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Perhe- ja synnytysvalmennus perheiden hyvinvoinnin tukijana Voisiko virtuaalitodellisuudesta olla apua?
Abstract
Lapsiperheiden hyvinvoinnista on keskusteltu paljon pandemian aikana. Vuonna 2020 eduskuntaan perustettiin turvallisen odotus- ja vauva-ajan edistämisryhmä, joka on ottanut kantaa siihen, kuinka odotus- ja vauva-ajan palveluiden saatavuudella on merkittävä vaikutus lapsen ja perheen terveyteen sekä hyvinvointiin. Korona-aikana on ilmennyt vajeita niin lakisääteisten neuvolakäyntien kuin neuvoloiden järjestämien perhevalmennusten toteutumisessa (Eduskunnan turvallisen odotus- ja vauva-ajan edistämisryhmä, 2021). Ryhmän eduskunnalle tekemän lausunnon mukaan koronakriisi on lisännyt psyykkistä oireilua, stressiä ja eriarvoisuutta pikkulapsiperheissä muodostaen pitkäkestoisen riskin lapsen kehitykselle (Eduskunnan turvallisen odotus- ja vauva-ajan edistämisryhmä, 2021). Eduskunnan ryhmä onkin todennut, että nyt jos koskaan tarvitaan erityistä huomiointia odotus- ja vauvaperheiden hyvinvoinnin tukemiseen.
Samaan aikaan kätilöt ovat julkisuudessa nostaneet esiin odotuksen, synnytyksen ja synnytyksen jälkeisen hoidon ongelmia (HS 24.4.2021). Työntekijät kokevat työssään kohtuutonta kuormitusta ja eettistä stressiä, mikä on johtanut siihen, että kätilöitä on hakeutunut muihin töihin. Keskusteluun on nostettu myös potilasturvallisuus, kun kätilöinä toimii kokemattomampia työntekijöitä tai kun kätilöitä ei ole vuorossa riittävästi.
Perhe- ja synnytysvalmennus valmentaa perheitä synnytykseen ja lapsivuodeaikaan (Klemetti & Hakulinen-Viitanen 2013). Sillä voidaan vähentää synnytyksessä tarvittavien toimenpiteiden määrää (Mueller ym. 2020) ja synnytyspelkoa (Haapio 2017) sekä auttaa asettamaan odotuksia realistiselle tasolle (Mueller ym. 2020). Synnytysvalmennus edistää synnyttäjän keskustelutaitoja hoitohenkilökunnan kanssa, parantaa osallistumista päätöksentekoon ja vähentää synnytyksen kipukokemusta (Akca ym. 2017). Perheet tulevat tavallisesti valmennukseen hakemaan apua synnytyksen aikana pärjäämiseen sekä tukea vanhemmuuteen siirtymiseen (Koehn 2008). Tällöin valmentajan roolin tulisi muuttua ohjaajaksi, joka tarjoaa ympäristön ja verkoston oivalluksille, uuden oppimiselle ja tukee siirtymää vanhemmuuteen (Vekved ym. 2017). Synnytysvalmennus on usein suunniteltu valmentajan näkökulmasta (Koehn 2008), ja meidän tulisi siirtyä enemmän käyttäjälähtöiseen valmennukseen (Vekved ym. 2017). Äitiysneuvolaopas (Klemetti & Hakulinen-Viitanen 2013) suosittaa valmennuksen jatkuvaa kehittämistä, monimuotoisuutta ja vaihtoehtoja erilaisille perheille sekä internetin hyödyntämistä. Verkkovalmennuksissa uusimpia avauksia ovat olleet niin kutsutut käänteiset luokkahuoneet (Bergmann & Sams 2012) sekä virtuaalitodellisuuden hyödyntäminen (Ulrich ym. 2021). Virtuaalisten ympäristöjen on todettu vaikuttavan positiivisesti käyttäjän henkiseen oppimisympäristöön (Ulrich ym. 2021).
Perhevalmennusten toteutumisesta ei ole kansallista seurantaa. Tässä selvityksessä lähdimme kartoittamaan kätilöiden näkemyksiä odottajien valmistautumisesta synnytykseen. Tarkoituksenamme oli selvittää, millaista tarvetta ammattilaiset näkevät perhe- ja synnytysvalmennuksen ke324
YHTEISKUNTAPOLITIIKKA 87 (2022):3
hittämiseksi vai riittääkö nykyinen tarjonta. Lisäksi tarkastelimme, millainen tuntuma synnytyksiä hoitavilla ammattilaisilla on perheiden valmistautumisen tasosta ja kokevatko he, että perheiden tulisi tietää enemmän joistain erityisistä teemoista.
Selvityksen toisessa osassa kartoitimme, miten hyvin vuonna 2019 neuvolassa käyneet odottajat saavuttivat THL:n Äitiysneuvolaoppaassa (Klemetti & Hakulinen-Viitanen 2013) perhe- ja synnytysvalmennukselle asetetut tavoitteet. THL:n tekemän tutkimuksen mukaan vain 38 prosenttia odottajista ja 41 prosenttia toisista vanhemmista osallistui valmennuksiin (Klemetti ym. 2018), joten selvitimme myös syitä, miksi valmennukseen ei osallistuttu.
... The CBE provided to expectant parents varies, with some receiving no education [4]. According to the 2019 study, only 23% participated in the CBE offered by the prenatal clinic, and 77% did not [4]. ...
... The CBE provided to expectant parents varies, with some receiving no education [4]. According to the 2019 study, only 23% participated in the CBE offered by the prenatal clinic, and 77% did not [4]. The most common reason for not receiving CBE was multiparity (37%). ...
... For example, they had only one possible time to attend, and they were sick, the location was far away (100km), or the session was in the morning or during the day. Most parents who received CBE must still reach their learning goals [4]. Online learning removes participation barriers. ...
In Finland, prenatal clinics and birthing hospitals struggle with resources to provide expectant parents with childbirth education (CBE) and a tour of the hospital birthing unit. Not preparing for birth is common, and not knowing how and where to give birth causes parents unnecessary stress during pregnancy. One new possibility to complement CBE is using virtual reality (VR) to deliver content. The aim of this study is to describe midwives' views of the status of parents' preparation for birth and provide information on the VR CBE program's advantages and challenges from the midwife's perspective. The study consisted of two focus group sessions with seven participants. Participants were midwives with experience from a hospital birthing ward and had provided childbirth education. The data was analysed using a thematic content analysis approach. According to the midwives, the parents do not prepare for birth well enough. Preparing for birth affects the parents' knowledge about childbirth, their cooperation with the healthcare personnel, and how they trust the birthing process, themselves, and the healthcare personnel. Preparation can also have adverse effects if the birthing person is trying to give birth with a detailed plan or has false expectations. Parents should focus on knowledge, attitude, and mental and physical exercise in preparing for childbirth. By preparing from trusted sources, parents can make informed decisions. They have the skills to stay calm, relaxed, and open-minded during labour and birth. Physical and mental exercise will help them cope with labour and relax their mind and bodies during birth. Midwives see VR as offering great potential for concrete, realistic, and flexible childbirth education that can address current challenges. They were also worried that VR could replace face-to-face contact. However, since there is minimal such contact in the current CBE, VR could enhance childbirth education and offer a realistic and concrete image of birth and a hospital tour. Midwives want families to prepare better for birth and work on their knowledge, attitude, and exercise. By preparing, parents understand childbirth, trust themselves, the birthing process, and the midwives; cooperation works better. Midwives see VR as an excellent addition to childbirth education by offering realistic and concrete online childbirth education. VR should not replace face-to-face contact.
... Since the current Finnish CBE does not fully meet the users needs (Siivola & Leinonen, 2022) nor reaches the needed level of learning (Klemetti et al., 2018;Siivola & Leinonen, 2022), our first goal was to utilize user-centered development methods to build an online CBE program. When the pandemic forced the cancellation of traditional group learning classes and hospital tours, we set a second goal to develop an online CBE program in which parents could get the look and feel of the hospital while learning CBE content at the same time. ...
... Since the current Finnish CBE does not fully meet the users needs (Siivola & Leinonen, 2022) nor reaches the needed level of learning (Klemetti et al., 2018;Siivola & Leinonen, 2022), our first goal was to utilize user-centered development methods to build an online CBE program. When the pandemic forced the cancellation of traditional group learning classes and hospital tours, we set a second goal to develop an online CBE program in which parents could get the look and feel of the hospital while learning CBE content at the same time. ...
During the pandemic in Finland, most childbirth education (CBE) programs were canceled or transferred online. We aimed to improve the situation by developing a virtual reality (VR) CBE. This article describes the process of developing a VR CBE pilot program and the results from the preliminary user test. To create the VR experience, we used 360° videos as the main content. The program is usable with VR headsets, a computer, tablet, and smartphone. When using the program with a VR headset, the users felt they were in the birthing room; they did not feel motion sickness, nor did they have usability challenges. The users preferred using the program on their own, studying independently with a tablet or mobile device.
... During the pandemic, clinics stopped face-to-face group classes. In some municipalities, the CBE consists of just one online session or email (Siivola & Leinonen, 2022). The lack of CBE in the prenatal clinic services increased the need for interactive online education where participants can meet with a childbirth educator. ...
Since many childbirth education (CBE) courses have moved online, there is a need for a pedagogical design model for online learning. In this study, an online CBE course was flipped, user studies were conducted, and a pedagogical design model was developed. Flipped learning was chosen as it combines asynchronous and synchronous learning activities. The developed model was further strengthened by conducting a pilot study with public health nurses. User data were collected with questionnaires and analyzed using inductive thematic analysis. The results show that in informal learning settings, emphasis should be on which elements are asynchronous or synchronous and mandatory or voluntary. Additionally, time management and interaction between participants and their peers and the instructor should be considered for future training.
The purpose of this grounded theory study was to describe and understand contemporary childbearing women's perceptions of the role of childbirth education in preparing for birth. Participants were interviewed three times: prior to beginning classes, at the end of classes, and within 2 weeks after giving birth. Constant comparative analysis of the data was concurrent with data collection. The core process that emerged was "Negotiating the Journey," with supporting categories of "Exploring the Unknown," "Making It Real," and "Sensing the Readiness." The findings indicated that, for contemporary women, the value of childbirth education may not be in affecting physiological birth outcomes but rather in helping them to be ready for childbirth and, thereby, completing an important developmental milestone.
Past evaluation of the effectiveness of childbirth education classes related to obstetric outcomes and satisfaction with the birth experience have not shown consistent results. This study explored the relationship between attendance of set curriculum childbirth education class and the labor and birth process, as well as maternal satisfaction with the birth experience. Participants were 197 low-risk, primiparous women, self-selected into two groups consisting of 82 women who attended a childbirth class and 115 women who did not. Data were collected from medical records and a postpartum satisfaction survey was completed by each participant. The authors designed the Likert-type satisfaction survey based on “control” as a key factor in satisfaction. Data analysis revealed that women who took a class were less likely to be induced and had lower use of analgesics during labor. A logistical regression model showed that an increase in the number of interventions increased the risk for cesarean surgery for all women. Labor interventions were used significantly less in women who took a childbirth class. No statistical difference was seen in the perception of control or overall satisfaction of the birth experience. Childbirth education may help women prepare for what to expect in birth and minimize the use of medical interventions.
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