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Who should facilitate parent parent education programs?

Several times during the workshop in Dublin I was approached by group members asking about using a team approach for the presentation of pre-natal education programs. There are pluses and minuses about using a number of facilitators for a group and I explained what these were. In general however, from an educational standpoint and to promote continuity of care and information, having the one presenter facilitate the entire program works best. This approach presumes, of course, that the facilitator is competent to cover all the possible topics in a pre-natal program. As for the question of which professionals should be involved, I have always maintained that the background of the presenter should not be an issue, providing they are skilled, competent and knowledgeable.

I have been forced to have a major re-think of these beliefs in light of my experience in Dublin. It was clear from the start that most of the group were public health nurses, well used to telling parents how to manage the post-natal period, but most were very unfamiliar with the needs of pregnant parents and the hospital system. I was astounded that no-one in the group could tell me any of the disadvantages for the baby of epidurals, for example, beyond the possibility of a forceps birth. The physiology of pain, or indeed that pain is a normal part of the birth process, was news to most as well. An exercise that explored their own beliefs regarding labour revealed that most saw it is a negative, painful experience that could best be managed with drugs.

At another point, I was roundly challenged by several group members who proclaimed that they would never allow their personal feelings to colour the information they gave to prospective parents, yet at other times they cited their own experience as the basis for the advice they gave. The language they used (“patients”, “delivery”, “fetus” etc) displayed a lack of awareness of the impact of their words and some were very sceptical of encouraging parents to “join in” so that better learning could occur. One person loudly stated that a lecture followed by a question time was, in her experience, very well received by parents, yet when challenged as to how she would evaluate whether any actual learning had occurred she had no ideas, other than that they “would ask questions”.

I came to the conclusion that public health nurses may not be the next people to work with pregnant parents, unless they had recent and on-going contact with hospital maternity units, found ways of getting feedback from parents (for example, through organising a group reunion) and spent time in the hospital rooms with labouring women. It is very easy to get out of touch unless a conscious effort is made to keep current with the research, the services and the birth process itself. It is not good enough to rely on one’s professional education of some years ago, or one’s own personal birth and parenting experiences, as a basis informing expectant parents. This is especially so when so many of those personal experiences have been negative or even traumatic.

I have to admit that if a pregnant woman asked me if she should attend the classes run by some of these educators I would have to express doubts as to their worth. It could be that these parents would not be fully informed, may receive out of date information and be subjected to subtle messages that reflected the presenters attitudes and beliefs. I think that sometimes pregnant parents are better off with no education than poor quality education.

There were some educators in this group who clearly had a good grasp of the complexities of pre-natal education, did make an effort to provide learner centred programs, and were flexible in their attitudes and general approach. I just wish there had been more of them, for the sake of pregnant Irish women

Posted by andrea at July 08, 2005 11:00 PM