August 28, 2002

Quality pre-natal education for all

I am off to Wagga Wagga again tonight to present a workshop on "Dynamic Pre-natal Education" for the Regional Community Health Service. Once again it has got me thinking about the overall scene that surrounds parent education programs.......

Why do hospital administrations believe that anyone can present prenatal programs, without any specific training first? There seems to be a very widespread view that anyone who is a midwife is well qualified to teach classes, and that anyone who may be available can be rostered to undertake the classes, sometimes at very short notice. I

Is this fair to parents and presenters? Have these administrators actually considered what results may flow from these decisions?

Let’s consider the recipients of this education first, especially as they are undertaking the greatest risks. Expectant parents who attend these prenatal education programs, they believe that the leader will be competent and skilled, knowledgeable about their subject and able to facilitate effective learning. These are the qualities they will expect the teachers in their children’s school to possess - it is unimaginable that school principals would recruit casual passers-by to teach maths to 10 year olds. Yet this is exactly what happens in the education department in maternity units!

Hospitals have a duty of care to ensure that the programs they offer fulfil their promise. Perhaps they feel that because they usually don’t charge for their classes, parents can’t expect much; yet this is not they way that parents are likely to view it. Where fees are charged for classes, such as in some private hospitals, the need for qualified educators is even more acute, since the hospital is advertising their programs as part of their maternity packages. “Truth in advertising” might be reasonably argued to be a pertinent issue here!

Another issue is the stress that performing complex tasks without any training places on the staff involved. Leading adult education groups requires a variety of skills and proven competence. To throw inexperienced staff into this field could be seen as an occupational health and safety issue, given that the stress that may result to staff could have been avoided if the necessary training had been provided in advanced.

The importance of prenatal education cannot be denied: it is the best opportunity available in the general community to instil some basic parenting skills into parents; it generates a captive audience for health promotion strategies; it is a prime example of preventive medicine in action. It could be argued that if health administrators were serious in spending their limited budgets wisely that this is one area that holds significant potential for wide spending. Although there is scant evidence that prenatal education produces improved outcomes in either birth or parenting, the qualifications of the educator running the programs being used for these studies is rarely stated. Perhaps if they had been better educated and had clearly defined aims and objectives for their program, effective evaluation might be possible. Perhaps the wrong outcomes were being measures in the first place - an issue worth considering as well.

I am appalled at the quality of most prenatal programs for expectant parents. Educators are often required to “toe the party line” and advertise the services of the hospital and avoid discussion of services and options that the hospital would prefer not to provide. The notion of “informed choice:” is a myth, and parents are gently lead into accepting often substandard care (in terms of birth outcomes) in our hospitals. I believe that hospitals must accept the responsibility of providing quality education for pregnant parents and that this rests largely on their acceptance of the need for appropriate education and support of their educators. Many are struggling to do the best they can, under sometimes impossible conditions. When are hospital administrators going to really look at what they are doing in this area?

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