Chapter 15 Antenatal education
principles and practice
Pregnancy is a time when women and their partners are especially open to reflecting on their lifestyles and healthcare options. For health professionals, it provides an opportunity to help women learn how to use healthcare services effectively, and to acquire information and skills that will enable them to have the best possible experience of birth and early parenting.
There has perhaps been a tendency to see antenatal education as part of a different enterprise from that of Education. Since the inception of the health service, the education of pregnant women has been the province of midwives and health visitors whose primary training is as clinicians rather than as educators. The mind-set of the clinician, particularly of clinicians working in areas closely allied to medicine, has traditionally been that of the expert, the person who has knowledge, who decides and who takes responsibility for the patient. This is a very different mind-set from that of the educator.
In recent years, this clinical mind-set has started to change as a result of pressure from central government, aiming to mould the NHS into a more patient-sensitive service. The ‘new deal’ was heralded by the publication in 1997 of the NHS Plan which recognized the expertise of patients in relation to their own health and ill health, and their democratic right to be consulted about a service for which they were paying increasingly heavily in their taxes. One policy document after another (DH 1993, 1997, 2003, 2004a, 2007) stressed that health professionals must engage with patients and assist them to achieve health and well-being by taking into account their individual life circumstances.
While such policies have at least started to find their way into practice when care is being delivered to powerful patient populations such as the ethnic majority, the articulate, the affluent and the socially confident, it continues to be the case that the disenfranchised are likely to be subjected to an authoritarian model of care in which their voice is not heard. As consumers of healthcare, the childbearing woman is disenfranchised by reason of her exceptional vulnerability which is dependent, in part, on increasing social hysteria regarding the ‘dangers’ of pregnancy and birth.
Within the current policy context, and given negative social perceptions of childbirth, antenatal education might be considered to have a major part to play. Yet it has become a ‘Cinderella’ service, under-funded for years and increasingly marginalized to the point where some Trusts have withdrawn provision altogether and many others have reduced it to a single session in late pregnancy. Has it been marginalized because midwives and other key players in maternity care services have become increasingly confused about whether antenatal education should be educating women to challenge the medical model of childbearing or to conform to it?
It is strange that midwives have generally failed to see the potential of antenatal education to empower not only those they serve but also themselves. It provides a golden opportunity to help women to believe in the ability of their bodies to give birth, and in the ‘rightness’ and safety of midwifery care for themselves and their babies. Who better to sell this message than those most immediately interested in having a strong midwifery profession?
For 40 years at least, education has been explicitly linked to liberation (and implicitly so, of course, since Plato). In South America, the great liberation theologian and educator, Paulo Freire (1921–1997), wrote about the power of education to liberate the people from the ignorance and superstition which made them helpless in the face of exploitation by the educated and powerful. Education bestows political, social and personal power because it enables people to be self-directing. Being self-directing leads to greater self-esteem, and is, Knowles (1984) suggests, both the mark of adulthood and its ongoing goal.
Worldwide, the majority of women and men choose to become parents. Parents are the first teachers of the new citizens of the global community. As becoming-parents, pregnant women and their partners need exposure to a model of education that respects and enhances their autonomy and decision-making skills at the start of a long period in their lives which will be characterized by making decisions on behalf of vulnerable others, namely their children.
The goal of antenatal education is therefore to help pregnant women and their supporters to make, and take responsibility for, their own choices. This puts it firmly into the political arena in which government policy aims to create a public that is astute about healthcare, understands its limits, appreciates that people must match care provided by professionals with care they provide for themselves, and that there are no guaranteed outcomes. In order for pregnant and new parents to become part of this critical mass of healthcare consumers, they need:
Information is about facts but facts, although apparently objective, do not mean the same thing to everyone who has access to them. Couples who receive the information that unexplained stillbirth increases from 3/1000 babies to 6/1000 after 42 weeks of pregnancy will, should the woman go post-dates, use that information to make very different decisions (if invited to make a decision). A woman may know that smoking during pregnancy is bad for her baby and herself, but not know it within the context of her own life where smoking helps her relax and where best friends who smoke have given birth to apparently healthy babies. A terrified woman may be given the information that an epidural will help her relax, but know from bitter experience of abuse that lying passively on her back is not relaxing. Education cannot escape grappling with ontological dilemmas – what we know, how we know it, how we experience it – the nature of knowing itself. Therefore it cannot direct the learner, but only walk alongside her.
Education extends people’s knowledge of themselves. Becoming-parents may make decisions based on influences of which they are not fully aware. Education aims to increase self-awareness by exposing learners to different ways of thinking. Women who have been offered only a consultant unit in which to have their baby may find their feelings about birth transformed when taken to visit the local midwife-led unit and given the chance to situate their ideas about birth within a different birthing context. Antenatal education enables becoming-parents to exchange views, understand how facts are coloured by individual concepts of risk, and reach their own decisions.
Finally, in order to be self-directing in our lives, we need certain skills or competencies. These cannot be learned by observing others or from books. They have to be learned by doing. Nobody becomes confident in bathing a baby by watching someone else bathe a baby. Few people are confident in communicating with a person in authority without practising being assertive. Children are far more open to learning skills than adults – perhaps because nearly all their learning is, in their early years, around skills. Adults have generally become fearful of skills-learning because ‘failure’ is much more evident when practising a skill than when receiving information or participating in a discussion (Daines et al 2002). Yet parents-to-be crave competence in, for example, baby-care skills (Nolan 1997; Singh & Newburn 2000), and educators must become confident facilitators of practical learning activities.
In summary: antenatal education aims to:
The measurable outcomes of effective antenatal education will be:
Recent studies of the structure and functioning of the learning brain are of considerable assistance to educators in creating effective learning opportunities for becoming-parents. This new understanding can be applied whether working with parents-to-be on a one-to-one basis or in small groups. Neurophysiology tells us that there is a ‘toggle switch’ in the brain, the Reticular Activating System (RAS), which acts to switch off cognitive learning when the emotional centre of the brain – the amygdala – is highly stimulated (Hannaford 2005). Put simply: we cannot learn if we are feeling very emotional, anxious or self-conscious. Many parents-to-be meeting their midwife for the first time, or joining an antenatal class, will feel nervous about how they will be perceived by the midwife/educator and other parents in the group. Expectant parents who are receiving difficult or different news – perhaps that their baby has been diagnosed with Down Syndrome, or that they are having twins – are highly aroused emotionally and the cerebral cortex where learning takes place is consequently deactivated. They are not able to take in information, as anyone who has been with people in such situations or experienced them personally, will know very well.
In an antenatal class, parents must be at ease before they are able to engage with the teacher and each other in learning activities. Helping people relax when they are in a group means helping them to learn each other’s names and start to get to know each other by identifying common ground. The importance of opening activities either in an individual interview or in a small group situation cannot be over-estimated.
There are many ice-breaker activities available, but the key features of all are that:
The introduction to the first class (and the first 10 min of any class) is therefore for social learning (Box 15.1). Parents will learn that this is their group; that their participation and what they have to say are valued, and that this class will be an enjoyable experience.
Box 15.1 Introduction by the group leader (session for mothers and partners)
These classes are going to focus on what you want to learn about. They’re also a wonderful opportunity to make friends. So can I ask you to spend a few moments now talking to someone you don’t know and finding out a little about them. You could start by asking them when their baby is due and what their pregnancy has been like. You could talk about which football team you support or what kinds of things you like to do in your spare time. Whether you’ve lived in this area a long time or are new to it … anything at all! I’m not going to ask you to introduce the person you’ve been talking to, so don’t worry about remembering everything they tell you.
Being able to help people relax requires the group leader to be relaxed herself, not rushing into the session at the last minute. Adult learners are fiercely pragmatic; their time is precious; they come to antenatal classes with expectations that they will acquire something which justifies the time (and perhaps the money) they are putting into them. Resentment and unease are instantly created if it appears that the group leader is not well prepared. Educators need to be available to learners, to be ‘with’ them in the same way that midwives are accustomed to understanding their role as being ‘with’ women during labour.
Given that adult learners, whatever their background, like to feel that their individual needs are being addressed, allowing expectant parents to set their own agenda is important. Agenda setting in a group allows individual and collective uncertainties, worries or simply the need to know more, to be expressed in a safe way. It is often a good idea to split class participants into small groups to think about their agenda, perhaps basing the groups on gender, thus allowing the men to express their unique angle. Whatever the approach, it is beneficial to allow everyone to feel they can be as general or particular as they like in what they choose to include on the agenda, and also that they are not being forced to reveal more than they wish. Generally, an issue which one person is too shy or hesitant to articulate will be voiced by somebody else.
Once an agenda has been agreed, it is good practice to have it on display in each session so that everyone, including you, can keep an eye on it. When giving a ‘trailer’ for the following session, look at the agenda and relate what you plan to cover in the items stated there. This reassures people that you are mindful of their needs and therefore encourages future attendance.
Agendas should enable a course to be opened up, not closed down. Yet some educators will allow themselves to be restrained by an agenda and omit things from classes because ‘they have not been asked for’. Careful use of an agenda can allow subjects which you know will be useful to be aired, yet which have not been specifically asked for. Many women and men coming to classes would say they are not sure what they need to know, because they do not know what it is they don’t know! Some of the issues which are very real for them are hard to put into words. So agenda setting is just one of many ways of finding out what is on everyone’s mind. It also puts the expectant parents centre stage which in itself helps to build confidence.
The two agendas in Box 15.2 are from real classes and are used as examples. The variety of agendas set by parents is infinite, as infinite as the personalities and backgrounds of the people you come across. Agenda 1 was put together by a group of women and Agenda 2 by a mixed gender group, but the men particularly asked for the first two and the last items.
There are a number of things to note:
So how can these agendas be extended and used?
Postnatal issues for mother and baby can be drawn out of ‘How maternity care works’. ‘Partner’s role in labour’ can be extended into life beyond birth – as Agenda 2 already allows. ‘What to take to hospital’ can be used to look at maternal physical and emotional health. If physical skills had not been mentioned, pain relief options would have been the obvious trigger for including them.
‘B-Day’ – what to expect’ gives permission for developing physical skills as does ‘the role of the father in labour’ and ‘anything to give confidence’. ‘Making the baby thing real’ is also a gift to the facilitator who can encompass so much under this heading.
The key is to value agendas and not to judge them. Agendas are as important for what they do not say as for what they do. If you are surprised that certain subjects have not been included, you can mention this and help the group consider aspects of the transition to parenting that they may not have thought about. The key is for you yourself to think broadly and imaginatively.
The only way to acquire a practical skill is by practising.
Ancient wisdom, many people’s preference for kinaesthetic learning, and what everyone knows from experience – all confirm the need for practice. Yet many antenatal classes focus solely on information sharing and discussion and exclude skills work, thereby sending out a subliminal message to parents that labour is a cerebral event which can be talked through, rather than a profoundly physical event taking place principally in the pelvis!
Childbirth educators are often fearful of attempting practical work. They are nervous that parents will refuse to participate. Acquiring confidence in this area of antenatal education requires you to be clear in your own mind about why you are going to spend time practising physical skills for labour. Define your aims:
If your aims for antenatal classes are similar to these, you will already be convinced of the importance of practical skills work.
The vast majority of parents attending antenatal classes will respond positively if you yourself demonstrate what you want them to do, if you are confident when you invite them to participate (‘Can you all stand up now and try out the positions in the pictures I’m handing out’), and if you give them lots of positive, humorous feedback while they are practising.
It is often said that Practice makes perfect. Practice may make perfect, but the only thing it is guaranteed to do is to make permanent. Therefore, the childbirth educator has to take responsibility for ensuring that parents practise physical skills safely and that they acquire effective rather than ineffective skills.
All physical skills work for labour needs to be set in a realistic context. Ideally, the antenatal session will be held in a birthing room so that skills can be developed in the place where they will be put into practice (a marvellous idea – see Foster 2005). Otherwise, the educator needs to discuss with parents how they can use the furniture and equipment at the local consultant unit or birth centre to best effect. This can be done by taking photos of the birthing rooms and bringing them to classes so that parents can consider how the skills they are practising can be applied in the labour suite.
Physical skills work in antenatal classes is not all about preparing for labour; equally importantly, it is about preparing for parenting. The essential point remains the same – clients only learn by having a go. Demonstrating how to bath a baby does not improve your clients’ manual dexterity, and seeing just how competent you are may tend to undermine their confidence.
While it is easy to scorn working with dolls and condemn it as silly and unrealistic, in our experience, clients love undressing an attractive baby doll, bathing it and then re-dressing it! Doing something stimulates them to think of the questions that are important to them and to reflect on what caring for their babies will be like. In the course of undertaking practical work, all sorts of discussions will arise, enabling parents to share information about such things as baby equipment and exchange ideas about styles of parenting. The job of the facilitator is merely to direct these conversations so that they are as fruitful as possible in helping parents prepare for what lies ahead.
Often, midwives do not know from session to session exactly how large or small the antenatal group will be (Box 15.3). This can make it hard to plan how you will manage discussions – will there be a lot of discussion in the whole group? Will small group work feature more? How small is a small group? If you only have four couples, is it still worth breaking up into smaller units? And so on. Much depends on your feel for the group – are they lively or quiet? Are there some dominant individuals? Are there some who will not take things seriously and disturb the others? Are there some who are very quiet? Are there some who seem totally disengaged? All group members will have a personal angle on the sessions and it is important to try and work with their personalities, not against them, for optimum learning.
Box 15.3 Benefits of small group work
Splitting the large group randomly can be very productive, e.g. numbering off; a ‘birthday line’ – with groups chosen according to people’s birthdays; by the babies’ due dates; by where people live or where they were born. Alternatively, you may have particular reasons for arranging groups in certain ways – to get a good mix of personalities; to ensure that everyone has a chance to work with different class members; to bring those who might be having a similar experience together (e.g. couples/mothers expecting twins or anticipating an elective caesarean).
There are some key points to remember:
Sadly, the vast majority of information given in any class will have been forgotten by the next (Hughes 2000). This situation is particularly acute with adult learners who tend to operate a ruthless filtering system with regard to information, dumping whatever they do not perceive as immediately relevant, and storing in long-term memory only a very few items which appeal to their prejudices, they find exciting, or they feel they can use.
Among the antenatal teacher trainees whom the authors tutor, there is a tendency for students to lie awake in the early hours of the morning, worrying because they did not tell the parents who attended last evening’s class something the student considers essential. Lying awake worrying about having given too much information would generally be more appropriate!
So how can the midwife/educator decide how much information is sufficient and what that information should be? She does not want to ration information or act as a censor, making a unilateral decision about how much this particular group needs to know. Adult educators recognize that much of what learners wish to learn they already know – if not individually, then as a group. To enable group members to learn from each other, topics can be introduced with an invitation to share existing knowledge and first or second-hand experiences:
Such questions enable parents to take the lead. They will express themselves in words that are accessible to the other group members, rather than in the medical language which health professionals tend to use. The midwife/educator learns what the people in the group know rightly and what they know wrongly and something about the group’s attitudes towards the issue under discussion. If wrong information is shared, it is very usual for another parent to challenge what has been said, or to ask you for clarification, enabling the information to be corrected without any loss of face on the part of the person from whom it came.
Let’s imagine how information about pethidine can be gathered from the group and how you can identify what further information people need to have:
Group Leader: Has anyone ever had pethidine or a strong painkiller?
Father: Yes, I had it when I broke my leg.
Group Leader: How did it make you feel?
Father: Brilliant! I didn’t know where I was or what time of day it was. I was just floating!
Group Leader: So it really helped with the pain?
Father: Well – the pain was still there but it wasn’t connected to me any more.
Mother: My sister had it with her first baby and it made her sick. She hated it. She said it didn’t touch the pain at all.
Group Leader: Any other experiences?
Father: I think I had it when I had an injury at rugby. To be honest, I can’t remember much about it, but I think it was OK.
Group Leader: Well, what you’ve said gives a perfect picture of pethidine. Some women find it really helps in labour; some find it useless and quite a few feel out of control after they’ve had it.
Father: So if it’s only so-so for the mother, does it have any effect on the baby?
You can then reply to the question that has been asked, which will almost certainly generate more. The amount of information finally shared will depend on:
Studies into how humans learn have shown that emotional tagging, which means ensuring that learners are helped to apply information within the context of their individual lives, increases retention (Pert 1997). At the end of any information-rich topic, you can invite people to discuss with their partner or their support person how they feel about what they have just learned. This encourages class participants to tag information with their own feelings, retaining what they judge to be relevant and helpful.
You may, or may not, have choice in the location of your sessions for parent education. If you can choose, then opting for venues that are well-suited to the size of the group is important (participants don’t like to feel either cramped or lost in a space that is too big). You need room to move about; seating that is comfortable both for the pregnant and the non-pregnant, and more than one type of seating to cater for different needs; easily accessible refreshments; the capacity to regulate the room temperature; privacy for work in small groups; somewhere to display visual aids easily, and lighting that is not too harsh but not too dim either.
This is the ideal – and often not available. So the issue for the facilitator is how to manage the environment she is in. A rather unpromising room can still be used very productively (Box 15.4).
You will need a seat too, but remember to keep moving around. Sometimes stand, sometimes sit – that will allow others to do the same.
Body language is important, and not being in one position as a facilitator reinforces what you are saying about active labour. Give permission early in the first session to change position during the class. Make links between the comfort of the room – or the lack of it – and managing the environment for comfort in labour (Box 15.5).
Box 15.5 Making use of the space
A sense of privacy is important. Pregnancy is a time when people can feel that their privacy has been invaded and they have suddenly become ‘public property’. One reason why some are reluctant to attend antenatal groups is that they fear that they will have to talk about subjects which could embarrass them in front of strangers. When dividing into small groups, try to ensure that the groups cannot overhear each other; use break-out rooms if available. During physical skills work for labour, dim the lights and encourage individuals/couples to move so that they are not alongside others (Box 15.6). Anything that inhibits people will undermine the effectiveness of teaching physical skills so good use of space is vital.
The warmth of the welcome you give is the most important thing. Less than ideal surroundings can be tolerated if the facilitator shows that she cares about individuals, is interested in them and is pleased to see them.
As a midwife, you probably already regard education as an integral part of your work when giving antenatal and postnatal care to mothers, with or without their partners. Many of your opportunities for parent education occur outside group situations, when you are caring on a one-to-one or a one-to-two basis. The fundamental skills required for delivering parent education in groups apply just as much to other encounters with parents (Box 15.7).
People who may be considered to be members of particularly vulnerable groups still have many needs that are the same as those of any expectant parent. Caregivers need to demonstrate listening skills and a non-judgemental attitude just as they do for all parents. This does not mean that specialized skills are not also important. Standifird (2005) considers that caring for very young parents requires knowledge of the behavioural development of teenagers and understanding of the way that teenagers think. An in-depth appreciation of the issues surrounding teen-parenting leads to better focused parent education because educators can take into account the social context in which young people are bringing up their children (Cater & Coleman 2006).
Singh and Newburn (2000) and Singh et al (2002) found that all the pregnant women in their survey had some unmet information needs but young women, women from lower socioeconomic and minority ethnic groups felt most in need of more information. This is echoed in Soltani and Dickinson’s (2005) research, which showed that over half of a sub-group of non-professional women in their survey did not understand all of the written information given to them.
Caregivers benefit from a good understanding of the cultural norms and religious practices surrounding birth in a particular community. It is important to find out what are the barriers that prevent women from coming to classes. These have been identified by Byrom and Harding (2005) as the lack of an easily accessible venue, cultural issues and looking after older children. Women from minority ethnic groups are hungry for information to help them understand the local context of maternity care and make ‘the system’ work for them. Many have a need to de-brief previous experiences of birth and parenting. Most welcome the opportunity to meet others from the same background who are going through the same experiences. Ideally, educators who come from the cultural and religious background of the pregnant women will lead the classes and where this is not possible, thought should be given to training such people. In the experience of the authors, women are often delighted to be approached and offered training which will help them grow personally and professionally and enable them to be of service to members of their own community.
Expectant fathers and mothers often have identical issues which need to be addressed both in antenatal classes and through individual contact. For both, worries about coping as parents are high (Matthey et al 2002, Singh & Newburn 2000), but inevitably, the two genders may have varying standpoints on a number of issues, and the background and the type of community fathers come from will also play a part in determining their particular learning agenda. According to McElligott (2001) men want to attend antenatal classes, but are often disappointed that there is little effort made to target their particular needs. Childbirth educators direct their attention at women participants, using language that excludes the fathers. Yet men have an exciting and varied learning agenda in pregnancy. While they are concerned about the birth, they are perhaps even more interested in thinking ahead to the postnatal period and exploring how life will change when the new baby arrives. Information about babies‘:
Even more gratefully received will be the chance to practise babycare skills. Men are increasingly keen to be involved fathers rather than distant breadwinners, but are nervous about their ability to handle babies as confidently and competently as their partners. Helping men to acquire practical babycare skills is best done in single-sex small groups as women have a tendency to decry the efforts of fathers-to-be. In addition, inviting new fathers to classes to talk about their experiences at the birth and in the first few weeks of their babies’ lives is an effective way of increasing men’s understanding and making them feel special. Following a class which had been attended by three new Dads, one of the ‘pregnant’ fathers commented:
It was great to hear it from a real Dad. It’s always the mother’s worries that the hospital’s concerned about. Never mine. For the first time, I could ask exactly the questions I wanted answering without being considered selfish.
The idea of co-facilitation, with a female childbirth educator and a father worker leading the antenatal class together, is not new. Smith (2002) and Symon (2003) suggest that this is an effective way of meeting different gender needs. Friedewald et al (2005) also discuss projects for all-male groups. However, it may not be feasible to run fathers-only groups in your area; this does not mean that the benefits for men of sharing ideas with other men cannot be realized. The earlier section in this chapter looking at small group work provides ideas about how to use single gender groups to enable men to discuss the issues that are important to them, and to help them form a support network with other fathers whose babies will be of a similar age.
When visiting homes postnatally, you can target your approach to meet the particular practical, emotional and learning needs of both the mother and the father. Some men never attend classes and this might be the only time they have dedicated input from someone who is informed, and more particularly, seems to care about them. Remembering to address the needs of a father if he is present at a postnatal visit is important. Ignoring him will not only do him a disservice, it could be detrimental to the well-being of the mother and the baby as research suggests that women who have an understanding, well-informed partner are less at risk of postnatal depression (Barclay & Lupton 1999). Educating and supporting fathers is therefore an important area to think about (Smith 2002).o
It takes courage for lesbian parents to attend antenatal classes. Stewart’s research (2002) reveals that same-sex couples are anxious about how they will be received by maternity services and society in general, as they approach becoming a family. Lesbian and homosexual parents remain a curiosity, and may be the subject of bigotry and hatred.
Members of ‘minority’ groups are looking for acceptance, respect and support, just as are any other parents. Stewart (2002) notes that lesbian parents did not want a politically correct response, but wanted to be truly accepted on their own terms (p 417). Schott and Priest (2002, p 214) ask childbirth educators who feel uneasy at the prospect of having a lesbian couple in their classes to ask themselves why:
While it is always important to choose your language carefully whenever you are teaching parents, it is especially so when the group includes a lesbian couple. Instead of ‘Fathers’ or ‘Dads’, you can refer to ‘partners’ or ‘birth partners’. Single sex small group work needs consideration and probably discussion with the couple beforehand. It would also be useful to establish in advance of the first class, whether and how the couple wishes to discuss their situation with other class members.
Accepting the couple’s relationship means avoiding becoming hyper-aware of everything that you say. It can be easy to make the couple feel different simply by your determined efforts not to do so.
It was annoying having someone struggle to be okay about it … It was watching this person trying not to put their foot in it … being careful … an effort.
While it is important not to make any assumptions about the ‘kind of people’ a lesbian couple are, it is likely that their need for a support system is at least as great, and probably greater, than that of heterosexual couples attending classes. If through her respect, warmth and teaching skills, the childbirth educator can help the couple find a support network within the antenatal group, she is contributing to their having a successful and joyful parenting experience.
The world of parent education is changing. The general direction of government policy is to strengthen support to women and families and thereby improve health outcomes for all. The Child Health Promotion Programme (DH 2004b) and plans for a National Academy of Parenting Practitioners(2007) could have far reaching effects on all who work with parents at whatever stage they first meet them. At the same time as antenatal classes are becoming less available within the NHS, the social networking and support gained from these groups have perhaps never been so important. The recent report from the National Perinatal Epidemiology Unit, Recorded Delivery: a national survey of women’s experience of maternity care 2006 (NPEU 2007) emphasized how lost some of the women who participated in the survey felt in the postnatal period, especially if they had not had the chance to make friends at antenatal classes:
I was appalled by the lack of antenatal classes available to me … Antenatal classes were something I’d looked forward to about being pregnant. I have no friends with babies/pregnant and I would have benefited from meeting other women in my situation. (p 40)
Mothers need support from others to validate their relationship with their babies (Hawthorne 2007). Brazelton (2007) talks of the urgent need for support in ‘our stressful new world’ where families are reorganized around the pursuit of employment and its demands, isolated from extended family, friends and traditional institutions of succour. There is no time for family rituals and the transmission of family traditions, including with regard to child-rearing. A great opportunity for support could be lost to parents if they do not have opportunities to learn in antenatal groups.
Today, there are many parents – asylum seekers, families who speak little or no English, travellers, women with learning difficulties, women in prison – whose educational needs require specialist knowledge and support as well as the universal skills needed for the education of all parents. At the end of this chapter is a list of useful contacts to help you help them. The sheer diversity and extent of need clearly suggest that the way forward in parent education is through collaboration and partnership between midwives and specific voluntary organizations so that knowledge, expertise and resources can be shared to the benefit of all parents. In Box 15.8 are the thoughts of a group of National Childbirth Trust teachers who are running antenatal classes at a large teaching hospital serving a rich multicultural community, having been invited to do so by the Director of Midwifery Services. There are also comments from an antenatal teacher working for YWEB (Young Women Expecting Babies) to which local midwives refer teenage parents. Collaboration certainly brings challenges, but as these examples show, there is mostly gain –particularly for the expectant parents.
Box 15.8 Collaboration in antenatal education and support for women
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Matthey S, Morgan M, Healey L. Postpartum issues for expectant mothers and fathers. Journal of Obstetric Gynecological and Neonatal Nursing. 2002;31(4):428-435.
McElligott M. Antenatal information wanted by first time fathers. British Journal of Midwifery. 2001;9(9):556-558.
National Academy of Parenting Practitioners. Online. Available www.everychildmatters.gov.uk/napp/, 2007. 2 August 2007
National Perinatal Epidemiology Unit. Recorded delivery: a national survey of women’s experience of maternity care 2006. Oxford: NPEU, 2007.
Nolan M. Antenatal education: failing to educate for parenthood. British Journal of Midwifery. 1997;5(1):21-26.
Pert C. The molecules of emotion. New York: Touchstone Books, 1997.
Schott J, Priest J. Leading antenatal classes: a practical guide. Oxford: Books for Midwives, 2002.
Singh D, Newburn M. Becoming a father: men’s access to information and support about pregnancy, birth and life with a new baby. London: The National Childbirth Trust and Fathers Direct, 2000.
Singh D, Newburn M, Smith N. The information needs of first-time pregnant mothers. British Journal of Midwifery. 2002;10(1):54-58.
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Soltani H, Dickinson FM. Exploring women’s views on information provided during pregnancy. British Journal of Midwifery. 2005;13(10):633-636.
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Stewart M. ‘We just want to be ordinary’: lesbian parents talk about their birth experiences. Bristol: MIDIRS, 2002.
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The following is a list of websites The following is a list of websites where you can find specific information and expertise when running classes for different groups of parents.
All parents All parents: www.nct.org.uk (The National Childbirth Trust)
Cultural identity Cultural identity: www.parentlineplus.org.uk/index.php?id=702
Fathers Fathers: http://www.fathersdirect.com; www.sowingseeds.co.uk (Sowing Seeds works with ethnic minority families, and especially fathers, in African Caribbean and African communities)
Parents with Disabilities: www.disabledparentsnetwork.org.uk
Mothers and babies in prison: www.sheilakitzinger.com/Prisons.htm;www.birthcompanions.org.uk
One-Parent Families: http://www.oneparentfamilies.org.uk/
Teenage Parents: http://www.everychildmatters.gov.uk/health/teenagepregnancy; http://www.dfes.gov.uk/teenagepregnancy/dsp_Content.cfm?PageID=85; http://www.connexions-direct.com/; www.tsa.uk.com/ (Trust for the Study of Adolescence)
Travellers Travellers:www.amicus-cphva.org/default.aspx?page=75 (CPHVA Community Practitioners and Health Visitors Association)