Antenatal Education Systematic Review Antenatal education programms

In pregnant women, how does group antenatal education compare to no antenatal education or individual antenatal education for improving outcomes of childbirth and parenting?

In pregnant women, how does group antenatal education compare to no antenatal education or individual antenatal education for improving outcomes of childbirth and parenting?

Antenatal education programs are key in improving maternal health all over the world. They have been widely embraced in most developed countries where antenatal education programs are routinely provided as part of antenatal care. They are associated with benefit such as increased knowledge of labor and childbirth, parent-child attachment, reduced anxiety and depression, and increased knowledge of parenthood. They often involve several scheduled sessions with a facilitator or care provider (often a trained patient educator, midwife, or general practitioner) that last about 1 -- 2 hours and focus on different aspects of labor, childbirth, and parenthood. These programs are often provided in groups meeting about seven (7) to ten (10) times for sessions running for 60 to 90 minutes on average over the course of the woman's pregnancy. All antenatal care that is provided in group-based settings is integrated with other antenatal care assessments such as information, peer support, and education.

Methods

The current systematic review compares the effectiveness of group-based antenatal education and no antenatal education or individual antenatal education on labor, childbirth, and parenthood outcomes. A systematic search of electronic databases was conducted. The identified studies were used to understand the effectiveness and cost-effectiveness of group-based antenatal education programs.

Results

The review identified five (5) randomized controlled trials conducted in different settings focusing on different aspects of antenatal care. The review highlights the paucity of research on effectiveness of antenatal education in developing countries. The identified studies provide low quality evidence that is at low risk of bias of the effectiveness of group-based antenatal education programs in promoting good labor, childbirth, and parenthood outcomes.

Discussion and conclusion

The limited evidence available suggests little to no difference in labor, birth, and parenthood outcomes though women in group-based antenatal education were more likely to initiate breastfeeding earlier than the comparator groups. There were no studies of the cost-effectiveness of group-based antenatal education programs. Therefore, the review could not highlight any significant differences in costs for the intervention and control.

Table of Contents

Abstract 4

Table of contents .. 5

Table of figures 10

Glossary of terms . 11

Chapter 1:

Introduction

Rationale and justification of the review

Introduction

Justification for antenatal education classes

Background

Antenatal education in developing countries and emerging economies

Research questions

Objectives of the review

Summary of chapter 1

Chapter 2:

Methods

Introduction

Literature Search Strategy

Searching other resources

Eligibility criteria

Types of studies and participants

Interventions

Outcome measures

Data collection and analysis

Data extraction and management

Assessment of risk of bias

Data analysis

Summary of chapter 2

Chapter 3:

Results

Introduction

Effectiveness of antenatal education

Benediktsson 2013

Bergstrom 2009

Corwin 1999

Mehdizadeh 2005

Ickovics 2007

Cost-effectiveness

Summary of chapter 3

Chapter 4:

Discussion

Introduction

Impact on childbirth outcomes

Health behaviors during pregnancy

Psychological outcomes

Attachment with the newborn baby

Participative forms of learning

Preparing for parenthood before childbirth

Stakeholder involvement and perspectives

Fathers

High-risk groups

Multicultural families

Agreement and disagreement with other reviews

Summary of chapter 4

Chapter 5:

Conclusion

Introduction

Review of evidence

Implications for policy

Implications for practice

Direction of future research

Reflection

Description

Feeling

Evaluation

Analysis

Action plan

Summary of chapter 5

Table 1: Characteristics of included studies

Table 2: Risk of bias analysis of included studies

Table 3: Characteristics of excluded studies

Table 4: Eligibility form for judging inclusion and exclusion of studies

Table 5: Risk of bias assessment tool

Table of figures

Figure 1: Study flow diagram

Glossary of terms

Antenatal

Occurring or existing before childbirth; prenatal

Anxiety

State of nervousness or worry that occurs as a mental disorder

Bias

Difference between the expected value and the true value of an experiment

Breastfeed

State of mother to produce breast milk for an infant to feed

Control

Standard care against which a specific intervention is compared

Depression

State of mind characterized by pessimistic ideas and inactivity

Epidural

Local anesthesia used during childbirth to reduce pain during labor

Heterogeneity

Quality of being different and not comparable to each other

Intervention

Care provided to improve a specific situation

Labor

Final state of pregnancy from the onset of contractions to childbirth

Oncology

Recently, policy documents in various countries have been reviewed to pave way for antenatal education programs National Childbirth Trust, 2007.
These policy documents emphasize the fact that antenatal education programs play a key role in preparing the mother and the family generally for childbirth, improving the expectant mother's confidence and self-esteem, and preparing them for care and feeding of the newborn. In addition to these, the antenatal education programs also help to increase the overall experience during pregnancy and childbirth Singh and Newburn, 2000(, Schneider, 2001)

These programs have become common in many developed countries but developing countries have lagged behind in their adoption of antenatal education programs. The major reason why developed countries have been faster in adopting education programs is because they recognize the importance of preparing expectant families for pregnancy, labor, childbirth, and care of the newborn baby. In particular, they recognize the significance of expectant women achieving the best physical and psychological health during the period of pregnancy Svensson et al., 2006.

They also see the importance of accessing good social support through attending the sessions with a member of family or a friend for support Robertson et al., 2009

( ADDIN EN.CITE, Lumbiganon et al., 2011)

1.1.2 Justification for antenatal education classes

I am currently working as a staff nurse in the Obstetrics and Gynecology ward at the Jeddah Branch of King Faisal Specialist Hospital and Research Centre in Saudi Arabia. The King Faisal Specialist Hospital in Saudi Arabia delivers the highest level of specialized healthcare within an integrated clinical practice and research setting. The hospital delivers 24-hour emergency care, dentistry services, medical oncology, cardiovascular, short-stay surgery services, as well as ophthalmology services. Despite the healthcare services delivered by the hospital, the King Faisal Specialist Hospital does not have antenatal education programs to educate pregnant women to prepare for childbirth and parenthood. Moreover, the hospital does not have a program to educate and equip clinical nurse specialists specializing in patient education to provide antenatal education to pregnant women.

Importantly, I have gained knowledge about the prenatal education in the UK and this has influenced my decision to choose antenatal education programs as the topic of my dissertation. Typically, there is a large difference between antenatal practice in the UK and Saudi Arabia. In the UK, antenatal education programs are offered free of charge to all pregnant women. These programs assist pregnant women to get a greater understanding of how they should prepare for childbirth and impart knowledge on the other aspects of parenthood such as breastfeeding. The antenatal education program that I attended in the UK assisted me to prepare for childbirth. The program also assisted me to manage my pregnancy effectively. While pregnant women with a supportive person are allowed to receive antenatal education in the UK, the issue is different in Saudi Arabia. Islam in Saudi Arabia forbids male and female individuals from being in the same location. Therefore, it is difficult for the mother to be accompanied by their spouse during antenatal education classes.

1.2 Background

Antenatal education is founded on the premise of using physical and psychological education methods to help mothers understand changes during pregnancy and understand how they can prevent and reduce pain and discomfort associated with pregnancy and childbirth Billingham, 2011

( ADDIN EN.CITE, Bergstrom et al., 2013, Artieta-Pinedo et al., 2010, Artieta-Pinedo et al., 2013)

. Recently, in developed countries, antenatal education classes have featured in policy documents. These emphasize their impact on preparing the mother for childbirth, improving behaviors of mothers and others such as the father and other family members during pregnancy, increasing self-esteem and confidence during pregnancy, and preparing the mother for feeding and providing care for the baby throughout infancy Ferguson et al., 2012

( ADDIN EN.CITE, Schachman et al., 2004)

Antenatal education, often referred to as childbirth education or prenatal education, offers a wide range of information for mothers to identify and prevent complications, ensure the well-being of the mother and their baby during the pregnancy period and after childbirth. As argued by Redman et al., 1991

(Brixval et al. (2014)

, antenatal education classes are mainly provided because scholars associate these with the importance of preparing mothers for labor, childbirth, and postnatal care. The authors posit that there is great significance of these classes in influencing health seeking behavior during pregnancy to reduce overuse of healthcare services and optimize health during pregnancy, and providing social support that improves the mother's well-being and self-esteem )

Until recently, it was largely unknown whether antenatal education classes were effective in positively influencing the psychological and physical well-being of pregnant women and their families. However, recently, studies have shown an increase in knowledge as a result of these antenatal education classes. These studies have also highlighted the importance of using a wide range of techniques in the classes to improve the health and well-being of the pregnant mother Su et al., 2007a ()

The impact of antenatal education classes on maternal emotional states as one of the psychological well-being factors is an important consideration in understanding the effect of these…