Getting What YOU Want From Prenatal Education …

by Andrea Robertson

Over the past six months, as you have been reading these columns about pre-natal education, I wonder how many times you have thought “I would love to try these teaching strategies in my classes, but I don’t have the time”?  This is a constant complaint that I hear from educators –  there is never enough time in the program for discussion, full exploration of any topic, dealing with participant’s questions, exploring individual needs. The list seems endless.

It is true that there will never be enough time to cover everything that parents want.

Responses during that first session to the question “What would you like to get from the classes?” indicate that parents have very high expectations and needs. Meeting them may be impossible with the way the program has been devised. In addition, many frustrated educators face cut backs in their programs and have to therefore trim their content, yet are being expected to  achieve the same outcomes for the participants as before.

When classes are being set up, the usual approach is to decide how many weeks can be afforded then to  work out how much can be squeezed into the available time. Using educational measures, this is ridiculous and unprofessional. The starting point should be with the question “what do expectant parents want and need to know and what skills will they require to nurture and care for their child?”  Having worked out a basic list of topics and skills (and building in space for individual needs), the next step is to ask “how much time will be required to achieve these outcomes?”. Then comes compromise – we would all love unlimited time to really work with parents in depth, yet the reality is that there are many demands on us, many parent groups to lead, other aspects of our workload to consider etc.

From many years of working with parents and over 22 years of training childbirth educators, I would suggest that a minimum of 18 hours in a class series  will be needed to begin to cover the necessary material adequately. We have set a minimum standard of 12 hours for those undertaking our Graduate Diploma in Childbirth education, not only to ensure that students have a reasonable chance of covering the topics they must teach for assessment, but also as a message to their employers about adequate preparation for parenthood programs.

What are your visions and goals regarding preparation for parenthood programs? More time? More resources?  Longer programs?  Smaller group sizes?  All of the above?  Here are some suggestions for working towards these goals.

• Decide what you want to achieve. Set down your educational outcomes for your clients (not birth outcomes, as these are beyond your control), using previous feedback from earlier classes and surveys of new parents as a starting point. List the basic topics that should be included and the parenting skills that will need practise during the sessions.  Write this up as a set of aims and objectives, keeping it simple and concise. This will form the basis of a submission to your employer, supervisor or boss.
• Devise a program that has the potential to enable these outcomes to be met: enough time, ideal class size (maximum of 20 people per group), timing in the  pregnancy (early pregnancy, separate parenting sessions,  classes  on birth near the end of the pregnancy), personnel needed and basic resources.  Work out a costing  for the entire program, remembering to include recurring costs such as refreshments and handouts as well as fixed costs such as educators salaries, venue expenses (if any), insurance (if necessary), teaching aids and resources ( including periodical replacement costs) and training needs for staff.  Using these figures, work out a basic cost per series, and a cost per client.
• Approach your administrators (the accountant will be most useful) and find out what your hospital’s budget is for each maternity case.  Part of this budget should be earmarked for prenatal education and this is the amount you should have to work with. Sit down with your administrators and look at the figures: is there enough money in the budget to cover the cost of the program you want/need to offer?  Many administrators have never had a conversation with the childbirth educator and may not realise that the classes are actually costing the hospital money. Often, staff are reassigned from the general pool to  lead the classes, and there is an assumption that this is not “costing” anything. The venue may be a dedicated space deemed to be “free”, even though this is not realistic.  Having a good had look at the financial aspects of providing classes is a very eye-opening exercise.
• You will need to convince your administrators that your program is worthwhile and worthy of funding. Some points you can raise in your discussion might include:
• Staff should be dedicated and specially trained. You wouldn’t expect any passing person in the  street to be hauled into a classroom to teach your child maths, just because they were available, would you?
  Expectant parents will be coming to your hospital through their pregnancy – this is an ideal time for good public relations, and building loyalty to the hospital and staff. “Selling” services is an important aspect of funding in these days of restricted public funding.
• This group of pregnant parents are a “captive” audience for education in a wide range of health issues that will have long term impacts on hospital resources. For example, if more women breastfed their babies, there would be fewer admission to hospitals for babies and toddlers. There are many similar  arguments that can be mounted around quit smoking campaigns, better nutrition, reduced drug taking etc. This may be the cheapest and easiest form of public education on vital health issues!
• Perhaps it is time to make a small charge for the classes. Many hospitals have found that asking parents to pay a nominal amount encourages attendance and promotes involvement. There is also a perception that “something for nothing” is worthless, but a service you pay for must be of value. A policy (unadvertised!) can be established to subsidise those who truly cannot afford anything.
• Asking people to pay for their handouts and refreshments helps to cover these costs. It may be possible to sell some items making a profit that can be used for purchase of equipment or other resources. Many hospitals in Australia use “Preparing for Birth: Mothers” and “Preparing for Birth: Fathers” to generate funds in this way.  Make sure that you clearly establish where these funds will be going, lest they end up in consolidated revenue for the hospital as a whole!
• If finding personnel to lead the classes is a problem or finding enough leaders to facilitate smaller groups is difficult, couples may be prepared to pay for classes, if they know they will be a part of a smaller, more intimate group. Educators can then be paid on a sessional basis, and there will be many midwives who want part time work that fits in with their families who may be interested in working one or two nights per week.
• Expectant parents have a right to good information and quality preparation for parenthood programs. Funding should be made available to provide these vital services. If we are to fully embrace the concept of “informed choice” and “informed consent”, the prenatal opportunities to pursue these important goals must be fully utilised. If we don’t do it, then who will?

Robertson, A. (1997) “Your Childbirth Education Classes – finding clients”, ACE Graphics, Sydney.  Available from ACE Graphics, 3.50 plus 1.50 postage.

Minchin, M. (1998) “Artificial Feeding: risky for any baby?”, Alma Publication, Melbourne. Available from ACE Graphics 2.00, plus 1.50 postage.

Robertson, A. (1999) “Preparing for Birth: Mothers – background notes for prenatal classes”, ACE Graphics, Sydney. 5.00 single copy from ACE Graphics, bulk prices up to 60% discount.

Robertson, A. (1999) “Preparing fro Birth: Fathers – background notes for prenatal classes, ACE Graphics, Sydney. 4.00 single copy from ACE Graphics, bulk prices up to 60% discount.

This article first appeared in an edited form in The Practising Midwife, Vol 2, No 8, September 1999.