Individual or group antenatal education for childbirth/parenthood.

BACKGROUND

Structured antenatal education programs for childbirth and/or parenthood are commonly recommended for pregnant women and their partners by health care professionals in many parts of the world. Such programs are usually offered to groups but may be offered to individuals.

OBJECTIVES

The objective of this review was to assess the effects of this education on knowledge acquisition, anxiety, sense of control, pain, support, breastfeeding, infant care abilities, and psychological and social adjustment.

SEARCH STRATEGY

The Cochrane Pregnancy and Childbirth Group trials register, the Cochrane Controlled Trials Register, and other databases were searched. The date of the last search was December, 1999.

SELECTION CRITERIA

Randomized controlled trials of any structured educational program provided during pregnancy by an educator to either parent, that included information related to pregnancy, birth, or parenthood were included. The educational interventions could have been provided on an individual or group basis. Educational interventions directed exclusively to either increasing breastfeeding success or reducing smoking were excluded, since reviews of these topics can be found elsewhere in The Cochrane Library.

DATA COLLECTION AND ANALYSIS

Trial quality was assessed and data were extracted by the author from published reports.

MAIN RESULTS

Six trials, involving 1443 women, were included. Twenty-two were excluded. The largest of the included studies (n = 1275) examined an educational intervention to increase vaginal birth after cesarean section. This high quality study showed similar rates of vaginal birth after cesarean section in 'verbal' and 'document' groups, relative risk (RR) 1.1 (95% confidence interval (CI) 1.0-1.2). More general educational interventions were the focus of the other five studies (combined n = 168). The methodological quality of these trials is uncertain, since details of the randomization procedure, allocation concealment, and/or participant accrual/loss were not reported. No consistent results were found. Sample sizes were very small, ranging from 10-67. Interventions, populations, and outcomes measured were different in each study. No data from the five general education trials were reported concerning labour and birth outcomes, anxiety, breastfeeding success, or general social support. Knowledge acquisition and factors related to infant care competencies were measured.

REVIEWER'S CONCLUSIONS: Individualized prenatal education directed toward avoidance of a cesarean birth does not increase the rate of vaginal birth after cesarean section. The effects of general antenatal education for childbirth and/or parenthood remain unknown.