Codesign and refinement of an optimised antenatal education session to better inform women and prepare them for labour and birth

Abi Merriel*, Miriam Toolan, Mary Lynch, Gemma Clayton, Andrew Demetri, Lucy Willis, Narendra Mampitiya, Alice Clarke, Katherine Birchenall, Chloe de Souza, Emma Harvey, Tamarind Russell-Webster, Eva Larkai, Mariusz Grzeda, Kate Rawling, Sonia Barnfield, Margaret Smith, Rachel Plachcinski, Christy Burden, Abigail FraserMichael Larkin, Anna Davies

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review


Objective: Our objective was to codesign, implement, evaluate acceptability and refine an optimised antenatal education session to improve birth preparedness. Design: There were four distinct phases: codesign (focus groups and codesign workshops with parents and staff); implementation of intervention; evaluation (interviews, questionnaires, structured feedback forms) and systematic refinement. Setting: The study was set in a single maternity unit with approximately 5500 births annually. Participants: Postnatal and antenatal women/birthing people and birth partners were invited to participate in the intervention, and midwives were invited to deliver it. Both groups participated in feedback. Outcome measures: We report on whether the optimised session is deliverable, acceptable, meets the needs of women/birthing people and partners, and explain how the intervention was refined with input from parents, clinicians and researchers. Results: The codesign was undertaken by 35 women, partners and clinicians. Five midwives were trained and delivered 19 antenatal education (ACE) sessions to 142 women and 94 partners. 121 women and 33 birth partners completed the feedback questionnaire. Women/birthing people (79%) and birth partners (82%) felt more prepared after the class with most participants finding the content very helpful or helpful. Women/birthing people perceived classes were more useful and engaging than their partners. Interviews with 21 parents, a midwife focus group and a structured feedback form resulted in 38 recommended changes: 22 by parents, 5 by midwives and 11 by both. Suggested changes have been incorporated in the training resources to achieve an optimised intervention. Conclusions: Engaging stakeholders (women and staff) in codesigning an evidence-informed curriculum resulted in an antenatal class designed to improve preparedness for birth, including assisted birth, that is acceptable to women and their birthing partners, and has been refined to address feedback and is deliverable within National Health Service resource constraints. A nationally mandated antenatal education curriculum is needed to ensure parents receive high-quality antenatal education that targets birth preparedness.
Original languageEnglish
Article numbere002731
Number of pages12
JournalBMJ Open Quality
Issue number2
Early online date10 Jun 2024
Publication statusPublished - 10 Jun 2024

Bibliographical note

Copyright © Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY. Published by BMJ.

Data Access Statement

Data are available upon reasonable request. Most data are presented in the text and supplemental material. The qualitative data are presented as quotes. Data will be available upon reasonable request and with appropriate ethical permissions.


  • Healthcare quality improvement
  • Maternal Health Services
  • Obstetrics and gynecology
  • Patient education


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