Chapter 8 Antenatal Education for birth & parenting

1. DR. Areefa Albahri Chapter 8Antenatal Education for birth & parenting By DR. Areefa Albahri Assistant Prof. of MCH Islamic University of Gaza

2. The chapter aims to • •examine the nature and purpose of antenatal education • •discuss the elements of antenatal education • •suggest effective teaching activities responsive to a variety of learning styles • •consider appropriate antenatal education for very young women, women from minority ethnic groups, same sex couples and fathers • •discuss collaborative working in the provision of antenatal education services.

3. The goal of antenatal education is therefore to help pregnant women and their supporters to make, and take responsibility for, their own choices. • In order for pregnant and new parents to become part of this critical mass of healthcare consumers, they need: • Informationis about facts but, do not mean the same thing to everyone who has access to them. A woman may know that smoking during pregnancy is bad for her baby and herself, but not know it within the context of her own life where smoking helps her relax and where best friends who smoke have given birth to apparently healthy babies.

4. Self-awareness • Education extends people's knowledge of themselves. Becoming-parents may make decisions based on influences of which they are not fully aware. • Education aims to increase self-awareness by exposing learners to different ways of thinking. • Antenatal education enables becoming-parents to exchange views, understand how facts are reach their own decisions.

5. Skills • Finally, in order to be self-directing in our lives, we need certain skillsor competencies. These cannot be learned by observing others or from books. • They have to be learned by doing. Nobody becomes confident in bathing a baby by watching someone else bathe a baby. • Few people are confident in communicating with a person in authority without practicing being assertive. Children are far more open to learning skills than adults – perhaps because nearly all their learning is, in their early years, around skills. Adults have generally become fearful of skills-learning because ‘failure’ is much more evident when practicing a skill than when receiving information or participating in a discussion (Daines et al 2002).

6. antenatal education aims to • enable becoming-parents to achieve a richer adulthood by enhancing their ability to make well-informed decisions appropriate to their individual circumstances • • increase their self-esteem so they can make a confident transition to parenthood through labour, birth and the early months of their children's lives • • nurture a critical mass of healthcare consumers able to act on an individual and political level to improve services. • The measurable outcomes of effective antenatal education will be: • • knowledgeable parents in possession of a range of evidence-based information which they can assess within the context of their personal circumstances • • self-aware parents who know why they are choosing to do things in certain ways and why others may choose to do things differently • • skilled parents who are able to carry out the day-to-day care of their children, and who can stand up for themselves.

7. Introductions and ice-breakers • new understanding can be applied whether working with parents-to-be on a one-to-one basis or in small groups. Neurophysiology tells us that we cannot learn if we are feeling very emotional, anxious or self- • conscious. • Many parents-to-be meeting their midwife for the first time, or joining an antenatal class, will feel nervous about how they will be perceived by the midwife/educator and other parents in the group. • Expectant parents who are receiving difficult or different news – perhaps that their baby has been diagnosed with Down Syndrome, They are not able to take in information, as anyone else.

8. Introduction by the group leader (session for mothers and partners) • These classes are going to focus on what you want to learn about. • They're also a wonderful opportunity to make friends. So can I ask you to spend a few moments now talking to someone you don't know and finding out a little about them. You could start by asking bout their baby , their pregnancy or which football team they support. • In an antenatal class, parents must be at ease before they are able to engage with the teacher and each other in learning activities. Helping people relax when they are in a group means helping them to learn each other's names and start to get to know each other by identifying common ground. The importance of opening activities either in an individual interview or in a small group situation cannot be over-estimated.

9. Agenda setting • Given that adult learners, whatever their background, like to feel that their individual needs are being addressed, allowing expectant parents to set their own agenda is important. Agenda setting in a group allows individual and collective uncertainties, worries or simply the need to know more, to be expressed in a safe way. • It is often a good idea to split class participants into small groups to think about their agenda, perhaps basing the groups on gender, thus allowing the men to express their unique angle. • Whatever the approach, it is beneficial to allow everyone to feel they can be as general or particular as they like in what they choose to include on the agenda, and also that they are not being forced to reveal more than they wish. Generally, an issue which one person is too shy or hesitant to articulate will be voiced by somebody else.

10. Example agendas • Agenda 1 • When to go to hospital • Physical skills for labour • Pain relief options • Signs of labour • Partner's role in labour • What to take to hospital • What happens at hospital • Role of the father in labour and afterwards • When to go to hospital • What happens post-birth

11. Childbirth educators are often fearful of attempting practical work. • They are nervous that parents will refuse to participate. Acquiring confidence in this area of antenatal education requires you to be clear in your own mind about why you are going to spend time practicing physical skills for labour. • Define your aims: • To empower women to give birth to their babies using their own resources • To minimize the use of potentially harmful interventions •To increase partners' confidence as birth companions.

12. Group work and discussions • You have a lot of question need clear answer: • This can make it hard to plan how you will manage discussions – • will there be a lot of discussion in the whole group? • Will small group work feature more? • How small is a small group? If • you only have four couples, is it still worth breaking up into smaller units? • Are there some who will not take things seriously and disturb the others? • Are there some who are very quiet? • Are there some who seem totally disengaged?

13. Why choose small group • Benefits of small group work • •Small groups allow people to get to know each other better • •Quieter people are more inclined to participate • •Those who have not contributed in the large group can be given responsibility as note-takers and a role in feeding back • •In single gender groups, subjects can be aired which may seem embarrassing in a large, mixed group • •allow both women and men to feel their ideas are valued – this is especially important for the men

14. There are some key points to remember: • •Make clear when feedback from the small group is required and when it is not. • •Use and value feedback when it is given – don't ask for feedback and then ignore it. • •Address issues which arise as soon as possible – or make a note to return to them later. • •Visit each group early in the exercise to check that everyone knows what the task is. • •Be aware of what is happening in the groups but keep a discreet distance so that people do not feel you are eavesdropping on their discussions. • •Be clear about time-keeping – let everyone know at the outset how long their group discussion will be, and then give a few minutes warning before bringing it to a close.

15. Avoiding information overload • Sadly, the vast majority of information given in any class will have been forgotten by the next . • there is a tendency for students to lie awake in the early hours of the morning, • So how can the midwife/educator decide how much information is sufficient and what that information should be? • She enable group members to learn from each other, topics can be introduced with an invitation to share existing knowledge and first or second-hand experiences:

16. Environment of classes • You may, or may not, have choice in the location of your sessions for parent education. Your education place should be • well-suited to the size of the group is important (participants don't like to feel either cramped or lost in a space that is too big). • You need room to move about; seating that is comfortable both for the pregnant and the non-pregnant, and more than one type of seating to cater for different needs; easily accessible refreshments; the capacity to regulate the room temperature; privacy for work in small groups • Body language is important,

17. Lighting and visual aids •Always check that the lights you do use are bright enough for everyone to see visual aids • •Ensure that everyone is well-positioned to see visual aids – get people to move if their view is obstructed or awkward.

18. Tips for working with teens 1. Be clear about what age group your classes are for. It is likely that 13-year-olds will be frightened by 17-year-olds, and 18-year-olds will consider themselves in a very different phase in their lives from 15-year-olds. • 2. At the booking visit, ask young Mums for their consent to text them with useful information. Produce high quality flyers to advertise classes – young people live in a world of sophisticated advertising. • 3 Make the class a social as well as an educational event; provide lunch or at least, interesting snacks. Focus on the young Mums as much as on their babies.

19. 4 Be relaxed about people arriving after the class has begun and leaving before it ends. Any attendance is better than none. • 5 Modify classes to fit the group's agenda as closely as possible. The young Mums themselves know what information they need. Financial worries, relationship difficulties and finding accommodation are important issues as is establishing a support network. • 6 Encourage the Mums to come with a companion of their choice – sister, mum, boyfriend, best friend, etc. • 7 Invite young Mums who have just had their babies to visit the classes and tell their pregnant peers ‘what labour's really like’.