Davies Anna, Larkin Michael, Willis Lucy, Mampitiya Narendra, Lynch Mary, Toolan Miriam, Fraser Abigail, Rawling Kate, Plachcinski Rachel, Barnfield Sonia, Smith Margaret, Burden Christy, Merriel Abi
Academic Women's Health Unit, Bristol Medical School, University of Bristol, 5 Tyndall Avenue, Bristol, BS8 1UD, UK.
North Bristol NHS Trust, Southmead Hospital, Southmead Road, Bristol, BS10 5NB, UK.
BMC Pregnancy Childbirth. 2024 Dec 28;24(1):875. doi: 10.1186/s12884-024-07066-x.
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.
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.
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.
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.
对分娩的期望以及这些期望是否得到满足，会影响产后心理健康。由于怀孕人群的变化和不断发展的证据，产时干预措施（例如引产）正在增加，这可能导致期望与分娩经历之间出现差异。英国国家卫生与临床优化研究所（NICE）建议进行产前教育（ANE），以使女性为分娩做好准备，但英国国民健康服务体系（NHS）并没有规定的产前教育课程。我们旨在探讨女性对分娩的期望以及她们对NHS和非NHS产前教育后常见干预措施和并发症的理解。
对年龄≥16岁、在单一NHS信托机构接受过产前护理的产后女性（产后<12个月）进行定性焦点小组访谈。使用半结构化主题指南来探讨参加产前教育后的分娩期望以及对分娩干预措施和并发症的了解。数据进行了转录，至少两名研究人员进行了主题分析。
46名女性（平均年龄：33.5岁；81%为英国白人）参与了8个小组。65%为初产妇，35%进行了剖宫产。50%参加了NHS产前教育，59%参加了非NHS产前教育。参与者认为产前教育课程中呈现了一种“分娩等级制度”，即“更好的分娩”包括阴道分娩、最小程度的疼痛缓解和有限的干预。参与者描述了对分娩的控制和选择的期望，尽管有些人表示被鼓励对分娩过程持开放态度。参与者指出她们的期望与随后的经历之间存在差异，这对她们的心理健康产生了不利影响。虽然参与者收到了有关常见分娩干预措施和并发症的信息，但课程中在这些方面花费的时间有限，导致她们认为这些情况很少见。参与者认为，收到关于干预频率的敏感呈现的信息可以让女性做好准备，并在产后支持她们的心理健康。
产前教育影响了女性对分娩的期望，这可能导致期望与经历之间出现差异。关于分娩和分娩干预措施的风险因素及频率的更好信息，可能有助于女性形成基于证据的分娩期望，缩小期望与经历之间的差距，从而对产妇产后心理健康产生影响。需要制定一个强制性的产前教育最低课程，以确保所有女性都能获得高质量的教育。
