A New Approach to Prenatal Education

by Andrea Robertson

Do you know how the current “accepted” approach to prenatal programs was determined? No? Well no-one does – it seems to have evolved many years ago, and has never been seriously evaluated. This raises some interesting questions: how do we know that the typical model of 6 sessions per series of 2 hours each, starting at around 30 weeks gestation is the most effective format? Would some other format be more attractive or useful for clients? Would other approaches enable us to reach those people who normally avoid prenatal education? There are a number of issues to consider.

• Most parents come to prenatal classes to “learn how to have a baby”, and many expect that better education will help them achieve the birth experience they desire. Although no amount of education will ultimately affect the birth outcome 1 (this is primarily influenced by the attitudes, values and practices of the caregiver in charge ) the most important decisions that a pregnant woman makes revolve around choosing an appropriate caregiver and birth place and these decisions are usually made early in the pregnancy. If we are serious about using prenatal classes as a means to better birth outcomes , perhaps we should consider providing a program that focused on this issue, amongst other relevant topics. Such a program would need to be scheduled for around 14 weeks of pregnancy, and may take two sessions to cover adequately. Think of the topics that could be included: choosing a caregiver and birth place, nutrition, adjusting to being pregnant, taking care of yourself during the pregnancy, the pros and cons of medical tests, information about fetal development, signs of premature labour… you will probably need two sessions to include them all.
• Parenting is a topic that is often squeezed into limited time. When the evaluations come in, parents often complain “you never told me about…” even though time was spent on the topic. Timing is the relevant issue here: including it too close to the end of the pregnancy (“let’s worry about the baby care if we survive the birth!”) reduced its impact. Consider giving these vital topics their due importance by offering separate sessions that just concentrate on parenting and nothing else. Around 26 weeks works well – the baby is making its presence felt, the birth is quite some time away, and the focus is on “getting ready for baby”. Topics could include: making relationship adjustments, managing maternity leave, sharing the workload of the baby and house, child care, what to buy, community resources, developing communication channels within the family etc.
• Another common problem concerning class attendance is finding the right “fit” for programs for specific groups. Scheduling of prenatal classes is often centred on when staff are available, rather than when parents would be likely to come. Thus many fathers may miss out because it is more convenient to offer daytime classes or adolescent groups may collapse because they are offered in a traditional format that doesn’t suit their rather erratic style of attendance. If people don’t attend our programs, rather than blaming them for their lack of interest, we must ask ourselves whether we offered a program that aroused their interest. For variety, you could experiment with:
  • Weekend sessions – either consecutive Saturdays or Sundays, or an entire weekend. These may suit busy working people who have few spare evenings, or generally work long hours; refresher clients, who want a concentrated program at a time when they can leave other children with friends or family; people who don’t want to go out at night but who want to involve the fathers; couples where the man works evenings, and the woman works days, farmers who cannot spare the time during the week, etc.
  • “Revolving door” programs, where there is no set number of classes but a regular meeting time for anyone who may want to attend. This type of program suits adolescents, women on their own, women who are looking more for support rather than a formal “class”.
  • A broader timescale for the classes: e.g. two classes in early pregnancy, followed by two classes for parenting issues, followed by 4 sessions devoted to birth and the first contact with the baby. Spreading the sessions over 6 months in this way really helps people to develop friendships and support networks, as they have 6 months in which to connect rather than the 6 weeks that shorter programs offer.
  • One educator taking all the sessions in the series, instead of a “team” approach. The advantage of this format is that there is continuity of educator (and integrated information), which leads to a better understanding of the needs of the group members, is educationally more sound and makes individual support more likely.
  • “No agenda ” programs! This may sound scary, however many experienced educators already use this approach to gain maximum flexibility in meeting the needs of the group. Instead of having a set agenda for each session of the series, the educator encourages the group to decide what topics will be covered each time. Her preparation needs to be just as thorough, but instead of following a set sequence of topics, each topic is prepared individually, enabling easy reshuffling to locate the agreed agenda items for the session. This approach discourages clients from selective attendance, and if they are actively involved in deciding what will be included, they have a vested interest in participating. Surprisingly, you can cover just as many topics as you would using a pre-set agenda, and the level of satisfaction for everyone is much greater.
  • One-on-one in the antenatal clinic. There is no rule that says prenatal education must be offered in a group setting, even though there are obvious social advantages for getting expectant parents together. For some women, personal counselling might work better, and the time they spend waiting in the antenatal clinic could be used effectively. You may even end up with very small groups by drawing in the woman’s mother or partner as well. If you can access an interpreter you will be able to communicate with the non-English speakers, who often welcome a chance to have their questions answered in their own language.
  • To create further interest, consider changing the venue for the program. Moving away from the hospital or community health setting will give you a whole new image, and be less threatening for many of your potential clients. Useful meeting places might include the local school, church hall, community hall, youth centre or the back room of the pub. You could also consider a swish hotel for those “weekends away” classes for the yuppies in our midst!

Apart from considering these broad approaches to format, have you considered offering programs that address the special needs of your clients? Depending on your location and general clientele, you may be able to offer classes for:

• Grandparents
• Siblings
• Adolescents
• Women who have had a previous Caesarean section
• High-risk women (e.g. those in the antenatal ward at the hospital)
• Fathers only (a male facilitator will help here)
• Handicapped women
• Twins mothers

There are lots of opportunities for fun and experimentation with prenatal education, and no excuses for boredom. Let your imagine take wing, and soar above the mundane. Your clients will love going along for this kind of personal ride!

References

[1] Shearer M., “Effects of prenatal education depend on the attitudes and practices of obstetric caregivers”, Birth, 17:2 June 1990

Published in The Practising Midwife Vol 2 No 2, Feb 1999