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

 

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 methods

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. We updated the search of the Cochrane Pregnancy and Childbirth Group's Trials Register on 7 July 2011 and added the results to the awaiting classification section of the review.

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.

[Note: the 58 citations in the awaiting classification section may alter the conclusions of the review once assessed.]

 

Plain language summary

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

Benefits of antenatal education for childbirth, and the best educational approaches to use, remain unclear.

Antenatal education aims to help prospective parents prepare for childbirth and parenthood. Prospective parents often look to antenatal education to provide important information on issues such as decision making about and during labour, skills for labour, pain relief, infant and postnatal care, breastfeeding and parenting skills. There are many varied ways of providing this antenatal education and some may be more effective than others. The review found nine trials involving 2284 women. Interventions varied greatly and no consistent outcomes were measured. The review of trials found a lack of high-quality evidence from trials and so the effects of antenatal education remain largely unknown. Further research is required to ensure that effective ways of helping health professionals support pregnant women and their partners in preparing for birth and parenting are investigated so that the resources used meet the needs of parents and their newborn infants.

 

摘要

背景

個別或團體的分娩和/或父母產前教育

在許多國家，一般會建議孕婦和其伴侶進行由健康照護專業人士提供的結構性的分娩和/或父母產前教育計畫，這類計畫一般提供給團體，但是也可以提供給個人。

目標

評估這類教育對於獲取知識、焦慮、控制感、疼痛、分娩和生育支持、哺母乳、嬰兒照護能力、心理和社會調適等的效果。

搜尋策略

我們搜尋 Cochrane Pregnancy和Childbirth Group's Trials Register (2006年4月)、CINAHL (1982年2006年4月)、ERIC (1984年2006年4月)、EMBASE (1980年2006年4月)、以及PsycINFO (1988年2006年4月)。我們以人工方式搜尋1956年2006年4月的Journal of Psychosomatic Research，並回顧相關報告的參考文獻。

選擇標準

任何由教育者在孕婦懷孕期間，提供給父母親之一、有關懷孕資訊、分娩和父母親教育的結構式教育計畫之隨機控制試驗(Randomized controlled trials)。這些教育介入方式可以提供給團體或個人。但關於專門用以增加哺乳成功率、產後憂鬱之知識與因應技巧、改善母親焦慮憂鬱和自尊的心理社會健康、減少抽煙等研究計畫則被排除。

資料收集與分析

2位作者評估試驗品質並且由發表的報告摘錄資料。

主要結論

納入9篇試驗、2284名婦女，排除37篇研究。其中8篇研究聚焦在教育介入(總共有1009人)。報告這些試驗的隨機步驟、分派之隱匿、和/或參與者自然累積或失去。並未詳細報告也沒有一致性的結果。樣本數為小型到中型，範圍從10 – 318人。沒有關於焦慮、哺母乳成功率、或一般社會支持的資料。測量關於獲取知識、控制感、與勝任嬰兒照護相關的因素、以及一些分娩和生育結果。納入的最大型研究(n = 1275人)檢視一個增加剖腹產後的自然產的教育和社會支持介入方式。這個高品質研究顯示，口頭教育組和衛教文件組的剖腹產後自然產比率相似(RR為1.08, 95% CI為0.97 – 1.21)。

作者結論

一般的分娩和/或父母產前教育的效果依舊不清楚。針對避免反覆剖腹產的個人產前教育，並未增加剖腹產後自然產比率。

翻譯人

此翻譯計畫由臺灣國家衛生研究院(National Health Research Institutes, Taiwan)統籌。

總結

個別或團體的分娩和/或父母產前教育。 產前教育對於生產的助益，以及使用的最佳教育方式都還不清楚。產前教育的目標是幫助即將為人父母者準備好生育和養育。將為人父母者，通常將產前教育視為提供有關分娩決策、分娩技巧、疼痛緩解、嬰兒和產後照顧、哺母乳和養育技巧的重要資訊。有多種方式提供產前教育，有些可能會比較有效。回顧9篇試驗、2284名婦女，各種介入方式差異很大且結果並不一致。發現這些試驗缺乏高品質的證據，所以產前教育的效果依舊是不清楚。需要後續研究，以確定有助於健康專業人士用以支持孕婦和其伴侶面對生產和為人父母的有效方法，以讓所用的資源符合這些父母親和他們的新生兒之所需。