Finding Common Ground in Antenatal Education

1. Finding Common Ground in Antenatal Education Vivienne Brady, School of Nursing and Midwifery, Trinity College Dublin. Email: bradyvi@tcd.ie Dr. Joan Lalor, (Supervisor) School of Nursing and Midwifery, Trinity College Dublin. Funding: Health Research Board Grant Number: NM/2008/21. School of Nursing and Midwifery, TCD Student Stipend

2. Setting the Scene • Aim: • To develop antenatal education in preparation for motherhood, based on knowledge created in collaboration with mothers to be, mothers and antenatal educators. • Guided by a Participatory Action Research approach, influenced by feminist concerns. • Data Gathering: Group meetings (n=18) and individual (n=7) conversations. • Analysis: Voice-centred Relational Method

3. Using Action Research to Develop Antenatal Education (ANE)

4. Not Knowing • Uncertainty in articulating knowledge needs in preparation for birth and motherhood. • Making sense of position in the services • ‘And I suppose it’s in the hospital’s best interest too because their way of informing you is a way of disciplining you. Because it’s a way of telling, teaching you how to behave when you come in here. So it’s in their interest to inform you to behave in a certain way because I suppose with the labour thing it’s moulding your expectations of what a hospital can do and what midwives do etc, etc.’ • (ARC2 W9 21/40)

5. Time and Space • In the absence of space to explore fears, anxieties and feelings about birth - acceptance of the package or process of care that is offered as a way of making birth possible. • ‘...once you go into the hospital you are part of the system and it could be over in ten minutes or it could take two days or whatever the case may be, but you are part of the system and they will tell you...it’s great once you get to hospital because it’s someone else’s problem then so I reckon’ • (ARC1 AN W2)

6. Becoming a Mother • Caring for baby particularly in the first month after birth • Anticipated loneliness and isolation after birth • ‘I haven’t a clue, and I kind of got a bit depressed you know...I would be over the moon if antenatal classes were things to do with coping with and being handed the child in the first month...I want them to able to give me really practical tools....’ • (ARC2 W9 21/40)

7. Women say they want ‘information’ yet they frequently returned to their emotional needs of support and confidence building as new mothers • ‘...I had done a lot of research anyway...I think it was back to the reassurance thing and I think for me it was actually physically coming in here, and physically seeing somebody and I guess the things I really got out of it was, you know, for example, you saying oh ‘call us whenever you want or whatever’ (CIG PN W6) Women’s Knowledge Needs for Pregnancy, Birth and Motherhood • Women frequently returned to their emotional needs of support and confidence building as new mothers • ‘...I had done a lot of research anyway...I think it was back to the reassurance thing and I think for me it was actually physically coming in here, and physically seeing somebody...the things I really got out of it was...you saying oh ‘call us whenever you want or whatever’ • (CIG PN W6)

8. Women’s Knowledge Needs for Pregnancy, Birth and Motherhood • Questioning the viability of ANE set within the confines of institutional structure, with large volume of attendees and the ensuing generic nature of classes in preparing for motherhood as a life changing event • ‘...all you want in those first few weeks is somebody to just tell you what to do. And the truth is nobody can really tell you what to do...experiences are so different that it’s impossible for an antenatal class to cater for everything. So I suppose it does by its nature have to be quite general and give little bits of information about a lot of things.’ • (ARC1 PN2 W4)

9. Needing Other Mothers • The value of knowledge grounded in the real-life experiences of other mothers. • ‘I guess until you’ve been through it (birth) you don’t really understand’ • (ARC 1 PN W1) • Valuing ‘maternal authority’, or, turning to other women to make sense of experiences • (Belenky et al. 1986, p. 62)

10. Needing Other Mothers • This drive for human connection with others in shared experiences is illustrated by women’s commitment to be part of the research conversations. • This highlights the deficit that exists in creating space for women to meet after birth. • ‘The only real opportunity has been to chat in this group actually so that’s why I quite enjoyed the first meeting. And I was really eager to see you again to see how everybody had got on.’ • (ARC1 PN2 W4) • Human relationships are the hidden warp threads holding everything together. • (Hunter et al. 2008)

11. Essential Components of Learning for Pregnancy, Birth and Motherhood • In creating space, women and co-researchers have co-constructed essential components of learning for pregnancy, birth and motherhood through ‘ordinary talk’ and have named these concepts ‘Who?’, ‘What?’, ‘How?’ and ‘Why?’ to reflect the continuum of pregnancy, birth and motherhood.

12. Finding Common Ground in Antenatal Education • Supported by women participants-a learning philosophy that requires the antenatal educator to view the woman as a whole entity, that is, a person with value systems and beliefs, who is engaged in obtaining knowledge that is fitting for her information and other needs. • Support in the form of an online database of information (including information on the hospital system) - a woman can choose to access information she believes is of personal relevance and meaning.

14. Conclusion • Finding common ground is integral to, but also extends beyond, the forum of structured hospital-based ANE, as all carers are invited to • ‘maximise the potential for women to take up the power that will enable them to lead fulfilling lives as individuals and as mothers’ • (Leap 2010, p. 19). • Ensuring that the woman is central and active throughout her maternity care experience • (Gray 2000).

15. Reference • Belenky M.F., Clinchy B.M., Goldberger N.R. and Tarule, J.M. (1986) Women’s Ways of Knowing. Basic Books Inc., United States. • Gray J. (2000) The Drama of Childbirth.Irish Sociological Chronicles3, 247-259. • Hunter B., Berg M., Lundgren I., Olafsdottir O. & Kirkham M. (2008) Relationships: the hidden threads in the tapestry of maternity care. Midwifery 24(2), 132-137 • Leap N. (2010) The less we do the more we give. In The Midwife Mother Relationship, 2nd edn. (Kirkham M., ed), Palgrave Macmillan, Houndmills. pp. 17-36. • Rogers C. (1994) Freedom to Learn. Merrill, Maxwell Macmillan International, Oxford. • Siddiqui J. (1999) The therapeutic relationship in midwifery. British Journal of Midwifery7(2),111-114.