A qualitative exploration of women’s expectations of birth and knowledge of birth interventions following antenatal education

Anna Davies, Michael Larkin, Lucy Willis, Narendra Mampitiya, Mary Lynch, Miriam Toolan, Abigail Fraser, Kate Rawling, Rachel Plachcinski, Sonia Barnfield, Margaret Smith, Christy Burden, Abi Merriel*

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

Abstract

Background: Expectations of birth, and whether they are met, influence postnatal psychological wellbeing. Intrapartum interventions, for example induction of labour, are increasing due to a changing pregnant population and evolving evidence, which may contribute to a mismatch between expectations and birth experience. NICE recommends antenatal education (ANE) to prepare women for labour and birth, but there is no mandated UK National Health Service (NHS) ANE curriculum. We aimed to explore women’s expectations of childbirth and their understanding of common interventions and complications following NHS and non-NHS ANE. Method: Qualitative focus groups were conducted with postnatal women (< 12 months postpartum) aged ≥ 16, who had received antenatal care at a single NHS Trust. A semi-structured topic guide was used to explore birth expectations following attendance at ANE and knowledge of birth interventions and complications. Data were transcribed and thematic analysis was undertaken by at least two researchers. Results: 46 women (mean age: 33.5years; 81% white British) participated across eight groups. 65% were primiparous, 35% had a caesarean birth. 50% attended NHS ANE and 59% non-NHS ANE. Participants perceived that a ‘hierarchy of birth’ was presented within ANE classes, where a ‘better birth’ involved vaginal birth, minimal pain relief and limited intervention. Participants described expectations of control and choice over their birth, though some described being encouraged to be open-minded about the course it may take. Participants identified a mismatch between their expectations and subsequent experiences, which adversely impacted their psychological wellbeing. While participants received information about common birth interventions and complications, limited time spent on these during classes resulted in expectations that they were rare. Participants felt that receiving sensitively presented information about the frequency of interventions could prepare women and support their psychological wellbeing after birth. Conclusions: Women’s expectations of birth are informed by ANE which may precipitate a mismatch between expectations and experience. Better information about risk factors and frequency of labour and birth interventions may support women to develop evidence-informed expectations of birth, reducing the expectation-experience gap, with consequent impact on maternal postnatal wellbeing. A mandatory minimum curriculum for ANE is needed to ensure high-quality education is available to all.
Original languageEnglish
Article number875
Number of pages15
JournalBMC Pregnancy and Childbirth
Volume24
Issue number1
Early online date28 Dec 2024
DOIs
Publication statusPublished - 28 Dec 2024

Bibliographical note

Copyright © The Author(s) 2024. This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit https://creativecommons.org/licenses/by/4.0/

Keywords

  • Psychological wellbeing
  • Birth expectations
  • Antenatal education
  • Qualitative
  • Focus groups
  • State Medicine
  • Prenatal Education/methods
  • Humans
  • Parturition/psychology
  • Focus Groups
  • United Kingdom
  • Delivery, Obstetric/psychology
  • Health Knowledge, Attitudes, Practice
  • Pregnancy
  • Young Adult
  • Prenatal Care/psychology
  • Adult
  • Female
  • Qualitative Research

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