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. 2007 Jul 18;2007(3):CD002869.
doi: 10.1002/14651858.CD002869.pub2.

Individual or group antenatal education for childbirth or parenthood, or both

A J Gagnon  1 , J Sandall
Affiliations

Individual or group antenatal education for childbirth or parenthood, or both

A J Gagnon et al. Cochrane Database Syst Rev. .

Abstract

Background: Structured antenatal education programs for childbirth or parenthood, or both, are commonly recommended for pregnant women and their partners by healthcare professionals in many parts of the world. Such programs are usually offered to groups but may be offered to individuals.

Objectives: To assess the effects of this education on knowledge acquisition, anxiety, sense of control, pain, labour and birth support, breastfeeding, infant-care abilities, and psychological and social adjustment.

Search strategy: We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (April 2006), CINAHL (1982 to April 2006), ERIC (1984 to April 2006), EMBASE (1980 to April 2006) and PsycINFO (1988 to April 2006). We handsearched the Journal of Psychosomatic Research from 1956 to April 2006 and reviewed the reference lists of retrieved studies.

Selection criteria: Randomized controlled trials of any structured educational program provided during pregnancy by an educator to either parent that included information related to pregnancy, birth or parenthood. The educational interventions could have been provided on an individual or group basis. Educational interventions directed exclusively to either increasing breastfeeding success, knowledge of and coping skills concerning postpartum depression, improving maternal psycho-social health including anxiety, depression and self-esteem or reducing smoking were excluded.

Data collection and analysis: Both authors assessed trial quality and extracted data from published reports.

Main results: Nine trials, involving 2284 women, were included. Thirty-seven studies were excluded. Educational interventions were the focus of eight of the studies (combined n = 1009). Details of the randomization procedure, allocation concealment, and/or participant accrual or loss for these trials were not reported. No consistent results were found. Sample sizes were very small to moderate, ranging from 10 to 318. No data were reported concerning anxiety, breastfeeding success, or general social support. Knowledge acquisition, sense of control, factors related to infant-care competencies, and some labour and birth outcomes were measured. The largest of the included studies (n = 1275) examined an educational and social support intervention to increase vaginal birth after caesarean section. This high-quality study showed similar rates of vaginal birth after caesarean section in 'verbal' and 'document' groups (relative risk 1.08, 95% confidence interval 0.97 to 1.21).

Authors' conclusions: The effects of general antenatal education for childbirth or parenthood, or both, remain largely unknown. Individualized prenatal education directed toward avoidance of a repeat caesarean birth does not increase the rate of vaginal birth after caesarean section.

PubMed Disclaimer

Conflict of interest statement

None known.

Figures

1.1
1.1. Analysis
Comparison 1 Individual maternal education versus routine care, Outcome 1 Observed maternal competence.
1.2
1.2. Analysis
Comparison 1 Individual maternal education versus routine care, Outcome 2 Adaptation to the maternal role (Lederman tool).
1.3
1.3. Analysis
Comparison 1 Individual maternal education versus routine care, Outcome 3 Adaptation to the maternal role (Sheehan tool).
1.4
1.4. Analysis
Comparison 1 Individual maternal education versus routine care, Outcome 4 Satisfaction with maternal role preparation.
2.1
2.1. Analysis
Comparison 2 Paternal education classes versus routine care, Outcome 1 Paternal sensitivity.
2.2
2.2. Analysis
Comparison 2 Paternal education classes versus routine care, Outcome 2 Paternal plus infant sensitivity.
2.3
2.3. Analysis
Comparison 2 Paternal education classes versus routine care, Outcome 3 Paternal knowledge.
3.1
3.1. Analysis
Comparison 3 Childbirth education classes + maternal attachment preparation versus childbirth education classes alone, Outcome 1 Frequency of maternal attachment behaviors.
4.1
4.1. Analysis
Comparison 4 Expanded childbirth education classes versus traditional childbirth education classes, Outcome 1 Parenting knowledge.
5.1
5.1. Analysis
Comparison 5 Individual vaginal birth after caesarean education/support versus routine care, Outcome 1 Vaginal birth after caesarean.
5.2
5.2. Analysis
Comparison 5 Individual vaginal birth after caesarean education/support versus routine care, Outcome 2 Attempted vaginal delivery.
5.3
5.3. Analysis
Comparison 5 Individual vaginal birth after caesarean education/support versus routine care, Outcome 3 Scheduled caesarean.
5.4
5.4. Analysis
Comparison 5 Individual vaginal birth after caesarean education/support versus routine care, Outcome 4 Unsuccessful attempt at vaginal birth after caesarean.
5.5
5.5. Analysis
Comparison 5 Individual vaginal birth after caesarean education/support versus routine care, Outcome 5 Urgent caesarean.
5.6
5.6. Analysis
Comparison 5 Individual vaginal birth after caesarean education/support versus routine care, Outcome 6 Uterine rupture or dehiscence.
5.7
5.7. Analysis
Comparison 5 Individual vaginal birth after caesarean education/support versus routine care, Outcome 7 Hysterectomy.
5.8
5.8. Analysis
Comparison 5 Individual vaginal birth after caesarean education/support versus routine care, Outcome 8 Maternal blood transfusion.
5.9
5.9. Analysis
Comparison 5 Individual vaginal birth after caesarean education/support versus routine care, Outcome 9 Perinatal death.
5.10
5.10. Analysis
Comparison 5 Individual vaginal birth after caesarean education/support versus routine care, Outcome 10 Apgar score < 7 at 5 minutes.
5.11
5.11. Analysis
Comparison 5 Individual vaginal birth after caesarean education/support versus routine care, Outcome 11 Neonatal intensive care unit admission.
5.12
5.12. Analysis
Comparison 5 Individual vaginal birth after caesarean education/support versus routine care, Outcome 12 Instrumental delivery.
6.1
6.1. Analysis
Comparison 6 Promotion of intrauterine attachment versus routine care, Outcome 1 Affectionate behavior (maternal attachment subscale).
6.2
6.2. Analysis
Comparison 6 Promotion of intrauterine attachment versus routine care, Outcome 2 Proximity maintaining (maternal attachment subscale).
6.3
6.3. Analysis
Comparison 6 Promotion of intrauterine attachment versus routine care, Outcome 3 Mother's attachment (maternal attachment subscale).
7.1
7.1. Analysis
Comparison 7 Augmented prenatal care versus routine care, Outcome 1 Prenatal care ‐ very helpful.
7.2
7.2. Analysis
Comparison 7 Augmented prenatal care versus routine care, Outcome 2 Prenatal care ‐ somewhat or not too helpful.
7.3
7.3. Analysis
Comparison 7 Augmented prenatal care versus routine care, Outcome 3 Compared with last time, prenatal care rated ‐ better.
7.4
7.4. Analysis
Comparison 7 Augmented prenatal care versus routine care, Outcome 4 Compared with last time, prenatal care rated ‐ same.
7.5
7.5. Analysis
Comparison 7 Augmented prenatal care versus routine care, Outcome 5 Compared with last time, prenatal care rated ‐ worse.
7.6
7.6. Analysis
Comparison 7 Augmented prenatal care versus routine care, Outcome 6 Average time reported with nurse per visit ‐ less than 15 minutes.
7.7
7.7. Analysis
Comparison 7 Augmented prenatal care versus routine care, Outcome 7 Average reported time with nurse per visit ‐ about 30 minutes.
7.8
7.8. Analysis
Comparison 7 Augmented prenatal care versus routine care, Outcome 8 Average time reported with nurse per visit ‐ about 45 minutes.
7.9
7.9. Analysis
Comparison 7 Augmented prenatal care versus routine care, Outcome 9 Average time reported with nurse per visit ‐ about 60 minutes.
7.10
7.10. Analysis
Comparison 7 Augmented prenatal care versus routine care, Outcome 10 Average reported time from entering to leaving clinic ‐ about 1 hour.
7.11
7.11. Analysis
Comparison 7 Augmented prenatal care versus routine care, Outcome 11 Average reported time from entering to leaving clinic ‐ about 1.5‐2.5 hours.
7.12
7.12. Analysis
Comparison 7 Augmented prenatal care versus routine care, Outcome 12 Average reported time from entering to leaving clinic ‐ about 3 hours or more.
7.13
7.13. Analysis
Comparison 7 Augmented prenatal care versus routine care, Outcome 13 Same nurse reported as providing care each visit.
7.14
7.14. Analysis
Comparison 7 Augmented prenatal care versus routine care, Outcome 14 Nurse rated as "very helpful".
7.15
7.15. Analysis
Comparison 7 Augmented prenatal care versus routine care, Outcome 15 Knowledge of risk factors ‐ told she or her baby might be "at risk" or "have problems".
7.16
7.16. Analysis
Comparison 7 Augmented prenatal care versus routine care, Outcome 16 Knowledge of risk factors ‐ changed behavior during pregnancy in response to information about risks/problems.
7.17
7.17. Analysis
Comparison 7 Augmented prenatal care versus routine care, Outcome 17 Knowledge of risk factors ‐ told how much weight to gain.
7.18
7.18. Analysis
Comparison 7 Augmented prenatal care versus routine care, Outcome 18 Self‐report of behavioral change/status ‐ regular vitamin‐mineral supplementation.
7.19
7.19. Analysis
Comparison 7 Augmented prenatal care versus routine care, Outcome 19 Self‐report of behavioral change/status ‐ smoking cessation (for smokers only).
7.20
7.20. Analysis
Comparison 7 Augmented prenatal care versus routine care, Outcome 20 Self‐report of behavioral change/status ‐ perceived mastery.
7.21
7.21. Analysis
Comparison 7 Augmented prenatal care versus routine care, Outcome 21 Mean birthweight.
7.22
7.22. Analysis
Comparison 7 Augmented prenatal care versus routine care, Outcome 22 Low birthweight (less than 2500 g).
7.23
7.23. Analysis
Comparison 7 Augmented prenatal care versus routine care, Outcome 23 Mean gestational weight age, week.
7.24
7.24. Analysis
Comparison 7 Augmented prenatal care versus routine care, Outcome 24 Preterm birth.
7.25
7.25. Analysis
Comparison 7 Augmented prenatal care versus routine care, Outcome 25 Intrauterine growth restriction.
7.26
7.26. Analysis
Comparison 7 Augmented prenatal care versus routine care, Outcome 26 Low Apgar score ‐ at 1 minute.
7.27
7.27. Analysis
Comparison 7 Augmented prenatal care versus routine care, Outcome 27 Low Apgar score ‐ at 5 minutes.
7.28
7.28. Analysis
Comparison 7 Augmented prenatal care versus routine care, Outcome 28 Neonatal intensive care unit stay.
7.29
7.29. Analysis
Comparison 7 Augmented prenatal care versus routine care, Outcome 29 Congenital anomalies.
7.30
7.30. Analysis
Comparison 7 Augmented prenatal care versus routine care, Outcome 30 Mean maternal weight gain during pregnancy, kg ‐ if BMI less than 19.8 (at risk).
7.31
7.31. Analysis
Comparison 7 Augmented prenatal care versus routine care, Outcome 31 Mean maternal weight gain during pregnancy, kg ‐ if BMI is greater than or equal to 19.8 (not at risk).
7.32
7.32. Analysis
Comparison 7 Augmented prenatal care versus routine care, Outcome 32 Caesarean deliveries.
8.1
8.1. Analysis
Comparison 8 Group maternal education versus routine care, Outcome 1 Back or pelvic pain (during labour).
8.2
8.2. Analysis
Comparison 8 Group maternal education versus routine care, Outcome 2 Length of labour (hours) ‐ active phase.
8.3
8.3. Analysis
Comparison 8 Group maternal education versus routine care, Outcome 3 Length of labour (minutes) ‐ second stage.
8.4
8.4. Analysis
Comparison 8 Group maternal education versus routine care, Outcome 4 Vaginal delivery.
8.5
8.5. Analysis
Comparison 8 Group maternal education versus routine care, Outcome 5 Oxytocin.
8.6
8.6. Analysis
Comparison 8 Group maternal education versus routine care, Outcome 6 Episiotomy.
8.7
8.7. Analysis
Comparison 8 Group maternal education versus routine care, Outcome 7 Birthweight.
8.8
8.8. Analysis
Comparison 8 Group maternal education versus routine care, Outcome 8 Increased daily activity.
8.9
8.9. Analysis
Comparison 8 Group maternal education versus routine care, Outcome 9 Headache.
8.10
8.10. Analysis
Comparison 8 Group maternal education versus routine care, Outcome 10 Sleep disturbance.
See this image and copyright information in PMC

Update of

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