What are the benefits of antenatal education as a maternal health promotion tool? A systematic review with meta-analysis
Main Article Content
Abstract
Introduction: Antenatal education is a low-cost intervention designed to increase the knowledge of pregnant women on pregnancy and childbirth and reduce fear related to labor pain. However, the impact of antenatal education programs on maternal outcomes is unclear. Objective: To investigate whether structured antenatal education programs affect maternal health outcomes. Methods: Electronic databases were searched from inception to November 2019, and randomized controlled trials investigating antenatal educational programs for low-risk pregnant women were included. Results: A total of 348 studies were identified; nine were included in this review. One study assessed the number of antenatal visits, while three showed that antenatal education programs significantly improved childbirth self-efficacy (outcome expectancy16.00 [95% CI 9.86-22.15] and efficacy expectancy 20.44 [95% CI=13.62-27.25]). Self-diagnosis on labor was investigated in two studies, and five demonstrated that antenatal education increased the frequency of vaginal delivery (odds ratio 1.28 [95% CI 1.01-1.63]) but not episiotomy (as observed in three studies). Conclusion: Structured antenatal education programs may increase childbirth self-efficacy and the frequency of vaginal delivery.
Downloads
Article Details
This work is licensed under a Creative Commons Attribution 4.0 International License.
Authors who publish with this journal agree to the following terms:
Authors retain copyright and grant the journal right of first publication with the work simultaneously licensed under a Creative Commons Attribution License (CC BY) that allows others to share and adapt the work with an acknowledgement of the work's authorship and initial publication in this journal.
Authors are able to enter into separate, additional contractual arrangements for the non-exclusive distribution of the journal's published version of the work (e.g., post it to an institutional repository or publish it in a book), with an acknowledgement of its initial publication in this journal.References
World Health Organization (WHO). WHO recommendations: intrapartum care for a positive childbirth experience. Geneva: World Health Organization, 2018.
Althabe F, Bergel E, Cafferata ML, Gibbons L, Ciapponi A, Alemán A, et al. Strategies for improving the quality of health care in maternal and child health in low- and middle-income countries: an overview of systematic reviews. Paediatr Perinat Epidemiol. 2008;22(Suppl 1):42-60. http://doi.org/10.1111/j.1365-3016.2007.00912.x
Homer CSE. The 'Ready for Child' structured antenatal training programme increases likelihood of mother's arriving at the maternity ward in active labour and decreases use of epidural analgesia. Evid Based Nurs 2011;14(1):16-17. http://doi.org/10.1136/ebn.14.1.16
Gagnon AJ, Sandall J. Individual or group antenatal education for childbirth or parenthood, or both. Cochrane Database Syst Rev. 2007;2007(3):CD002869. http://doi.org/10.1002/14651858.CD002869.pub2
Fleming SE, Vandermause R, Shaw M. First-time mothers preparing for birthing in an electronic world: Internet and mobile technology. J Repr Infant Psychol. 2014;32(3):240-53. https://doi.org/10.1080/02646838.2014.886104
Stichler JF, Weurding B. Women's health education: the first step to self-care. Adv Pract Nurs Q. 1995;1(3):12-8.
Abbasi P, Charandabi SMA, Mirghafourvand M. Comparing the effect of e-learning and educational booklet on the childbirth self-efficacy: a randomized controlled clinical trial. J Matern Fetal Neonatal Med. 2018;31(5):644-50. https://doi.org/10.1080/14767058.2017.1293031
World Health Organization (WHO). WHO recommendations on antenatal care for a positive pregnancy experience. Geneva: World Health Organization, 2016.
Bandura A. Self-efficacy mechanism in physiological activation and health-promoting behavior. Madden J. Neurobiology of leaning, emotion and affect. New York: Raven, 1991; p.229-70.
Goodman P, Mackey MC, Tavakoli AS. Factors related to childbirth satisfaction. J Adv Nurs 2004;46(2):212-9. https://doi.org/10.1111/j.1365-2648.2003.02981.x
Fair CD, Morrison TE. The relationship between prenatal control, expectations, experienced control, and birth satisfaction among primiparous women. Midwifery. 2012;28(1):39-44. https://doi.org/10.1016/j.midw.2010.10.013
Stevens NR, Wallston KA, Hamilton NA. Perceived control and maternal satisfaction with childbirth: a measure development study. J Psychosom Obstet Gynaecol. 2012;33(1):15-24. https://doi.org/10.3109/0167482X.2011.652996
Lowe NK. Self-efficacy for labor and childbirth fears in nulliparous pregnant women. J Psychosom Obstet Gynaecol. 2000;21(4):219-24. https://doi.org/10.3109/01674820009085591
Slade P, Escott D, Spiby H, Henderson B, Fraser RB. Antenatal predictors and use of coping strategies in labour. Psychol Health. 2000;15(4):555-69. https://doi.org/10.1080/08870440008402013
Hemminki E, Simukka R. The timing of hospital admission and progress of labour. Eur J Obstet Gynecol Reprod Biol. 1986;22(1-2):85-94. https://doi.org/10.1016/0028-2243(86)90093-6
Cheyne H, Dowding DW, Hundley V. Making the diagnosis of labour: midwives' diagnostic judgement and management decisions. J Adv Nurs. 2006;53(6):625-35. https://doi.org/10.1111/j.1365-2648.2006.03769.x
Almeida MA, Araujo Júnior E, Camano L, Peixoto AB, Martins WP, Mattar R. Impact of cesarean section in a private health service in Brazil: indications and neonatal morbidity and mortality rates. Ceska Gynekol. 2018;83(1):4-10.
Panna LK, Mirza TT, Rahim R, Gush AK, Shikha SS, Sharmin T. Indications of Primary Caesarean Section: In A Medical College Hospital, Bangladesh. Mymensingh Med J. 2019;28(2):286-90.
Eslami S, Aslani A, Tara F, Ghalichi L, Erfanian F, Abu-Hanna A. The impact of a computerized decision aid on empowering pregnant women for choosing vaginal versus cesarean section delivery: study protocol for a randomized controlled trial. Trials. 2015;16:549. https://doi.org/10.1186/s13063-015-1070-x
Del Carmen GA, Stapleton S, Qadan M, Del Carmen MG, Chang D. Does the Day of the Week Predict a Cesarean Section? A Statewide Analysis. J Surg Res. 2019;245:288-94. https://doi.org/10.1016/j.jss.2019.07.027
Kim AM, Park JH, Kang S, Yoon TH, Kim Y. An ecological study of geographic variation and factors associated with cesarean section rates in South Korea. BMC Pregnancy Childbirth. 2019;19(1):162. https://doi.org/10.1186/s12884-019-2300-0
Alzate MM, Dongarwar D, Matas JL, Salihu HM. Phenotypes and markers of cesarean delivery among Colombian women. Int J Gynaecol Obstet. 2019;147(2):187-94. https://doi.org/10.1002/ijgo.12942
Weidle WG, Medeiros CRG, Grave MTQ, Dal Bosco. Escolha da via de parto pela mulher: autonomia ou indução?. Cad Saude Coletiva. 2014;22(1):46-53. https://doi.org/10.1590/1414-462X201400010008
Jiang H, Qian X, Carroli G, Garner P. Selective versus routine use of episiotomy for vaginal birth. Cochrane Database Syst Rev. 2017;2:CD000081. https://doi.org/10.1002/14651858.CD000081.pub3
Zanetti MRD, Petricelli CD, Alexandre SM, Torloni MR, Nakamura MU, Sass N. Episiotomia: revendo conceitos. Femina. 2009;37(7):367-71.
Cumpston M, Li T, Page MJ, Chandler J, Welch VA, Higgins JP, et al. Updated guidance for trusted systematic reviews: a new edition of the Cochrane Handbook for Systematic Reviews of Interventions. Cochrane Database Syst Rev. 2019;10:ED000142. https://doi.org/10.1002/14651858.ED000142
Huedo-Medina TB, Sánchez-Meca J, Marin-Martinez F, Botella J. Assessing heterogeneity in meta-analysis: Q statistic or I² index?. Psychol Methods. 2006;11(2):193-206. https://doi.org/10.1037/1082-989X.11.2.193
Mehdizadeh A, Roosta F, Chaichian S, Alaghehbandan R. Evaluation of the impact of birth preparation courses on the health of the mother and the newborn. Am J Perinatol. 2005;22(1):7-9. https://doi.org/10.1055/s-2004-837738
Ip WY, Tang CS, Goggins WB. An educational intervention to improve women's ability to cope with childbirth. J Clin Nurs. 2009;18(15):2125-35. https://doi.org/10.1111/j.1365-2702.2008.02720.x
Mullany BC, Becker S, Hindin MJ. The impact of including husbands in antenatal health education services on maternal health practices in urban Nepal: results from a randomized controlled trial. Health Educ Res. 2007;22(2):166-76. https://doi.org/10.1093/her/cyl060
Maimburg RD, Vaeth M, Dürr J, Hvidman L, Olsen J. Randomised trial of structured antenatal training sessions to improve the birth process. BJOG. 2010;117(8):921-8. https://doi.org/10.1111/j.1471-0528.2010.02584.x
Serçekuş P, Başkale H. Effects of antenatal education on fear of childbirth, maternal self-efficacy and parental attachment. Midwifery. 2016;34:166-172. https://doi.org/10.1016/j.midw.2015.11.016
Madhavanprabhakaran GK, D’Souza MS, Nairy K. Effectiveness of Childbirth Education on Nulliparous Women’s Knowledge of Childbirth Preparation, Pregnancy Anxiety and Pregnancy Outcomes. Nurs Midwifery Stud. 2017;6(1):e32526. https://doi.org/10.5812/nmsjournal.32526
Bilgin NC, Ak B, Ayhan F, Kocyigit F, Yorgun S, Topcuoglu MA. Effect of childbirth education on the perceptions of childbirth and breastfeeding self-efficacy and the obstetric outcomes of nulliparous women. Health Care Women Int. 2020;41(2):188-204. https://doi.org/10.1080/07399332.2019.1672171
Hatamleh R, Abujilban S, AbuAbed ASA, Abuhammad S. The effects of a childbirth preparation course on birth outcomes among nulliparous Jordanian women. Midwifery. 2019;72:23-9. https://doi.org/10.1016/j.midw.2019.02.002
Lowe NK. Maternal confidence for labor: development of the Childbirth Self-Eficacy Inventory. Res Nurs Health. 1993;16(2):141-9. https://doi.org/10.1002/nur.4770160209
Ip WY, Chung TKH, Tang CS. The Chinese Childbirth Self-Efficacy Inventory: The development of a short form. J Clin Nurs. 2008;17(3):333-40. https://doi.org/10.1111/j.1365-2702.2006.01919.x
Chen I, Opiyo N, Tavender E, Mortazhejri S, Rader T, Petkovic J, et al. Non-clinical interventions for reducing unnecessary caesarean section. Cochrane Database Syst Rev. 2018;9(9):CD005528. https://doi.org/10.1002/14651858.CD005528.pub3
National Collaborating Centre for Women's and Children's Health (UK). Antenatal Care: Routine Care for the Healthy Pregnant Woman. London: RCOG Press, 2008.
Ball JA, Washbrook M. Birthrate plus: a framework for workforce planning and decision making for midwifery services. Hale: Books for Midwives Press, 1996.
Aral I, Köken G, Bozkurt M, Sahin FK, Demirel R. Evaluation of the effects of maternal anxiety on the duration of vaginal labour delivery. Clin Exp Obstet Gynecol. 2014;41(1):32-6.
Gattuso SM, Litt MD, Fitzgerald TE. Coping with gastrointestinal endoscopy: self-efficacy enhancement and coping style. J Consult Clin Psychol. 1992;60(1)133-9. https://doi.org/10.1037//0022-006x.60.1.133
Kroelinger CD, Oths KS. Partner support and pregnancy wantedness. Birth. 2000;27(2):112-9. https://doi.org/10.1046/j.1523-536x.2000.00112.x
Vonderheid SC, Norr KF, Handler AS. Prenatal health promotion content and health behaviors. West J Nurs Res. 2007;29(3):258-76. https://doi.org/10.1177/0193945906296568
Friede T, Röver C, Wandel S, Neuenschwander B. Meta-analysis of two studies in the presence of heterogeneity with applications in rare diseases. Biom J. 2017;59(4):658-71. https://doi.org/10.1002/bimj.201500236
Davey J, Turner RM, Clarke MJ, Higgins JP. Characteristics of meta-analyses and their component studies in the Cochrane Database of Systematic Reviews: a cross-sectional, descriptive analysis. BMC Medical Res Methodol. 2011;11:160. https://doi.org/10.1186/1471-2288-11-160
Turner RM, Davey J, Clarke MJ, Thompson SG, Higgins JPT. Predicting the extent of heterogeneity in meta-analysis, using empirical data from the Cochrane Database of Systematic Reviews. Int J Epidemiol. 2012;41(3):818-27. https://doi.org/10.1093/ije/dys041