on epidural rates, experience of childbirth and parental stress in mothers and fathers: a randomised controlled multicentre trial

    BJOG: An International Journal of Obstetrics&Gynaecology

    (2009)
  • A. Berlin et al.

    Content and Presentation of Content in Parental Education Groups in Sweden

    Journal of Perinatal Education

    (2016)
  • C.S. Brixval et al.

    Effect of antenatal education in small classes versus standard auditorium-based lectures on use of pain relief during labour and of obstetric interventions: results from the randomised NEWBORN trial

    BMJ Open

    (2016)
  • T. Deave et al.

    The transition to parenthood: what does it mean for fathers?

    Journal of Advanced Nursing

    (2008)
  • T. Deave et al.

    Transition to parenthood: the needs of parents in pregnancy and early parenthood

    BMC Pregnancy Childbirth

    (2008)
  • C.L. Dennis et al.

    Psychosocial and psychological interventions for preventing postpartum depression

    Cochrane Database Systematic Review

    (2013)
  • H.M. Fabian et al.

    Childbirth and parenthood education classes in Sweden. Women's opinion and possible outcomes

    Acta Obstetrica Gynecological Scandinivia

    (2005)
  • Cited by (50)

    • Maternity care during a pandemic: Can a hybrid telehealth model comprising group interdisciplinary education support maternal psychological health?

      2023, Women and Birth
      Citation Excerpt :

      Antenatal education curricula vary by program and health service, but the underlying objectives remain the same: to provide preparation for pregnancy, labour and birth, and to a lesser extent, parenting [33]. While the objectives and effectiveness of antenatal education vary [3,78,8], a recent review of health education strategies targeting pregnant women, authors commented that the continuation of health education strategies after childbirth contributed to improved maternal and child outcomes [45]. This is timely given the increasing evidence suggesting women feel dissatisfied with respect to their postnatal care [75], revealing an inability to access timely information when needed, thereby impacting on their parenting confidence, as well as physical and mental health outcomes [71].

    • Determination of mothers' thoughts and adaptation behaviors regarding the infant: A descriptive study

      2022, Pediatrics and Neonatology
      Citation Excerpt :

      It was discovered in one study that having more than one child boosts parenting self-efficacy and contentment.14 However, it is well recognized that when women begin to consider having a child, they require a wealth of information about the role of motherhood and baby care, regardless of prior experience.15 While the scale score in our study was higher than the national average, the fact that mothers’ knowledge levels were close to the national average (41%) in a previous study15 indicates that they required training, regardless of their level of knowledge.

    View all citing articles on Scopus
    View full text