Co-design and refinement of an optimised antenatal education session to better inform women and prepare them for labour and birth
Authors: Merriel Abi , Toolan Miriam , Lynch Mary , Clayton Gemma , Demetri Andrew , Willis Lucy , Mampitiya Narendra , Clarke Alice , Birchenall Katherine , de Souza Chloe , Harvey Emma , Russell-Webster Tamarind , Larkai Eva , Grzeda Mariusz , Rawling Kate , Barnfield Sonia , Smith Maggie , Plachcinski Rachel , Burden Christy , Fraser Abigail , Larkin Michael , Davies Anna 
Published: December 2023

Objective

To co-design, implement, evaluate acceptability and refine an optimised antenatal education session to improve birth preparedness.

Design

There were four distinct phases: co-design (focus groups and co-design workshops with parents and staff); implementation of intervention; evaluation (interviews, questionnaires, structured feedback forms), and systematic refinement.

Setting

A single maternity unit with approximately 5,500 births annually.

Participants

Postnatal and antenatal women/birthing people, birth partners and clinicians.Outcome measures:To establish whether the optimised session is deliverable, acceptable, meets the needs of women/birthing people and partners, and refine it with input from parents, clinicians and researchers.

Results

The co-design was undertaken by 35 women, partners and clinicians. Five midwives were trained and delivered 19 Antenatal education (ACE) sessions to 142 women and 94 partners. 121 women and 33 birth partners completed the feedback questionnaire. Women/birthing people(79%) and birth partners(82%) felt more prepared after the class with most participants finding the content very helpful or helpful. Women/birthing people perceived classes were more useful and engaging than their partners. Interviews with 21 parents, a midwife focus group and a structured feedback form resulted in 38 recommended changes: 22 by parents, 5 by midwives and 11 by both. Suggested changes have been incorporated in the training resources to achieve an optimised intervention.

Conclusions

Engaging stakeholders (women and staff) in co-designing an evidence informed curriculum resulted in an antenatal class designed to improve preparedness for birth, including assisted birth, that is acceptable to women and their birthing partners, and has been refined to address feedback and is deliverable within NHS resource constraints. A nationally-mandated antenatal education curriculum is needed to ensure parents receive high-quality antenatal education that targets birth preparedness.

Key messages

What is already known

Antenatal education is used to prepare women/birthing parents for labour, birth and the postnatal period, but it has been eroded. Antenatal education has potential to support women/birthing parents in developing their expectations around labour and the postnatal period, via improved health literacy. Improving antenatal education could be impactful as the expectation-experience gap is linked to post traumatic stress disorder.

What this study adds

We have shown that a co-designed, optimised antenatal class can provide information helpful to parents and important to staff, within the constraints of the NHS resources

How this study might affect research, practice or policy

This study can be used to understand what parents need from antenatal education, and how to begin to address the expectation-experience gap.