Recent findings cast doubt over the effectiveness of antenatal (pre-birth) relaxation classes as preparation for childbirth. A team of researchers led by clinical psychologist Dr. Malin Bergstrom at the Karolinska Institute in Sweden looked at the effects of natural childbirth preparation on epidural use, childbirth experience and parental stress among 1,087 first-time mothers and 1,064 first-time fathers.
The parents received four two-hour sessions of either “psychoprophylactic” training (relaxation, breathing and psychological coping techniques) or standard antenatal education during the third trimester of pregnancy, and one followup session after delivery. The standard care group were given information about childbirth and parenting based on the standard Swedish antenatal education program.
Dr. Bergstrom explains, “The general aim of antenatal education is to prepare partners for childbirth and the transition into parenthood. In this randomized controlled multicenter trial, conducted at 15 antenatal clinics in Sweden, we compared two models of antenatal education with the same structure but with different content.”
The epidural rate was the same (52 percent) in both groups, as was the spontaneous vaginal birth rate (66 percent), report the team in BJOG: An International Journal of Obstetrics and Gynaecology. The cesarean section rate was slightly lower in the “natural” group, at 20 percent versus 21.5 percent in the standard group. But the use of instruments such as forceps and ventouse during delivery was two percent higher in the “natural” group, 14 percent versus 12 percent in the standard group.
The researchers add, “There were no statistically significant differences in the experience of childbirth or parental stress between the randomized groups, either in women or men. Natural childbirth preparation including training in breathing and relaxation did not decrease the use of epidural analgesia during labor, nor did it improve the birth experience or affect parental stress in early parenthood (measured at three months),” they conclude.
Journal editor, Professor Philip Steer, commented, “The findings of this study are contrary to what many of us would expect. The lack of benefit from psychoprophylactic techniques is disappointing, and suggests that parents’ experience of childbirth is affected more by their personality and previous psychological orientation than by the relatively limited training that is possible during pregnancy.
“An alternative view is that standard antenatal classes are ‘good enough’ and therefore represent an effective use of limited resources.”
Effectiveness of Pre-Birth Education
A study by the same team at the Karolinska Institute measured 1,197 first-time mothers’ opinions on antenatal (pre-birth) childbirth and parenthood education. The study also compared experiences of labor and breastfeeding between participants and non-participants.
Of class attendees, the majority (74 percent) believed the education helped prepare them for childbirth. Nearly half (40 percent) thought the classes helped prepare them for early parenthood.
However, no significant differences were found on memory of labor pain, mode of delivery, overall birth experience, duration of breastfeeding, or assessment of parental skills. The classes were considered less helpful by mothers who were young, single, had low level of education, lived in a small city, and were smokers.
The researchers say, “Participation in childbirth and parenthood education classes did not seem to affect first-time mothers’ experience of childbirth and assessment of parental skills, but did expand their social network of new parents.” Fifty-eight percent of the mothers had met with other class participants in the year after giving birth.
As for new fathers, a study from Australia found that men believed that antenatal classes had prepared them for childbirth. A large majority (89 percent) agreed that the classes helped them feel more confident during labor, and more confident in their role as a support person.
But fathers did not feel that the classes had prepared them for the lifestyle and relationship changes after the birth. The authors report on previous work showing that, “for most men, first-time fatherhood involves significant changes both in self-identity and their relationship with their partner, and the amount of tension the birth caused in their relationship greatly surprised men.”
They state, “Not only is there a growing recognition of the role of fathers from pregnancy through labor, childbirth, and infancy, fathers are also now demanding a greater role in these early stages. Consequently, a need exists to better understand the experiences of fathers and support them in the transition from expectant to new fathers.”
Antenatal education programs for childbirth, parenthood, or both, are widely available for pregnant women and their partners in many parts of the world. The effects remain largely unknown, but seem positive overall. Reports suggest that parents gain reassurance and new friends from attending. Individualized education may be more effective, but would be difficult to provide on limited healthcare budgets.
Bergstrom, M., Kieler, H. and Waldenstrom, U. Effects of natural childbirth preparation versus standard antenatal education on epidural rates, experience of childbirth and parental stress in mothers and fathers: a randomised controlled multicentre trial. BJOG 2009.
Fabian, H. M., Radestad, I. J. and Waldenstrom, U. Childbirth and parenthood education classes in Sweden. Women’s opinion and possible outcomes. Acta Obstetricia et Gynecologica Scandinavica, Vol. 84, May 2005, pp. 436-43.
Fletcher, R., Silberberg, S. and Galloway, D. New fathers’ postbirth views of antenatal classes: satisfaction, benefits, and knowledge of family services. Journal of Perinatal Education, Vol. 13, Summer 2004, pp. 18-26.