CONSULTATION DRAFT

4.2 Preparing for pregnancy, childbirth and parenthood

Structured antenatal education that is suited to the individual can help women to be informed
about pregnancy, birth and parenting. Psychological preparation for parenthood may reduce the
risk of postnatal depression.

4.2.1 Background
Structured education in preparation for childbirth and parenthood has come about as traditional
methods of information sharing have declined . Many maternity health care providers, including
public health departments, hospitals, private agencies and charities, and obstetricians’ and
midwives’ practices, provide antenatal education. Antenatal education may be delivered one-on-
one or in groups (eg in a women’s group or a class situation).
Antenatal education programs have a range of aims including :
• influencing health behaviours;
• building women’s confidence in their ability to labour and give birth;
• preparing women for the pain of labour and supporting their ability to give birth without pain
relief ;
• preparing women and their partners for childbirth;
• preparing for parenthood;
• developing social support networks;
• promoting confident parenting; and
• contributing to reducing perinatal morbidity and mortality.
Antenatal education programs generally cover a range of topics and may include:
• physical wellbeing (nutrition, physical activity, smoking, alcohol, oral health);
• emotional wellbeing and mental health during pregnancy and after the baby is born (adapting
to change, expectations, coping skills, knowing when to get help);
• labour (stages of labour, positions, breathing and relaxation, support, pain relief);
• birth (normal birth, assisted births, caesarean section, perineal tears);
• breastfeeding (skin-to-skin contact, benefits of early breastfeeding, infant attachment,
breastfeeding as the physiological norm in the first 6 months of life);
• early parenthood (normal newborn behaviour, sleeping and settling, immunisation); and
• ways to find support and build community networks after the baby is born.

Discussing antenatal education

Summary of the evidence

The evidence on antenatal education is heterogeneous, with outcomes measured including
experience of birth and parenting, postnatal mental health and experience of antenatal education.

Knowledge and health behaviours

A Cochrane review found that women gain knowledge from antenatal education but that the effect
of this knowledge on childbirth or parenthood remains largely unknown . A prospective cohort
study found that 74% of first-time mothers considered that antenatal education helped them to
prepare for childbirth but only 40% considered that the education helped them prepare for
parenthood .
Low level evidence suggests that antenatal education may improve some health behaviours during
pregnancy (eg nutrition, physical activity) and in early parenthood (eg SIDS prevention).
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Birth experience and outcomes

Studies have found no statistically significant difference in the overall birth experience between
women who participate in antenatal education programs and those who do not . Studies into
specific outcomes have found the following.
• Mode of birth: There is mixed evidence on the effect of antenatal education on mode of birth .
Antenatal education does not appear to significantly affect mode of birth among women in
general or among women with a previous caesarean section . Specific education on bearing
down technique in labour did not affect mode of birth . Including a component on the risks of
induction in antenatal education decreased rates of non-medically indicated elective induction
of labour .
• Pain: Some studies have found that women who participated in antenatal education
experienced lower levels of pain during birth . Other studies have reported that participating
women had lower epidural analgesia use , higher analgesia use or that there was no difference
in epidural analgesia use or overall pain relief .
• Self-diagnosis of labour: Women given education about self-diagnosing labour pains had a
higher rate of correct self-diagnosis than women who did not . However, a small systematic
review found no evidence of specific criteria for identifying labour .
While the overall experience and outcomes of birth do not appear to be affected by antenatal
education, there is some evidence that it reduces anxiety about the birth , increases use of coping
strategies and partner involvement and that participants experience greater childbirth self-
efficacy .

Recommendation 1 Grade B
Advise women that antenatal education programs are effective in providing information about
pregnancy, childbirth and parenting but do not influence mode of birth.

Psychological preparation for parenthood

Studies into the inclusion of psychological preparation for parenthood in antenatal care have found
that at 6 weeks after the birth:
• women with depression antenatally who participated in antenatal group education focusing on
coping skills, recognising distress and seeking help had a reduced risk of subsequent postnatal
depression (OR: 0.83; 95%CI: 0.65–0.98)(n=1,719) ;
• women who participated in antenatal sessions focusing on coping skills, cognitive
restructuring, problem-solving and decision-making skills had an overall reduction in
depressive symptoms compared with women in the control group (mean Chinese EPDS score
6.5 versus 8.9) and the effect persisted at 6 months (5.8 versus 7.6) (n=184) ;
• women who participated in antenatal interpersonal psychotherapy had fewer depressive
symptoms (changes in EPDS score: –1.56 versus 0.94) and greater satisfaction with
interpersonal relationships than women who received only antenatal education (n=194) ; and
• antenatal education on psychosocial issues associated with parenthood had a positive effect on
mood (mean EPDS score 4.5 compared with 11.4 at baseline) in women who reported low self-
esteem antenatally (but not those with medium or high self-esteem antenatally) and partners
were significantly more aware of their partners’ experience of parenthood (n=268) .
An RCT reported benefits from a couple relationship and coparenting education program,
particularly among women at high risk of relationship and parenting adjustment problems.

Recommendation 2 Grade B
Include psychological preparation for parenthood as part of antenatal care as this has a positive
effect on women’s mental health postnatally.
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Parents’ experience of antenatal education

Parents have expressed satisfaction with antenatal education as preparation for childbirth .
Mothers who were young, single, with a low level of education, living in a small city or who smoked
were less likely to find the classes helpful . Male participants valued the inclusion of an all-male
session .
Studies into parents’ preferences for antenatal education have found that the following factors are
valued:
• style of education: information provided by a health professional in person rather than sole use
of other impersonal media and using a range of learning strategies ;
• discussion: parents value being encouraged to ask questions, seek clarification, and relate
information to their own circumstances ;
• social networking: one of the core aims of antenatal education is to assist women to develop
social support networks ;
• group size: small peer groups encourage participants to get to know and support each other,
while larger groups make it harder for women to ask questions ;
• practising skills: parents value experiential learning with plenty of opportunity to practise
hands-on skills ;
• content: parents have expressed a preference for antenatal education to include more
information on psychoprophylaxis during labour , psychological care , preparation for
parenthood and breastfeeding ; and
• timing of education: education is helpful early in pregnancy when information needs are high ,
with a component offered postnatally.

Practice point a
Assisting women to find an antenatal education program that is suitable to their learning style,
language and literacy level may improve uptake of information.

Practice summary: antenatal education

When: At an early antenatal visit.

Who: Midwife; GP; obstetrician; Aboriginal and Torres Strait Islander Health Practitioner;
Aboriginal and Torres Strait Islander Health Worker; multicultural health worker.
Discuss the benefits of antenatal education: Explain that, while antenatal education is
unlikely to change the mode of birth, it may help women to prepare for the birth. It is also a
good opportunity to establish a network of peers and to develop skills for adapting to
parenthood.
Involve partner or family: Discuss the benefits of other family members attending antenatal
education with the woman.
Provide information: Support antenatal education by giving women appropriate resources
(eg written materials suitable to the woman’s level of literacy, audio or video, web sources).
Take a holistic approach: Give information about locally available antenatal education
programs and assist women to select a program that is suitable for them. Give women
booklets/ handouts relating to emotional health and wellbeing during pregnancy and early
parenthood.
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Resources
Antenatal education and planning for the birth. In: MinymakuKutjuTjukurpa Women’s Business Manual, 4th
edition. Congress Alukura, Nganampa Health Council Inc and Centre for Remote Health.
http://www.remotephcmanuals.com.au

Consumer resources
• Pregnancy, birth and baby — http://www.pregnancybirthbaby.org.au/

• Raising children — http://raisingchildren.net.au/

• Australian Breastfeeding Association — www.breastfeeding.asn.au/

• Healthinsite — http://www.healthinsite.gov.au/

• Eat for Health — http://www.eatforhealth.gov.au/

• Healthy Active Australia — http://www.healthyactive.gov.au/

• Health for Women — http://www.healthforwomen.org.au/

• Sexually transmitted infections — http://www.sti.health.gov.au

• Pregnancy, Birth and Baby Helpline — 1800 882 436

Mental health resources

• Mindhealthconnect— http://www.mindhealthconnect.org.au/

• The Beyond Babyblues Guide to Emotional Health and Wellbeing During Pregnancy and Early Parenthood.
http://www.beyondblue.org.au/index.aspx?link_id=7.980#Postnatal

• Emotional Health during Pregnancy and Early Parenthood (available in a range of languages).
http://www.beyondblue.org.au/index.aspx?link_id=7.980#Postnatal

• Hey Dad — First 12 Months Booklet. http://www.beyondblue.org.au/index.aspx?link_id=7.980#Postnatal

• Managing Mental Health Conditions during Pregnancy and Early Parenthood. A Guide for Women and their
Families. http://www.beyondblue.org.au/index.aspx?link_id=7.980#Postnatal

Multicultural resources
• Multicultural Health (Queensland Health) — Pregnancy and postnatal topics
http://www.health.qld.gov.au/multicultural/public/pregnancy.asp

• NSW Multicultural Health Communication Service — Pregnancy and postnatal topics

http://www.mhcs.health.nsw.gov.au/topics/Pregnancy_and_Post_Natal.html

Sources of reliable online health information

• Health on the Net Foundation http://www.hon.ch

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