Prenatal education ... time to lift our game

Also by Andrea Robertson Book: The Midwife Companion Book: Preparing for Birth: Mothers Book: Preparing for Birth: Fathers Book: Your Childbirth Education Classes: Finding Clients Weblog: Andrea's Diary On the same subject Andrea's Papers

by Andrea Robertson
		Andrea Robertson is a Consultant in Childbirth Education from Sydney, Australia. Her books include Preparing for Birth, Making Birth Easier, Empowering Women, and The Midwife Companion. As the Principal of Associates in Childbirth Education, an independent training organisation, she oversees the world's first Graduate Diploma in Childbirth Education, and presents highly acclaimed training workshops for midwives and educators on teaching and practical midwifery, within Australia, and in many overseas countries.

The most effective education occurs when people take an active part in the learning process. The old-style "talk and chalk" presentations that many of us remember from our school days are now recognised as inappropriate, especially for educating adults. Most of us learn best through active participation and getting involved, especially when we have decided for ourselves what we need to know and are therefore motivated to find answers or learn the necessary skills.

Prenatal programs in many settings still revolve around an educator standing out the front talking to a group of parents who sit passively in rows, apparently absorbing 'useful' information The program is devised by the educator to reflect what they feel parents should know and the order of the topics is determined by the time available, the resources to hand and the expertise of the teacher. "Discussion" takes the form of a question and answer session, with the educator offering advice and personal opinion in response to parents' questions. If the group are lucky, the leader will have a sense of humour, the session will have fun anecdotes and an interesting range of visual aids to look at and the people will go away feeling that they have had 'a good night out'. However, we need to ask ourselves, have any useful skills been learned by parents that they can use when confronted by the inevitable dilemmas pf parenthood? Have they remembered the bountiful facts that have been offered? Has their confidence in being able to labour normally and without the need for intervention risen? Will they be able to replicate the practical measures they were told about when they are in labour? The chances are high that the answers to these question will be 'no'. If this is the case, shouldn't we be taking a closer look at the way we present prenatal education? It is hard to justify funding or supporting programs that have such poor outcomes!

One of the main reasons that educators take this approach of 'chalk and talk' is that they have no training in either running adult education groups or devising effective presentations. Doing a job without the necessary training is very stressful in any field and would be considered scandalous in any other area of medicine or nursing, yet it seems to be perfectly acceptable to require an untrained educator to teach adults how to become parents. The attitude of many hospital administrators seems to be that any midwife who is available can be rostered to take the classes and that providing a list of topics to be covered will be sufficient preparation Teaching aids and other resources may be considered an expensive luxury and the educator may be equipped only with a few old, scruffy charts, a broken pelvis and a dirty baby doll. In case you think I am exaggerating, take a look around you - many of the hospitals I have visited fit this description to a T.

In today's world of sophisticated marketing, slick television images, advertising hype and the Internet, we must keep pace with current selling strategies if we are to get our message across to expectant parents. Take a look at how others are selling baby equipment to this sector of our community: promotions to health professionals, smart charts on display, glossy brochures and magazines, videos, interactive Web sites - all eye-catching, engaging and seductive. If we want to be heard in this competitive world, we have to match, or at least keep pace with these strategies when we facilitate with our programs.

The research done on the effectiveness of prenatal education programs has highlighted that much of it is a waste of time (check the Cochrane Library for details). These results largely reflect the fact that the outcome of a birth is dependent on the caregiver in charge of the process at the time, rather than the education the parents have received. It may also be an indication that parents did not have the skills they needed to negotiate their way around the health care system to achieve the birth they desired (now there's a potential midwifery led research project!). If we accept that women are fully equipped with the instinctive know-how to give birth easily and safely, then one vital way of improving poor outcomes, such as a rising caesarean section rate, may be by the better training of parents prenatally in how to seek appropriate care. This might be much more useful than teaching women how to breathe and relax in labour! It's skills parents need rather than volumes of information. Knowing a row of useful facts about caesareans is not nearly as useful as having the skills to use this ammunition effectively during negotiations with caregivers.

It is time we lifted our game with prenatal education. Parents are desperate for ideas on how to manage the enormous changes that pregnancy and parenthood bring and they are keen to attend parenthood classes. Our hospitals acknowledge this by scheduling some sessions for those who are willing and able to attend. Many parents are not being reached, and many of those who do come are disappointed by the experience. We can't afford to let this once-in-a-lifetime opportunity for promoting life skills to slip away through a lack of commitment within the system. There are a number of steps we (you and me!) can take:

• We need to value prenatal education programs for their potential to change people's lives through the development of important life skills.

• We can make sure that those who facilitate the programs want to be involved, have a commitment to the task and are willing to learn the skills necessary for successful education

• We can attend practical, accredited training courses with a track record of delivering the necessary skills for facilitating prenatal education in a variety of formats for clients of differing needs.

• Administrators must be encouraged to see that the quality of the prenatal program reflects on their maternity services as a whole. The provision of these services should have been included as part of the maternity unit budget and this money should be identifiable and spent appropriately.

• Acknowledge that it takes expertise and skill to facilitate effective education. It is not something 'that anyone can do if they are a midwife'. A commitment to providing adequately trained leaders is essential - parents would expect those who teach their children in school to have qualifications and they certainly expect that other training courses are run by qualified instructors. We are just lucky that parents rarely complain, probably because they have no opportunities to shop around and experience various forms of classes before their babies are born.

• We can make sure that we present professionally: our equipment, teaching aids, handout materials and advertising must reflect the importance of the work we do. If they are shabby or disorganised (or even non-existent!) parents may form the view that we don't care very much about them or their needs.

• We will put a range of evaluations processes in place to gauge the usefulness of what we do. We will use this to improve our program and also for supporting our work.

• If we can't get the resources and training that we need, we may have to use targeted feedback from the parents to strengthen our case with administrators and managers. We can approach the accountants to reveal the actual budget for the prenatal program and we can agitate for this money to be actually spent on the provision of the services. In preparation for this process we can work out the actual costs for our programs so we have a basis from which to negotiate.

• We can be more open and vocal amongst our colleagues about the work we do and its importance. We are the essential link in the provision of information so that parents can make informed choice; we have a role in protecting our employers and colleagues from litigation arising from a lack of information; parents come to us, separately from contact with other health professionals, because they see us as the people who can help them best prepare for the challenges of parenthood.

If you were a pregnant parent, would you feel your classes gave you the skills you needed to enjoy birth and parenthood? Would you recommend your program to your best friend? Let's make this year (the true beginning of the new millennium) the turning point in prenatal education, and commit ourselves to becoming better prepared to work with parents, raising the profile of the work we do and gaining the resources we need to be effective. It could be quite a year!

This article first appeared in The Practising Midwife Vol 4, No 1, January 2001