The Effectiveness of Modified Childbirth Education Program
Condition: Nursing Caries
Study type: Interventional

Summary: 
      A randomized control trial to test the effectiveness of childbirth education programs on
      maternal anxiety, maternal-fetal attachment, childbirth self-efficacy, and marital
      satisfaction based on Roy Adaptation Model. The modified childbirth education class as the
      experimental group was set up by PI following health authority guidelines in Indonesia. the
      measurement variable outcomes in the experimental group were compared to the control group
      after 4 weeks of intervention. statistical analysis applied to compare demographic
      characteristics between two groups as well as to compare the mean score of the variable
      between two groups.
    

Detailed description: 
      The curriculum of the modified childbirth education (CE) program was created along with
      suggestions and recommendations from experts. The participants were recruited from five
      different health centers in Yogyakarta. the computer random block size was applied to
      determine the randomization (sequence 4,6,8) and allocation concealment was assured by using
      sequentially numbered, opaque, sealed envelopes. The participants in the intervention group
      are pregnant women and their husbands. The instructors employed teaching methods such as a
      group discussion, watching videos, and brainstorming, as well as questions and answer
      periods, demonstrations, childbirth simulation, and practice. The primary investigator (PI)
      will teach particular sessions, including maternal-fetal attachment skills, parenting skills,
      comfort measures, childbirth positions, as well as knowledge about anatomy and physiology
      during pregnancy and birth. The materials and learning methods as the control process are
      expected to influence the four modes as the effectors that can reduce maternal anxiety and
      increase maternal-fetal attachment, childbirth self-efficacy, as well as marital satisfaction
      as the outcomes of adaptation level. The study setting for the intervention group was
      conducted at the antenatal care laboratory of 'Aisyiyah University of Yogyakarta. For safety
      and protocol concerns during the pandemic Corona Virus Disease-19 situation, the class was
      set up in a big classroom and adequate ventilation that can accommodate 12 couples and is
      equipped with yoga mats and pillows, as well as convenient access to a restroom. The couples
      and researcher team were required to wear masks and wash their hand before and after entering
      the class. Research assistants printed handouts and lead the group through WhatsApp
      application to following up practicing skills at home and also respond to the question from
      the participant at any time. During the intervention, the health workers from the
      participating health centers have been invited to observe the intervention. Classes consisted
      of 180-minute sessions held once a week for four weeks

      The control group participants in this study have attended standard childbirth education
      classes during the same period as the intervention group. The control group classes were
      conducted at the primary health centers where they were recruited, not at the university. The
      facilitators of the control groups were midwives who are already providing prenatal education
      classes at the clinics. The classes followed the government curriculum, which consists of
      three classes per month and does not invite husbands to participate. However, in this study,
      participants in the control group have four classes over a one-month period to better match
      the program of the intervention group. The material for the standard curriculum includes
      anatomical and physiological changes during pregnancy, pregnancy care, birth, and postpartum
      care. The classes also address family planning after giving birth, newborn care, preventing
      infectious disease, and procedures for obtaining a birth certificate. The midwives also
      discuss and debunk unhealthy local myths, beliefs, and cultural practices surrounding
      pregnancy, childbirth, and the postpartum period. For the fourth class, the control group has
      a half-hour to fill out the questionnaires and a half hour for feedback and discussion. Then
      the researcher and assistants have provided the control group participants with a condensed
      two-hour class of prenatal yoga, comfort measures, and maternal-fetal attachment activities.
      We conducted online briefing sessions with midwives who are the childbirth education program
      facilitator at five health centers. The briefing discussed the objectives of the study, the
      administration of the questionnaire, and the quality control issues relating to biases,
      fabricated data, missing data, and ethical issues. These were established in an effort to
      ensure consistency in the process of data collection.
    

Intervention name(s): modified childbirth education program
Intervention type(s): Behavioral
Intervention description(s): The participants in the intervention group are pregnant women and their husbands. The instructors employed teaching methods such as a group discussion, watching videos, and brainstorming, as well as questions and answer periods, demonstrations, childbirth simulation, and practice. The primary investigator (PI) will teach particular sessions, including maternal-fetal attachment skills, parenting skills, comfort measures, childbirth positions, as well as knowledge about anatomy and physiology during pregnancy and birth Classes consisted of 120-minute sessions held once a week for four weeks.
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: None (Open Label)
Primary purpose: Prevention
Keywords: Randomized control trial