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Preparing Expectant Couples for New-Parent Experiences: A Comparison of Two Models of Antenatal Education
Abstract
This paper describes a pilot antenatal education program intended to better prepare couples for the early weeks of lifestyle changes and parenting. Eight weeks after birth, data were collected by questionnaire from 19 couples who participated in a pilot program and from 14 couples who were enrolled in a routine hospital program. Women in the pilot program were significantly more satisfied with their experience of parenthood. Facilitated gender-specific discussion groups formed a key strategy in the pilot program.
... However, despite fathers generally being supportive of breastfeeding, the literature highlights several factors that can affect the level of support they are equipped to offer. These factors include social support, knowledge, empowerment, and other specific barriers (see Textbox 1 [13,14,16,17,[19][20][21][22][23][24][25][26][27][28][29]). ...
... Social support [13,14,16,[20][21][22][23] • Insufficient social support ...
... Australians are enthusiastic users of social media, with approximately 68% of Internet users having at least one social media profile [51]. Breastfeeding research with fathers shows that peer support and peer connection is highly valued [14,16,21,23], and results from the FIFI study demonstrated that this approach can affect women's breastfeeding duration [12]. ...
Background:
Despite evidence of the benefits of breastfeeding, <15% of Australian babies are exclusively breastfed to the recommended 6 months. The support of the father is one of the most important factors in breastfeeding success, and targeting breastfeeding interventions to the father has been a successful strategy in previous research. Mobile technology offers unique opportunities to engage and reach populations to enhance health literacy and healthy behavior.
Objective:
The objective of our study was to use previous research, formative evaluation, and behavior change theory to develop the first evidence-based breastfeeding app targeted at men. We designed the app to provide men with social support and information aiming to increase the support men can offer their breastfeeding partners.
Methods:
We used social cognitive theory to design and develop the Milk Man app through stages of formative research, testing, and iteration. We held focus groups with new and expectant fathers (n=18), as well as health professionals (n=16), and used qualitative data to inform the design and development of the app. We tested a prototype with fathers (n=4) via a think-aloud study and the completion of the Mobile Application Rating Scale (MARS).
Results:
Fathers and health professionals provided input through the focus groups that informed the app development. The think-aloud walkthroughs identified 6 areas of functionality and usability to be addressed, including the addition of a tutorial, increased size of text and icons, and greater personalization. Testers rated the app highly, and the average MARS score for the app was 4.3 out of 5.
Conclusions:
To our knowledge, Milk Man is the first breastfeeding app targeted specifically at men. The development of Milk Man followed a best practice approach, including the involvement of a multidisciplinary team and grounding in behavior change theory. It tested well with end users during development. Milk Man is currently being trialed as part of the Parent Infant Feeding Initiative (ACTRN12614000605695).
... This finding is not only unique to heterosexual couples, but lesbian couples too, according to Larsson and Dykes (2009) felt that antenatal classes had no room for their partners. It has been suggested that gender-neutral language and gender-specific topics should be put into consideration in order to make couples feel more included (Schmied et al., 2002;Schott, 2002 as cited by Friedewald, 2007;Friedewald, 2008). The idea/concept of integrating all-male forums into antenatal education has been supported, arguing that it is a medium through which to address and meet expectant and new fathers' specific needs (Schmied et al., 2002;Friedewald, 2007;Nolan, 1997a). ...
... It has been suggested that gender-neutral language and gender-specific topics should be put into consideration in order to make couples feel more included (Schmied et al., 2002;Schott, 2002 as cited by Friedewald, 2007;Friedewald, 2008). The idea/concept of integrating all-male forums into antenatal education has been supported, arguing that it is a medium through which to address and meet expectant and new fathers' specific needs (Schmied et al., 2002;Friedewald, 2007;Nolan, 1997a). ...
... Among other suggestions, Svensson et al. (2008) points out in detail, the specifications of the nature of prenatal programs that participants wish to have at their disposal. According to Schmied (2002), learning approaches that adopt adult learning strategies are most likely to achieve their intended purposes. The program development terms suggested were: "Hearing Detail and Asking Questions", "Learning and Discussing", "Sharing and Supporting Each Other". ...
Objective:
contribute to the existing body of knowledge about the specific needs of first-time parents specifically for early parenthood.
Method:
the databases PubMed, MEDLINE, PSYCINFO, CINAHL, EMBASE, Family Studies Abstracts, and Web of Science, were searched using search terms: prenatal, antenatal, preparation, education, parents, parenthood. The meta-synthesis included 12 articles representing 12 studies. The meta-ethnographic approach of Nobilt and Hare was used in the meta-synthesis.
Synthesis and findings:
first-time expectant and new parents reflect a need for antenatal education to actively include male partners pre- and postnatal. Participants wished for early and realistic information about parenting skills, and to have the opportunity to seek support and help from health professionals when need arose especially during the early postnatal period. Another element was the need to learn both from peers and other new parents coming as guest speakers. Participants wished to have been well informed ahead of time, about the possible changes in their conjugal relationship and the related coping strategies.
Key conclusions:
equal emphasis should be placed both during the prenatal and postnatal periods in antenatal education classes.
Implications for practice:
interventions aiming at enhancing positive transitions to parenthood could be introduced early during the postnatal period. Parenthood education classes could adopt adult learning strategies that are participatory, and experiential in nature.
... Other investigators have also reported high attendance by men when recruitment is a direct approach to the couple already attending classes, or the service is simply provided to the couple at the classes (Coffman et al, 1994;Friedewald et al, 2005), or is a direct approach to the woman, when she and her partner as a couple have already decided to attend antenatal classes together (Schmied et al, 2002). These high partner attendance rates have been found with single-session programs when recruitment has Coffman et al. (1994), USA Condon et al. (2006), Australia Davey et al. (2006) Misri et al. (2000), Canada Morgan et al. (1997), Australia Reay et al. (2006), Australia Schmied et al. (2002) ...
... Other investigators have also reported high attendance by men when recruitment is a direct approach to the couple already attending classes, or the service is simply provided to the couple at the classes (Coffman et al, 1994;Friedewald et al, 2005), or is a direct approach to the woman, when she and her partner as a couple have already decided to attend antenatal classes together (Schmied et al, 2002). These high partner attendance rates have been found with single-session programs when recruitment has Coffman et al. (1994), USA Condon et al. (2006), Australia Davey et al. (2006) Misri et al. (2000), Canada Morgan et al. (1997), Australia Reay et al. (2006), Australia Schmied et al. (2002) ...
... targeted the couple (Coffman et al, 1994), or with multisession programs when the couple had already decided to attend similar classes (Schmied et al, 2002), or where programs incorporate a gender-specific discussion time within a session as part of the program already being attended (Friedewald et al, 2005). ...
The aim of this article is to review the published evidence on the effectiveness of strategies to engage men in psychosocial services during the perinatal period, and to consider anecdotal information from unpublished Australian programs. Thirteen published studies were found that provided some information on the enrolment numbers of men, together with the strategies used in each study. In addition, anecdotal information from nine Australian programs has been reported. Engaging men is more likely to succeed if they are, at least initially, offered a single-session program, rather than multiple sessions, they receive a personal invitation to attend, the initial emphasis is on practical things men can do rather than emotional issues, programs are not scheduled to coincide with televised major sporting fixtures, their partner is already attending the service, and the sessions are scheduled to occur several weeks into a program, not at the start. After-hours services may in some circumstances result in better enrolment by men, and use of plain language by program facilitators is better than counselling 'jargon' when engaging and working with men. Perinatal psychosocial services aimed at including men should consider carefully the strategies they employ if they wish to optimise the attendance of fathers or expectant fathers.
... Antenatal classes originating in the 1950s served to educate women about labour and relaxation exercises (McElligott, 2001 ). However, over the intervening 55 years, a shift has occurred to broaden the content of these classes to include topics such as preparation for lifestyle and relationship changes (e.g., see Fletcher, Silberberg, & Galloway, 2004; Schmied, Myors, Wills, & Cooke, 2002 ) and parenting education. In concert with a broadening of the curriculum, there has been a gradual inclusion of expectant fathers in these classes and, more recently , the development of gender-specific groups within antenatal programs. ...
... The advantages and impact of antenatal education programs, both for women and for couples, have been the subjects of extensive research. However , the main focus has been to evaluate the effect of attendance at the classes on birth outcomes (see a review of this literature in Schmied et al., 2002). Those researchers who have investigated the role of fathers in these programs have largely found the classes wanting. ...
... One such model is to conduct male-specific sessions within antenatal programs, a format reported in the American literature in the late 1980s (Taubenheim & Silbernagel, 1988). Despite such early beginnings, very little evaluation of these new models of antenatal education has occurred beyond their effects on labour and birth outcomes (Schmied et al., 2002). More specifically, the few published evaluations of all-male classes have not examined the content or processes involved. ...
This paper describes an all-male discussion forum for expectant fathers led by a male facilitator. The 617 participants completed an evaluation form and were unanimous in their agreement about the benefits of the forum, in particular the opportunity to discuss issues of importance to them with others in a similar situation. The results should encourage those developing antenatal education programs to be more inclusive of expectant fathers and to acknowledge their feelings, unique role, and contribution.
... These studies suggest that there is a need for adequate social contacts and role models to help guide parents expecting their first baby. Furthermore, other studies have also consistently found that the support women gain from participating in a small social group which meets regularly over a period of four to eight weeks is one of the most valuable aspects of class attendance (Schmied et al. 2002). Social support and particularly being part of a social network has been shown to have a positive effect on preparation for motherhood (Gagnon & Sandall 2011) with substantial benefits for class participants in the formation of ongoing friendship and support groups for early parenting. ...
... Another approach to ANE was to consider the gender of the antenatal educator who presented information to the class participants. In their Australian pilot study Schmied et al. (2002) compared the level of satisfaction of 19 couples who participated in a newly designed pilot program with 14 couples who attended a routine program of ANE. The routine hospital program consisted of two early sessions between 18 -20 weeks' gestation and a further six sessions starting at 28 weeks' gestation. ...
Antenatal education has been normalised in Australian maternity services and is currently delivered within antenatal care services or as formal standalone educational experience for women and their partner or support person. Antenatal education has evolved little over the years. Despite many changes in childbirth and parenting practices, this education still hopes to prepare women for birth and achieve optimal physical health during pregnancy. Despite these developments and the value placed on antenatal education, little is known about the way in which antenatal education activities are developed, implemented or evaluated. The aim of the research was to explore the key factors that influence pedagogy and practice of antenatal education in a range of contexts; and to examine to what extent current antenatal education provides meaningful and effective learning experiences from the perspectives of both the educators and the consumers (class participants).
A research methodology of Interpretive Description guided this research study. The methodology produced a qualitative description of experiences from a sample of antenatal educators and consumers of antenatal education. Data were collected through individual in-depth interviews with antenatal educators and antenatal class participants. Perspectives and experiences of 18 participants were explored in a total of 25 interviews. In addition to the interviews, educators were asked to discuss an example of a learning activity or learning material that they had used during their class. The researcher included other processes to enhance reflexivity, including learning materials that antenatal educators brought to the interview to discuss, and field notes taken directly after each interview. Interpretive Description was used to gain insight into participants’ perceptions and experiences. It provided the researcher with an opportunity to generate knowledge about antenatal education practice and understand the experiences of the participants involved in the study.
... Parents in our study had no problem discussing gender issues or sex after childbirth. Schmied et al. (2002) found parent benefit from participating in gender discussions groups (Schmied et al., 2002). ...
... Parents in our study had no problem discussing gender issues or sex after childbirth. Schmied et al. (2002) found parent benefit from participating in gender discussions groups (Schmied et al., 2002). ...
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.
... Another finding revealed that although coping strategies for labor were being taught, they were not being used. Schmied, Myors, Wills, and Cooke (2002) investigated the relationship between satisfaction and antenatal education programs using mixed methodology. Descriptive statistics were used to evaluate the differences between participants in two different programs. ...
... To summarize the reported research, most have been descriptive in design (Bennett et al., 1985;Broussard and Weber-Breaux, 1994;Crowe & von Baeyer, 1989;Knapp, 1996;Lazarus, 1997;Mackey, 1990;McCraw & Abplanalp, 1982;Schmied et al., 2002;Slaninka, et al., 1998) and concern the impact of formal childbirth learning environments. From these investigations, a wide range of reasons for women attending class has been reported. ...
Research on knowing in childbirth has largely been a quantitative process. The purpose of this study was to better understand the ways nine, first-time mothers learn about birth. A phenomenological approach using a feminist view was used to analyze two in-depth interviews and journals to understand first time expectant mothers' experiences of knowing in childbirth. The findings demonstrated a range of knowledge that contributed to issues of control, confidence, hope, and conflict. The participants also described an increased dependency on their mothers and a lack of intuition contiguous to the birth process. These findings contribute understanding as to how expectant mothers know birth, suggesting that their knowing does not diminish conflict surrounding and may even exacerbate it. Childbirth educators may want to include instruction on negotiating power differential in relationships encountered during childbirth, and to assess the expectant mother's view of birth and her expectations for birth. Schools of nursing should consider the inclusion of women-centered care curricula in schools of nursing at both the undergraduate and graduate levels. Clearly, the politics surrounding birthing remain in place and must be removed to provide a supportive environment for normal birth.
... Such education has traditionally used didactic presentations to deliver information deemed important by health professionals (Myors and Mabbutt, 1997).Whilst the majority of mothers are provided with some form of breastfeeding information in Australian hospitals, in antenatal classes and breastfeeding clinics, the content and delivery is not uniform (Zareai et al., 2007). More recently, antenatal education focus has changed from women only, to include partners and family members (Schmied et al., 2002). Previous studies have reported that fathers often perceive that current information provided is not always appropriate to their needs (Barclay et al., 1996; Tohotoa et al., 2009), is maternally biased (Singh and Newburn, 2001; Tohotoa et al., 2009) and reinforces a feeling of being on the sideline rather than central to the pregnancy and birth experience (Moriaty, 2002). ...
... However, others found that antenatal classes did not meet the needs of the male partner in relation to the emotional and psychological aspects of parenthood (Donovan, 1995). Australian researchers reported that participants in a men's only discussion group felt more comfortable making contact with other fathers than in a mixed gender group (Schmied et al., 2002). Mc Elligott's (McElligott, 2001) Scottish study (n ¼ 54) found fathers wanted information about their role and the care of their baby following delivery whilst Fletcher et al. (Fletcher et al., 2004) in an Australian study of 212 fathers, suggested that fathers were prepared for childbirth , but not for lifestyle and relationship changes (Fletcher et al., 2004). ...
Entry into fatherhood is a challenging period with new responsibilities and changes in family dynamics. Hegemonic imagery
of men portray them as capable, confident and able which can disadvantage expectant fathers who often struggle to make sense
of the changes occurring around and within their own parenting journey. Although fathers historically have not been included
in breastfeeding classes, antenatal education programs can be an opportunity to inform and support them in their new role.
Forty-five antenatal sessions for fathers (n = 342) of 1h duration were conducted by five male educators between May 2008 and June 2009 in Perth, Western Australia. A
theoretical framework from health promotion literature was used as a guide in the program's development. Fathers in the intervention
group gained information about their role, the importance of communication and the benefits of breastfeeding to both mother
and baby. An evaluation was obtained from fathers immediately after the session and again at 6 week post-birth, whilst mothers
reported on the perception of their partners’ support for breastfeeding in the 6 week survey. The aim of this paper is to
describe the development and process evaluation of a perinatal education and support program for fathers to assist their partners
to breastfeed.
... Earlier studies concerning formal childbirth learning environments were largely descriptive and found that prenatal education imparted knowledge and confidence and helped participants deal with fear related to childbirth (Bennett, Hewson, Booker, & Holliday, 1985;Broussard & Weber-Breaux, 1994;Crowe & von Baeyer, 1989;Knapp, 1996;Lazarus, 1997;Mackey, 1990). Recently, Schmied, Myors, Wills, and Cooke (2002) investigated the relationship between satisfaction with new parenting and antenatal education. Significant results included the benefits of using adult education principles and gender-specific groups as they related to women's later reports of satisfaction with parenting. ...
... Most of the reported research on perinatal education was descriptive in design and concerned the impact of formal childbirth learning environments (Bennett et al., 1985;Broussard & Weber-Breaux, 1994;Crowe & von Baeyer, 1989;Mackey, 1990;Schmied et al., 2002;Slaninka, Galbraith, Strzelecki, & Cockroft, 1996). From these investigations, a wide range of reasons for women attending class has been reported. ...
Research on knowing in childbirth has largely been a quantitative process. The purpose of this study was to understand the ways first-time mothers learn about birth. A phenomenological approach, using a feminist view, was used to analyze two in-depth interviews and journals to understand
nine first-time expectant mothers' experiences of knowing in childbirth. The findings demonstrated a range of knowledge that contributed to issues of control and conflict. The participants also described an increased dependency on their mothers and a lack of their own intuition contiguous
to the birth process. These findings contribute understanding to how expectant mothers know birth, suggesting that their knowing does not diminish conflict surrounding the event and may even exacerbate it when not combined with learning skills to manage conflict. Childbirth educators may want
to include instruction on negotiating power differential in relationships encountered during childbirth in order to strengthen a first-time mother's ability to receive the care she wants. Educators may also want to assess the expectant mother's view of birth and her expectations for birth.
Schools of nursing should consider the inclusion of women-centered care curricula at both the undergraduate and graduate levels. The mothers' responses in this study clearly reveal that the politics surrounding birthing remain in place and must be removed in order to provide a supportive environment
for normal birth.
... With such capital, midwifery clinics could provide a platform for the inclusion of the husband as a client of maternity care to encourage them to be attentive and supportive, not only the wellbeing of their wife but also the entire family. Parental-related programs proven to be effective are those that require the attendance of the couple, such as birth and breastfeeding preparation, prenatal, and postnatal yoga classes, 56 which could be offered in the community. The formalization of husband involvement in maternal health care may also start by adding content on the desirable role husbands play in the health of mothers to the maternal and child health book, generally provided at the first ANC visit. ...
Introduction:
Indonesia is actively promoting husband involvement in maternal health care, since it has been claimed to impact the wellbeing of mothers. This study aims to investigate the extent to which spousal relationship, husband involvement, and maternal health behavior affect postpartum depression among Indonesian mothers.
Method:
A survey was carried out among 336 postpartum mothers who received maternal care in 27 independent midwifery clinics in 7 regions of West Java Province, Indonesia. The measurement model of husband involvement comprising 4 dimensions, namely maternity care engagement, instrumental support, emotional support, and informational support were developed and validated using confirmatory factor analysis. The Quality of Marriage Index (QMI) and the Edinburgh Postnatal Depression Scale (EPDS) were also validated and used to measure spousal relationship and postpartum depressive symptoms. A structural equation model was specified to examine the association between spousal relationship, husband involvement, maternal healthy behavior, and postpartum depression.
Results:
The study confirms the assumption that the quality of the spousal relationship could determine husband's involvement during pregnancy, childbirth, and postpartum (γ = .60, P < .001), eventually leading to better maternal healthy behavior (γ = .015, P < .001) and a decrease in postpartum depressive symptoms among mothers (γ = -.21, P < .001).
Conclusions:
The study results suggest the needs to promote comprehensive husband involvement to enhance the wellbeing of mothers. This can be achieved through couple interventions at the community level and the inclusion of a supportive role for husbands in the maternal and childcare guidebook offered during ANC visits.
... Although many studies have been undertaken on the effects of childbirth preparation classes on childbirth experience across the world ( Schmied et al., 2002 ;Miquelutti et al., 2013 ;Rouhe et al., 2013 ), offering childbirth preparation classes is a new practice in Iran, initiated since 2018. Women in Iran are encouraged to attend childbirth preparation classes, but, to the authors' knowledge, no studies have been undertaken to date regarding the perspectives of Iranian women on the effect of these classes on their childbirth experiences. ...
Objective: to evaluate the perceptions of primiparous women about the effect of childbirth preparation classes on their childbirth experience.
Design: descriptive qualitative study.
Participants and setting: 13 Iranian women who participated in childbirth preparation classes and had a vaginal delivery were interviewed.
Measurements: semi-structured interviews were used to collect data.
Findings: six main themes were extracted from the data analysis: incentive and learning about pregnancy and childbirth; active participation in labour; sense of self-control; use of non- medical pain relief methods during labour; preferring vaginal birth to caesarean section; and positive childbirth experience.
Key conclusions: women reported that participation in childbirth preparation classes prepared them well for a vaginal birth, and these classes were perceived to be associated with a positive childbirth experience.
Implications for practice: attendance at childbirth preparation classes is perceived to have a positive effect on vaginal birth. Therefore, encouraging and supporting women to attend the full course of classes has the potential to increase women's preference towards vaginal birth, resulting in a reduction in the caesarean section rate.
... Lamaze sessions are planned interventions taken up voluntarily for the pregnant women on the 5th month of pregnancy. Every week, planned sessions on the posture, gate, physiotherapy exercises regarding strengthening the pelvic floor muscles are considered (11). A combination of hands-on activities along with the demonstration of parenting skills is incorporated. ...
Introduction: With the distinction of Indian culture having a strong family background, the natural birthing process has been in vogue. With transdisciplinary approaches, preparation for the normal birthing phenomenon is effective for parenthood. By continuum of care with the quality of services during pre, intrapartum, post-partum phase counseling to new mothers provides better bonding and minimizes the adversity.
... Where evaluation of childbirth education has occurred, the focus tends to be on labor and birth outcomes. 2 A review on information giving and education in pregnancy to determine which educational approaches were most welcomed by women and most helpful to them in learning about labor, birth, and early parenting. A systematic review was conducted on peer-reviewed studies on antenatal education, women's views and experiences published in English from 1996-2006. ...
Purpose: To assess the effectiveness of video assisted childbirth preparation in terms of gain in knowledge, difference in childbirth experience and reduction in post partum maternal stress. Study design: The design of the study was quasi experimental pre-test post-test control group design. Method: A purposive sampling technique was used to select samples. The data was obtained using Demographic proforma, Knowledge Questionnaire on Childbirth, Childbirth Experience Scale and Maternal Stress Scale. A video of 16 minutes on childbirth preparation was developed for the purpose of giving information on childbirth preparation. Results : Independent sample' t' test showed significant gain in the knowledge in the experimental group (p=0.001) but no statistical significance was found in childbirth experience (p=0.054) scores and post partum maternal stress(p=0.878). Conclusion: As a preventive health care measure to improve the outcome of future pregnancies, this childbirth preparation video can be used in the outpatient units to enhance knowledge, have a pleasant childbirth experience and reduce stress.
... If we want fathers to be involved in supporting mothers to breastfeed, greater resources need to be channeled to supporting them both in terms of information and recognising their thoughts and emotions at this time. There is little cost involved in opening breastfeeding education up to men and thinking about the fathers needs and viewpoints when discussing breastfeeding, with countries such as Australia actively involving men in the process (Schmied et al. 2002). However, delivery of this support needs consideration. ...
Increasing breastfeeding rates is a strategic priority in the UK and understanding the factors that promote and encourage breastfeeding is critical to achieving this. It is established that women who have strong social support from their partner are more likely to initiate and continue breastfeeding. However, little research has explored the fathers' role in breastfeeding support and more importantly, the information and guidance he may need. In the current study, 117 men whose partner had given birth in the previous 2 years and initiated breastfeeding at birth completed an open-ended questionnaire exploring their experiences of breastfeeding, the information and support they received and their ideas for future breastfeeding education and promotion aimed at fathers and families. Overall, the findings showed that fathers were encouraging of breastfeeding and wanted to be able to support their partner. However, they often felt left out of the breastfeeding relationships and helpless to support their partner at this time. Many reported being excluded from antenatal breastfeeding education or being considered unimportant in post-natal support. Men wanted more information about breastfeeding to be directed towards them alongside ideas about how they could practically support their partner. The importance of support mechanisms for themselves during this time was also raised. The results highlight the need for health professionals to direct support and information towards fathers as well as the mother–infant dyad and to recognise their importance in promoting and enabling breastfeeding.
... Stopping breastfeeding before hospital discharge is significantly related to a woman's perception that her partner or mother prefers formula milk feeding and to her own mother not breastfeeding (Scott & Mostyn, 2003;Scott et al., 2001). Establishing breastfeeding is a time of significant stress for women (Razurel et al., 2011;Schmied et al., 2002) and strongly related to ideals about motherhood (Razurel et al., 2011) and breastfeeding as symbolic of the good mother (Earle, 2000). For some, formula milk feeding eases the transition to motherhood (Earle, 2000). ...
... Antenatal information is useful for women as it helps them prepare for delivery [20]. One study has demonstrated that antenatal information contributed to maternal satisfaction with labor management and parenting experiences [21]. ...
Background
Malawi has a high perinatal mortality rate of 40 deaths per 1,000 births. To promote neonatal health, the Government of Malawi has identified essential health care packages for improving maternal and neonatal health in health care facilities. However, regardless of the availability of health services, women’s perceptions of the care is important as it influences whether the women will or will not use the services. In Malawi 95% of pregnant women receive antenatal care from skilled attendants, but the number is reduced to 71% deliveries being conducted by skilled attendants. The objective of this study was to describe women’s perceptions on perinatal care among the women delivered at a district hospital.
Methods
A descriptive study design with qualitative data collection and analysis methods. Data were collected through face-to-face in-depth interviews using semi-structured interview guides collecting information on women’s perceptions on perinatal care. A total of 14 in depth interviews were conducted with women delivering at Chiradzulu District Hospital from February to March 2011. The women were asked how they perceived the care they received from health workers during antepartum, intrapartum and postpartum. They were also asked about the information they received during provision of care. Data were manually analyzed using thematic analysis.
Results
Two themes from the study were good care and unsatisfactory care. Subthemes under good care were: respect, confidentiality, privacy and normal delivery. Providers’ attitude, delay in providing care, inadequate care, and unavailability of delivery attendants were subthemes under unsatisfactory care.
Conclusions
Although the results show that women wanted to be well received at health facilities, respected, treated with kindness, dignity and not shouted at, they were not critical of the care they received. The women did not know the quality of care to expect because they were not well informed. The women were not critical of the care they received because they were not aware of the standard of care. Instead they had low expectations. Health workers have a responsibility to inform women and their families about the care that women should expect. There is also a need for standardization of the antenatal information that is provided.
... While the effects of the fatherfocused group were not as high as expected, the author suggested these groups be a model for parental support, and asked for further research on this model. Schmied, Myors, Wills and Cooke (2002) describe a pilot antenatal education program run by a father with additional focus on father identity during pregnancy and birth, as well as awareness of men's own needs during labour and specific coping strategies during labour. Both women and men in this pilot program were significantly more satisfied with their experience of parenthood than those who participated in a conventional antenatal class. ...
Despite the near universal attendance of fathers at childbirth there is comparatively little research on men's experience of this event. This is accompanied by scant focus on men during childbirth education and during labour. To bridge this gap between practice and research a narrative literature review was conducted. For this purpose, a range of electronic databases were researched for the keywords “fathers/men and childbirth”.Key Findings: Most men find childbirth both wonderful and distressing. They often don't live up to their expectations and are confused about their role. Focusing childbirth education and hospital practices more on men's needs may reduce their distress levels and improve both maternal and paternal satisfaction.
... The effects of the preparative training on infant care, given to couples who were going to have their first babies, were analyzed in another study by Schmied, Myors, Wills and Cooke (2002); and it was concluded that the parents were affected positively by this prenatal preparative training on infant care. 12,13 The relation between the educational level of the mother (only literate [without any graduation], primary school graduates, secondary school graduates, high school or equivalent graduates and university or academy graduates) and the self-perception level of the mother when dealing with problems related to infant care was analyzed using the Kruskal-Wallis test. The results are shown in Table 2. ...
Babies need the presence of an adult, especially their mothers, from the moment they are born in order to have their needs fulfilled. The significance of the care, particularly during the newborn and the babyhood period, increases gradually as the children grow older. The adequate and efficient fulfillment of needs during the newborn and babyhood period are fundamental in terms of child development. On the other hand, many mothers don't know what to do about problematic situations related to infant care that they might encounter when they have a newborn baby.
The self-perception of 864 mothers, in various educational level groups, with 432 male and 432 female babies, was analyzed in regards to dealing with problems that arise related to infant care. A questionnaire, developed by Pridham and Chang (1991), was filled out during interviews with the mothers. The analyses of the data obtained as the result of the study were evaluated with the Kruskal-Wallis test while the statistically significant findings were dually compared using the Mann-Whitney test.
At the conclusion of the study it was determined that the gender of the baby did not effect the mother's self-perception during problem solving, whereas their educational levels created remarkable differences amongst their responses.
... A range of topics is incorporated for discussion within the forums (see Friedewald, Fletcher, & Fairbairn, 2005), during which time the female partners are led through various topics by a female facilitator. There is a paucity of evidence in the literature about the wide use of such programs, and reported programs have used group-directed discussions as their basis (Lee & Schmied, 2001;Myors & Mabbutt, 1997;Schmied, Myors, Wills, & Cooke, 2002;Symon & Lee, 2003). ...
This article describes the perspectives of men recruited to be educators and to facilitate all-male discussion forums for expectant fathers within antenatal education programs. The 8 participants indicated their general satisfaction with the recruitment process and the preparation for and support of the role. They also expressed their support for the overall concept and design of the forum. Suggestions were made regarding areas for improvement in the design and management of the forums. Results from this study may provide an operational framework to assist service providers in the development of male-facilitated programs for expectant fathers.
... Childbirth education has been implicated in decreasing maternal fear and anxiety, thereby contributing to a positive birth experience (Hetherington 1990, Lumley & Brown 1993. More than a decade later, mothers are still confirming how parent education helps prepare them for childbirth (Fabian et al. 2005) and add to maternal satisfaction (Schmied et al. 2002). Positive childbirth experiences have been associated with: personal control; perceived support; feeling informed; having choices; making decisions; having options in a supportive environment; having someone to promote self-confidence, and experiencing supportive communication (McKay & Yager Smith 1993, Jabunathan & Stewart 1995, Price 1995, Walker et al. 1995, Hart & Foster 1996. ...
This paper is a report of a study to develop and evaluate a childbirth educational programme for Malawian women.
Providing parent education is integral to the midwife's role. Malawian midwives face a challenge in fulfilling this role, with no existing childbirth education programme to facilitate this process.
A mixed method approach was used for this three-phase study. In Phase 1, childbirth information needs of Malawian women were determined from literature and interviews with midwives. In Phase 2, a structured childbirth education programme was developed. In Phase 3, a quasi-experimental design using sequential sampling was conducted to evaluate the education programme. Participants were pregnant women who attended antenatal clinics in 2002, with 104 in the control group and 105 in the intervention group. Changes in childbirth knowledge were determined over a 6-week period.
The childbirth education programme included information, teaching strategies and a schedule for implementation for content relevant to the antenatal, labour and birth and postnatal time periods. Results revealed no significant difference in knowledge in the control group between pretest and post-test scores. For the intervention group, however, an overall significant increase in knowledge across all time periods was demonstrated (P < 0.01).
A childbirth education programme, developed for the Malawian context, was associated with important increases in maternal knowledge about antenatal, labour and birth and postnatal topics. The findings have implications for midwives in other developing countries and offer an example of a midwifery-led initiative to provide formal childbirth education to these vulnerable women.
... A small number of all-male discussion models specifically aimed at expectant fathers within the existing framework of antenatal education have been reported. Although most of the models have had, as their basis, group-directed discussions (Lee & Schmied, 2001;Myors & Mabbutt, 1997;Schmied, Myors, Wills, & Cooke, 2002;Symon & Lee, 2003), slight variances have been incorporated in others. For example, Friedewald, Fletcher, and Fairbairn (2005) reported on a semistructured discussion forum that explores a range of designated topics specific to men as fathers. ...
Within childbirth education circles, catering effectively to the needs of expectant fathers who attend antenatal education programs has become an issue of concern. This article reviews the literature on all-male discussion groups for expectant fathers as a strategy to address identified deficits in relation to the inclusion of men within existing program structures. An exploration of the attributes considered appropriate for those who facilitate such groups is undertaken, and the article concludes with a report on the recruitment of male facilitators at a health service in New South Wales, Australia.
A preparação para o nascimento é uma área de intervenção, com interesse para a prática de cuidados do EEESMO, que tem vindo a aumentar nos últimos anos. Os programas visam o suporte e a capacitação dos casais para a transição para a parentalidade e nascimento, apoiando-os nas etapas da gravidez, do parto e do período pós-parto. Esta investigação teve como objeto a preparação para o nascimento e a compreensão desta temática no desenvolvimento da confiança materna nos cuidados ao recém-nascido. Pretende-se compreender os contributos dos cursos no desenvolvimento de competências parentais, especificamente, no crescimento do sentimento de confiança. Foi um estudo quantitativo, do tipo descritivo e transversal, tendo como questão de investigação “De que forma a preparação para o nascimento/ parentalidade contribui para a confiança materna nos cuidados ao recém-nascido?” Foi utilizada a técnica de inquérito por questionário que inclui a escala Mother and Baby Scales - MABS de Sereno et al (2012) que avalia a confiança materna nos cuidados ao recém-nascido. Teve como alvo 100 puérperas internadas num serviço de puerpério, 44 com frequência de curso de preparação para o nascimento e 56 sem sua a realização. As puérperas que frequentaram os cursos, consideraram que a experiência e os conhecimentos adquiridos foram importantes para o desenvolvimento da sua confiança no desempenho do papel materno. No entanto, o resultado da confiança global foi ligeiramente inferior e a falta de confiança nos cuidados ao recém-nascido foi ligeiramente superior, em relação ao grupo sem preparação para o nascimento. As dimensões de maior vulnerabilidade encontraram-se associadas à amamentação reveladas pelas subescalas Estado de alerta durante a alimentação e Falta de confiança para alimentar o bebé, em que as mães que frequentaram os cursos percecionaram os seus recém-nascidos em menor estado de alerta durante a amamentação e revelaram maior falta de confiança para amamentar (p<0,05). Os aspetos que consideraram mais relevantes a serem abordados nos cursos para o desenvolvimento da confiança materna referem-se a uma metodologia mais prática, partilha de experiências com outros pais e a continuidade dos cursos no período pós-parto.
To identify factors that women who have recovered from postnatal depression consider to be important in the recovery process and to measure the consensus among recovered women regarding the importance of those factors. A two-panel, three-round adapted Delphi exercise supplemented by a user-led interpretation work-shop. Panel one consisted of ten women who had been treated by a health visitor for and recovered from postnatal depression. Panel two consisted of 158 women who had recovered from postnatal depression who were London based members of a national support group for postnatal depression. There was a strong consensus among the participants about the 37 success factors that were identified. Factors that were identified as 'essential' in recovery from postnatal depression included: emotional support from partner; sleep; improved communication with partner; the diagnosis; practical support from partner; emotional support from friends; time to bond with the new baby; and prompt assessment by a health visitor. An interpretation group, made up of seven women who had recovered from postnatal depression, condensed the 37 factors into seven categories: diagnosis; positive action (or reaction) to intervene in the recognized problem; provision of support by people you know; professional or outside agency input; relationship between mother and baby; returning to work and continuity of care. There was a strong level of consensus among recovered women regarding a wide range of recovery factors. While all of the factors were considered to be, at least, 'important', social support from family and friends was generally rated more highly than support from health care professionals.
Evaluation of an education/counselling programme intended for pregnant/puerperal women in a secondary health care facility.
The education/counselling programme was launched in September 2004, following the preparation of environmental and material components. Evaluation of the two-year project was achieved by means of satisfaction surveys of service receivers and service providers, an information survey of service receivers and focus group discussions (FGDs) for both groups.
Forty percent of the pregnant women who attended antenatal visits and 90% of those who had recently delivered were given education/counselling in accordance with the project. The information survey showed that 92.5% of the pregnant women knew that they should take an iron supplement during pregnancy and the puerperium; 72% of the puerperal women knew of the danger signs postpartum and concerning the newborn, and 70% were aware of the methods of effective breastfeeding. The FGDs showed improved competence of the applicants in pre-delivery, pregnancy and puerperal care as well as in newborn nutrition. Feedback from service providers confirmed the patients' improved active participation in their self-care.
The safe motherhood education/counselling programme was successfully completed. The applicants and health care professionals benefited from the service.
To examine Chinese women's satisfaction with and the perceived effect of childbirth education class on their labour experience.
Attending childbirth education classes is a common activity for pregnant women. Nonetheless, evidence reveals that evaluation of the effects of childbirth education classes is inconsistent. Moreover, women's perceived effect of these classes has not been systematically examined.
This two-phase study adopted a mixed-method design with Donadedian's model as the theoretical framework. In Phase One, a random sample of 40 Chinese women was invited to complete a questionnaire after attending a childbirth education class. The questionnaire was focused on their satisfaction with specific aspects of the class. Descriptive statistics were performed to summarize participants' response. In Phase Two, six of the original 40 women were purposely selected for a semi-structured interview pertaining to the perceived effect of the childbirth education class on their labour experience. Thematic analysis was conducted on the interview data.
The participants expressed overall satisfaction with the class. The area that satisfied them the most was the performance of the midwife. The areas that satisfied them the least were the date, length, size and time of the class. Three themes emerged from the interview data, namely, 'learning about labour', 'contributing to a smooth labour process' and 'coping with uncertainty and handling anxiety.
This study supports using a mixed-method approach to evaluate client education activity, and highlights the importance of cultivating positive coping measures among the Chinese women after attending childbirth education class when facing childbirth-related anxiety.
This paper presents the results of a qualitative study conducted by midwife researchers into women's experience of new motherhood. Data were collected using focus groups involving 55 first-time mothers and analysed using grounded theory method. The analysis produced six categories: ‘realizing’, ‘unready’, ‘drained’, ‘aloneness’, ‘loss’ and ‘working it out’. The core category, ‘becoming a mother’, integrates all other categories and encapsulates the process of change experienced by women. Also explained are factors mediating the often distressing experience of becoming a mother. The analysis provides a conceptualization of early motherhood enabling the development of strategies for midwives, nurses and others helping women negotiate this challenge.
Sixty-seven women attending either hospital or community based antenatal classes completed assessments of their knowledge, anxiety and confidence prior to first attendance. After completion of the course these assessments were repeated. Highly significant increases in knowledge were shown. While initial knowledge levels were associated with demographic factors this effect was eliminated following classes. Confidence in coping with labour and in caring for the newborn infant also showed significant increases following classes. The effect on anxiety was less marked. Anxiety was unrelated to knowledge levels. Few differences were found between hospital and community based classes. However, the latter appeared to have the advantage of promoting social relationships. The implications of the findings for the development of antenatal care services are discussed.
The evaluation of the efficiency and effectiveness of antenatal education programmes has been identified as a priority in improving maternity services in Australia. Two hundred and ninety four primiparas completed a brief questionnaire in the 3 days following delivery; 82% of the women surveyed attended antenatal education classes. Women were less likely to attend if they were single, younger than 26 years, had lower levels of education, received care during pregnancy from the antenatal clinic and did not have private health insurance. Attenders at antenatal education were also more likely to plan on breast feeding, to be nonsmokers and to know of a greater number of community organizations to help new mothers. However, logistic regression analyses indicated that, with the exception of number of community organizations known, these differences were attributable to demographic differences between attenders and nonattenders. One hundred and forty two women and their partners attending the major provider of antenatal education classes in Newcastle were surveyed prior to and following classes. Significant increases in knowledge were evident following the programme among both women and their partners. Satisfaction with the programme was high as indicated by a large proportion of respondents attending all 4 classes, most programme components being reported as useful or very useful and only a small proportion of respondents experiencing problems with the programme.
After the development and initiation of prepared childbirth classes in a large, inner-city hospital, a case-controlled study was designed to assess their impact on obstetric outcomes. Prepared couples were matched with nonattenders on six variables: race, patient status (clinic or private), parity, marital status, age, and socioeconomic status. Statistically significant differences between the groups were found. Prepared couples were more likely to receive little or no pain medication and less conduction anesthesia than controls. Consequently, 79 percent of their deliveries were spontaneous, compared to 51 percent for controls (P < 0.001). Despite the increased pushing ability of the class attenders, over 80 percent of women in both groups had an episiotomy, which was, in turn, significantly associated with a second-, third-, or fourth-degree laceration, thus bringing into question its routine use. Further studies to identify additional factors associated with positive obstetric outcomes are warranted.
Objective: To compare client and health-care provider perceptions concerning health topics.
Design: A survey conducted at the first prenatal visit asked women to indicate levels of interest in 38 topics. Providers answered the same survey, indicating perceptions of clients' interests.
Setting: A prenatal clinic and a private office, both in an inner city area.
Participants:Two groups of prenatal clients (n =135 private care and n =250 public care) and their health-care providers (n =32 nurses and physicians).
Results:Significant differences were found (p < .01 for four topics, p < .05 for six topics) between the clients' interests and the providers' perceptions. Women in private and public care differed significantly (p < .01) in their levels of interest. Interest was significantly affected by parity, but not maternal education.
Conclusions: Nurses and other health professionals should be aware of the range of topics in which clients express interest. This study suggests that site of care and parity should be considered when developing prenatal health education.
This study explored components of a model of transition to being the mother of a new infant during an infant's first 3 months. Personal and situational conditions and maternal problem-solving factors (issue formulating and the use of help with issues) that may influence transition markers (maternal appraisal of problem-solving competence and evaluation of parenting) were examined for two study periods: the first 30 days postpartum and the next 60 days. For the second study period, variables contributing to maternal attention to infant growth, development and temperament (knowing issues) were also explored. Questionnaires and a daily log kept by 62 mothers of healthy term infants were data sources. Everyday supports (situational condition) contributed to use of lay help for the second period. Caretaking issues positively influenced use of clinician help throughout the study. The number of knowing issues a mother formulated contributed positively to problem-solving competence and to parenting evaluation; the use of problem-solving help had no effect. More clinician help received during the first month meant higher need for maternal action for both knowing and caretaking issues in the second and third months. Further study of the mechanisms of these relationships and examination of factors contributing to shifts in the transition process are needed.
The purpose of this study was to describe the experience of expectant and new fatherhood. The grounded theory method was used to gather data from 56 expectant and new fathers. Data were analyzed through the technique of constant comparative analysis. The essence of the experience of expectant and new fatherhood is laboring for relevance which consists of: (a) grappling with the reality of the pregnancy and child; (b) struggling for recognition as a parent from mate, coworkers, friends, family, baby, and society; and (c) plugging away at the role-making of involved fatherhood. Men were not recognized as parents but as helpmates or breadwinners which interfered with validation of the reality of the pregnancy or child. They felt excluded from the childbearing experience by their mates, health care providers, and society. Fathers found themselves without models to assist them in taking on the role of active and involved parent. The findings of this study promote greater understanding of the male experience of expectant and new parenthood and may serve as a beginning for the development of interventions to support and promote paternal behavior.
The records of 207 primigravid patients were reviewed over seven months to determine the relationship between childbirth education classes and the outcome of labor and delivery. Primiparous patients self-selected into two groups, attenders and nonattenders of childbirth education classes; 114 attended at least two classes and 93 attended one or no classes. A significantly higher percentage of attenders were older, better educated, or of higher socioeconomic status. There were nonsignificant trends toward longer second stage of labor, increased use of assistance at delivery (forceps or vacuum), and increased use of medication in the group that attended prenatal classes. A benefit of attendance at childbirth education classes in reducing interventions during labor and delivery was not demonstrated.
Revision of the self-report instrument, What Being the Parent of a New Baby Is Like (WPL), is reported. The WPL, developed to examine parents' perceptions of themselves as parents and of the parenting experience with young infants, was revised by improving its two subscales, Success (renamed Evaluation) and Centrality, and adding a third subscale, Life Change. With a sample of mothers of healthy infants, all three subscales of the revised instrument, WPL-R, had acceptable levels of internal consistency at 7, 30, and 90 days postpartum, and stability across administrations. Parity differences were demonstrated for all three subscales at 7 days and for Centrality at 30 days. Factor analysis identified item clusters consistent with the three subscales. With improved subscales affording a more comprehensive assessment of maternal experience, the WPL-R is a better instrument for evaluation of maternal adaptation than the WPL.
This longitudinal descriptive study compared the adjustment to new parenthood in two groups of first-time mothers and fathers. Participants included 106 married couples, 58 (55%) who attended prenatal childbirth education classes and 48 (45%) who did not. The study variables included prenatal, intrapartal, and new parent experiences. All mothers and fathers completed questionnaires during the last trimester of pregnancy and one month after delivery of a healthy newborn. Fathers were present during labor and birth regardless of prenatal class attendance. The groups differed in maternal age and in maternal and paternal education levels, but did not differ in measures of prenatal attachment, paternal childbirth involvement, childbirth satisfaction, parenting sense of competence, and ease of transition to parenthood. The results suggest the need for further study of the influence of prenatal classes on becoming a new parent, and of the effects of the father's presence during childbirth on birth and new parent experiences.
This research builds on the work of Barclay (1993) who studied couples during pregnancy and discovered that there was a mismatch between sexual interest levels of men and women during pregnancy. As well, little is known about the social and emotional experiences of men during their partners' pregnancies. One antenatal group consisting of six men, whose partners were in the second trimester of pregnancy, attended a series of five meetings and subsequent individual interviews. Additional data and insights were gained by the researcher and the research assistant attending other antenatal classes with men and women present. The research data consisted of transcripts of tape-recorded interviews, group discussions, observations and field notes made by the researcher and co-leader following each of the group sessions. The aim was systematically to develop a substantive grounded theory which was drawn from the experiences of the men during this transitional period in their lives. This paper discusses the process of analysis which led to the central phenomenon, the core category of the research, around which the grounded theory is built. Five theoretical constructs emerged from the data collected: (a) ambivalence in the early stages of pregnancy, (b) relationship with baby not real, (c) how should I be as a father?, (d) coping with the changing roles and lifestyle, and (e) disequilibrium in relationship with female partner. The last construct emerged as the basic social process. The nature of this relationship changed over the duration of the pregnancy. Emotional turmoil and anxiety in men contributed to the 'mismatch' in male and female expectations of the relationship.(ABSTRACT TRUNCATED AT 250 WORDS)
This study assessed the associations between attendance at childbirth preparation classes and the health behaviors, birth events, satisfaction with care, and later emotional well-being of women having their first child. A postal survey was conducted of a population-based cohort of 1193 women who gave birth in two weeks in 1989 in Victoria, Australia. The response was 71.4 percent (790/1107). Classes were attended by 245 (83.9%) of 292 primiparous women. Those who did not attend were significantly more likely to be under age 25 years, not to have completed secondary education, to be single, to have a low family income and no health insurance, and to be public hospital clinic patients. Differences between women who attended classes and those who did not, with respect to measures of pain and to the use of procedures, interventions, and pain relief, were rare and minor. No differences occurred between the groups in their satisfaction with the provision of information through pregnancy, birth, and the postnatal period. Only one of five measures of satisfaction with care was less favorable in nonattenders. Attenders were not more confident about looking after their infants at home or less likely to be depressed eight months after birth. Significant differences occurred between the groups on four health behaviors: cigarette smoking, missed antenatal appointments, breastfeeding, and alcohol consumption during pregnancy. Attendance at childbirth preparation classes in Victoria is not associated with differences in birth events, satisfaction with care, or emotional well-being among women having their first child.
As part of a study of childbirth and parenting education programmes in the Australian Capital Territory (ACT) service providers were surveyed for information on educational and administrative aspects of the service. Semi-structured interviews were conducted with representatives of both public (hospital-based) and private sector agencies. The survey was structured in a management problem-solving framework to gather data on educational strategies and administrative and organisational factors. This approach provided a coherent view of what health educators in childbirth education were doing and why, and identified needs that could be related to information about programme effectiveness gained from a parallel literature review (O'Meara, 1993) and a survey of client consumers. The study found that the organisation of childbirth and parenting education has not developed professionally in line with other health care services. Goals and objectives are ill-defined, and planning and co-ordination are inadequate for an integrated maternal health care system. Its main resource is a body of highly motivated teachers. Several recommendations are made for measures to enhance service effectiveness, based on needs identified in the study.
This paper reports on research conducted with 53 men who were attending antenatal classes with their partners who were pregnant for the first time. The men discussed their experience of pregnancy in focus groups that were run by male midwives who were also fathers. A grounded theory analysis of the men's discussions generated the categories of anxiety, ambivalence, adjustment, separation and need to know. There were two core categories, confusion, which was strongly expressed and development which was manifest in a minority of men. A descriptive narrative demonstrated that most first time fathers were confused as their relationship with their partner changed and that their roles in relation to the baby and other people were unclear. The men's sense of self was threatened and they responded negatively to the challenges they experienced and felt distanced from their partners. The findings have implications for clinical and educational services as they show that most men were alienated by the manner in which information was presented. The men also felt that services focused on their partner's labour and the birth of the child and neglected their greatest concerns, that is their changing identity, their relationships and their future role as fathers.
The history of antenatal education throws light on why contemporary class attenders represent only a particular section of the childbearing population. Since Victorian times, the non-availability of the women's network to middle class women has forced them to seek knowledge of their own bodies, confidence in their childbearing capacities and the support of other women through formal educational opportunities. Research suggests that antenatal classes often fail to provide women with a realistic account of birth and parenting to replace the lived experience of earlier decades and may not be facilitated in such a way as to create the support groups which class attenders so critically need. Teaching approaches often promote dependency amongst clients rather than nurturing the decision-making skills required by a consumer-driven maternity service.
To investigate patterns of attendance and non-attendance at National Health Service antenatal classes of first-time mothers in the indigenous white population of a large northern city of the UK.
Survey using questionnaires, and selected participants were then given an in-depth interview.
Five maternity wards in two large northern hospitals in the UK. In-depth interviews took place in the respondents' homes.
Fifty newly delivered women were surveyed of whom 18 took part in the follow-up interviews.
There was a clear hierarchy in attendance and non-attendance based on social class, with middle class women being the most regular attenders, closely followed by older, married, working class women. However, overall social class differences were found to be accounted for by the overwhelming non attendance of young, unmarried, working class women. Older, married, working class women were found to have attendance patterns which were close to their middle class counterparts, and what differences there were seemed to be based on material factors.
The majority of women felt that antenatal classes were too technical and did not address emotional and psychological issues. However, young, single unmarried women perceived the classes most negatively. If midwives are to attract such young women, their fears and their need for peer support will have to be recognised.
There is little evidence to associate attendance at antenatal classes with a reduction in psychological distress or increased satisfaction with the experience of labour. There may be several reasons for this, including failure to implement coping strategies. A within-subjects research design explored the use in labour of coping strategies taught in antenatal classes and the role of practice. Women's views about using these strategies and their expectations of their midwives and birth companions were also identified. Following Ethics Committee approval and providing informed consent, 121 nulliparous women completed a questionnaire at their final antenatal class. This included questions on confidence and the amount of effort required to use coping strategies, the involvement hoped for from birth companions and midwives in using coping strategies in labour and satisfaction with the amount of practice of coping strategies. Within 72 hours of delivery, women were interviewed to obtain a narrative of the events of labour and their use of the coping strategies (sighing-out-slowly breathing, Laura Mitchell relaxation and postural change). A questionnaire obtained information on the involvement of the midwife and birth companion. Women used the three coping strategies to different extents. Midwives were not involved to the extent that women had hoped for antenatally. Birth companions achieved a level of involvement closer to women's hopes than that achieved by midwives. A significant proportion of women expressed dissatisfaction with the amount of practice of coping strategies during antenatal classes. The findings of this study of a group of well-prepared women raise questions about the correct components of antenatal classes and how midwives and birth companions can be involved optimally in this aspect of a woman's labour. Further research is required to determine how women can best be helped to cope with the experience of labour.
To discover the expectations and experiences of childbirth preparation and childbirth of Swedish men in order to contribute to a basis of reflections in the midwifery profession.
Three tape-recorded interviews were performed: before and after childbirth preparation, and between one and three weeks after the baby was born.
Swedish maternity care.
Eleven men who participated with their partners in antenatal classes.
The interviews were analysed in several steps and included co-assessments by co-workers. Finally, an interpretation based on the concept 'vital involvement' was undertaken. Indications of vital involvement as well as various levels of involvement or distance were found. The participation in childbirth was more demanding than expected for the eleven men. They felt unprepared for an unpredictable process, the experience of time and pain, the woman's action, and their own reactions. The men who were regarded by the authors as vitally involved seemed to manage overwhelming feelings of helplessness during childbirth, to support the women, and experience the meeting with the baby positively.
It seems important for midwives to meet men individually, design childbirth preparation from men's perspective, follow up interpretations of the content, discuss expectations with regard to the men's role, and assess their experiences during the birth process.