September 02, 2003

Challenging the status quo pf prenatal classes

The doctors at one of our biggest maternity units in Sydney are trying to interfere in the running of the prenatal classes. This is a ploy that has been used elsewhere, usually by medicos that are feeling threatened by the challenge of facing women asking awkward questions after they have attended classes.

Many hospital based classes primarily aim to tell women about the services and policies that will apply when they come to the unit to give birth. When classes are led by staff who work in the unit they are much more likely to take this tack, because they may have little experience of other options or services offered elsewhere and feel they are obliged to “toe the party line” as employees of the hospital. The result is that parents are set up for accepting the policies that have been laid down by the doctors and the notion of informed choice is severely compromised.

The way that educators are recruited to run prenatal education for parents is also a significant factor. The usual method is to co-opt midwives from their regular duties to present classes. Frequently their training for this important and skilled role is to have them sit in on one or two programs taught by another midwife, then to hand them the written outline for the classes before being told to go and teach. Very few will have any formal education in adult learning, working with groups or even a check on their basic knowledge. They will stand in front of the group, lecturing to the given outline and inviting little interaction beyond the fielding of a few questions from the group members. Parents, bless them, knowing no better, will assume that this “expert” is giving them reliable, evidence based information and all the details they need to know. It is an appalling situation all round.

Every now and then an educator with a solid educational background in childbirth education will joins such a team. Their approach may be quite different - they will encourage participation, a flexible group driven agenda and explain options and choices that may not be easily obtainable in that particular institution. Clearly, such a professional educator is a threat to the status quo, and efforts to constrain her influence (she is usually very popular with the parents) are often attempted. If she can’t be reigned in, she might well be asked to leave, so that mediocrity can return and keep everyone comfortable. Shooting the messenger is a standard measure for silencing those who offer something different and there is evidence of that happening in this particular hospital.

Meanwhile, there is an urgent need for better standards in our prenatal classes. At present, many of them are so poor that parents would be better of not attending. There are no industry benchmarks for prenatal education against which the competency of individual educators can be measured and this enables hospitals to provide shoddy, limited programs with untrained educators. This is a situation that needs to be remedied and is one I intend to pursue, in the interests of parents and also of hospital employers. They have a duty of care to provide quality programs but at the present time there are no guidelines for assessing the competency of their staff.

Perhaps the doctors whoa re agitating for change at the hospital in Sydney are merely exposing the shortcoming in the present system. Perhaps they are trying to control the flow of information to parents so that it does not expose the limitations in the doctor-orientated hospital system or their own practises. This is an issue that deserves further exploration, and I will be following up with further comment as this situation progresses.

Posted by andrea at September 02, 2003 08:21 AM

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Posted by: blackjack on January 19, 2004 10:04 AM

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I realy do agree that we need a better standard for prenatal education. i'll start on september a ph.d. and i want to work on thesis to develop a prenatal education curriculum...you might have some informations to give me which help me to work on it

Posted by: alexandre on May 27, 2004 12:21 AM