EXPERIENCES OF CHILDBIRTH: HOW EFFECTIVE IS CHILDBIRTH EDUCATION?
Birth experiences of 94 pnmiparous women who had attended birth preparation classes, were compared to a control group of 22 women of similar age and parity who had not attended classes. The results revealed that in contrast to the control group, women who had attended classes were of higher socioeconomic status, were more likely to have the child's father present at birth, felt more prepared for the birth, and were somewhat more positive to the idea that women should have a choice between home birth and hospital birth However, there were no differences between the groups regarding the frequency of interventions in labour, the length of the labour, the pain experienced and their feelings of satisfaction. Thus, no substantial effect of childbirth education was evident in the management and experiences of the birth.
In recent years there has been a great deal of discussion about childbirth issues Much of the focus of the debate concerns the theme of 'the medicalization of childbirth' (eg Oakley 1975). Macintyre (1977, p.447) suggested that this interest among professionals as well as laymen is 'related both to a growing concern with women's issues, deriving from the impact of the feminist movement, and to public controversy about the maternity services ' Most childbirth educators believe that anxiety m pregnancy is related to heightened pain perception during labour and obstetrical complications (Read 1944) Consequently, the purpose of childbirth education is to reduce overall level of fear regarding childbirth This is accomplished by providing accurate knowledge of the birth process Childbirth education also usually involves training in specific techniques such as breathing and relaxation to give the woman a method for coping with labour contractions These techniques also contribute to reduction of fear Many organisations provide
LENA A. NORDHOLM Lena Nordhofm, Ph.D., is a Lecturer in Psychology at Cumberland College of Health Sciences, Sydney LISELOTT MUHLEN Ltselott Muhlen, M A , Dip.Psych, is a Lecturer in Psychology at Cumberland College of Health Sciences, Sydney
childbirth education in Australia, and although these classes are very popular, little is known about how effective they are Data from studies in other countnes suggests that there is some controversy about the effectiveness of childbirth education classes Klusman (1975) found that a Childbirth Education Association (CEA) course reduced the general anxiety level as measured by the I PAT scale However, Zax, Sameroff and Farnum (1975) did not find a reduction in maternal anxiety as a result of childbirth education Astbury (1980) also failed to find that childbirth education classes decreased maternal anxiety. The results of Cartwnght's 1979 survey similarly found no relationship between attendance of antenatal classes and reduction in anxiety Although the most recent evidence cited above suggests that childbirth classes have no effect on anxiety, it may be that other feelings, attitudes and experiences of birth are affected. A survey by Blankfield (1973) reported that two thirds of the sample felt that pieparation classes had helped them a
great deal in their labours and only 6 per cent found that they were of little or no value. The aim of the present study was to explore the effectiveness of childbirth education on variables relating to management and experiences of birth, by comparing women who had attended antenatal classes with those who had not It was hypothesized that childbirth education would be associated with positive birth experiences and enlightened attitudes toward childbirth,
Method In September 1979, questionnaires were distributed to mothers who had had a baby in the previous twelve months. The survey was conducted with the help of second year occupational therapy students at Cumberland College of Health Sciences, Sydney, The students had been briefed in the administration of the questionnaire, but had no knowledge of the hypotheses or aims of the study They collected the
The Australian Journal of Physiotherapy Voi 28, No 4, August 1982
3
Experiences of Childbirth
questionnaires from the respondents personally All questionnaires were anonymous and respondents were assured about confidential treatment of the information. The questionnaire covered a wide range of issues concerning childbirth. Data for the total sample (N=263) are reported elsewhere (Muhlen and Nordholm, I98l.) Only primiparous women (N=ll6) were included in the present report Of these, 94 had attended childbirth education classes, 21 with CEA, 10 with Parents Centres Australia and the remainder with various maternity hospitals. This group was labelled the Birth Preparation (BP) group. Twenty two had not attended classes and this group served as a Control (C) group. The questionnaire items relevant to this report are included in the Appendix.
Results Characteristics of the Sample The average age of the total group of respondents was 27 4 years, and the two groups did not differ significantly in age (Xgp = 27 6 and X c = 26 2). Social class was assessed by Congalton's 1969 classification of husband's occupation, which was coded from 1-4 An occupation rated I would typically be a higher managerial or professional occupation, while unskilled, 'bluecollar' occupations are rated 4 Table i presents the distribution of social class in the two groups As shown in Table 1, respondents m the control group were somewhat more likely to belong to lower status groups To test the significance of this association, a chi-square test was performed Due to the small observed frequencies, categories 1 and 2 were combined. The resulting chi-square was 9.80 which was significant at the 01 level (df-2). Management of Childbirth (Items 1-9) The Appendix presents percentage frequencies for discrete variables and means and standard deviations for continuous variables. An asterisk marks an item on which the two groups Birth Preparation (BP) and Control (C) differed significantly. 4
Table 1; Distribution of social class for mothers who had attended birth preparation classes (N = 92) and those who had not (N = 21) Group
Social Class
I II IN IV Birth Preparation 8 {8 7%) 44 (47 8%)38 (41 3%) 2 (2 2%) Control 0 9(42 9%) 8 (38 1%) 4 (19%) Note. 3 respondents
did not answer this question
Chi-square tests were performed to detect whether there were any significant relationships between having attended birth preparation classes and variables related to management of childbirth (items 1-4, 7-9). Only one relationship was statistically significant (x2 = 4 42, df- !,/?
Birth experiences of 94 pnmiparous women who had attended birth preparation classes, were compared to a control group of 22 women of similar age and parity who had not attended classes. The results revealed that in contrast to the control group, women who had attended classes were of higher socioeconomic status, were more likely to have the child's father present at birth, felt more prepared for the birth, and were somewhat more positive to the idea that women should have a choice between home birth and hospital birth However, there were no differences between the groups regarding the frequency of interventions in labour, the length of the labour, the pain experienced and their feelings of satisfaction. Thus, no substantial effect of childbirth education was evident in the management and experiences of the birth.
In recent years there has been a great deal of discussion about childbirth issues Much of the focus of the debate concerns the theme of 'the medicalization of childbirth' (eg Oakley 1975). Macintyre (1977, p.447) suggested that this interest among professionals as well as laymen is 'related both to a growing concern with women's issues, deriving from the impact of the feminist movement, and to public controversy about the maternity services ' Most childbirth educators believe that anxiety m pregnancy is related to heightened pain perception during labour and obstetrical complications (Read 1944) Consequently, the purpose of childbirth education is to reduce overall level of fear regarding childbirth This is accomplished by providing accurate knowledge of the birth process Childbirth education also usually involves training in specific techniques such as breathing and relaxation to give the woman a method for coping with labour contractions These techniques also contribute to reduction of fear Many organisations provide
LENA A. NORDHOLM Lena Nordhofm, Ph.D., is a Lecturer in Psychology at Cumberland College of Health Sciences, Sydney LISELOTT MUHLEN Ltselott Muhlen, M A , Dip.Psych, is a Lecturer in Psychology at Cumberland College of Health Sciences, Sydney
childbirth education in Australia, and although these classes are very popular, little is known about how effective they are Data from studies in other countnes suggests that there is some controversy about the effectiveness of childbirth education classes Klusman (1975) found that a Childbirth Education Association (CEA) course reduced the general anxiety level as measured by the I PAT scale However, Zax, Sameroff and Farnum (1975) did not find a reduction in maternal anxiety as a result of childbirth education Astbury (1980) also failed to find that childbirth education classes decreased maternal anxiety. The results of Cartwnght's 1979 survey similarly found no relationship between attendance of antenatal classes and reduction in anxiety Although the most recent evidence cited above suggests that childbirth classes have no effect on anxiety, it may be that other feelings, attitudes and experiences of birth are affected. A survey by Blankfield (1973) reported that two thirds of the sample felt that pieparation classes had helped them a
great deal in their labours and only 6 per cent found that they were of little or no value. The aim of the present study was to explore the effectiveness of childbirth education on variables relating to management and experiences of birth, by comparing women who had attended antenatal classes with those who had not It was hypothesized that childbirth education would be associated with positive birth experiences and enlightened attitudes toward childbirth,
Method In September 1979, questionnaires were distributed to mothers who had had a baby in the previous twelve months. The survey was conducted with the help of second year occupational therapy students at Cumberland College of Health Sciences, Sydney, The students had been briefed in the administration of the questionnaire, but had no knowledge of the hypotheses or aims of the study They collected the
The Australian Journal of Physiotherapy Voi 28, No 4, August 1982
3
Experiences of Childbirth
questionnaires from the respondents personally All questionnaires were anonymous and respondents were assured about confidential treatment of the information. The questionnaire covered a wide range of issues concerning childbirth. Data for the total sample (N=263) are reported elsewhere (Muhlen and Nordholm, I98l.) Only primiparous women (N=ll6) were included in the present report Of these, 94 had attended childbirth education classes, 21 with CEA, 10 with Parents Centres Australia and the remainder with various maternity hospitals. This group was labelled the Birth Preparation (BP) group. Twenty two had not attended classes and this group served as a Control (C) group. The questionnaire items relevant to this report are included in the Appendix.
Results Characteristics of the Sample The average age of the total group of respondents was 27 4 years, and the two groups did not differ significantly in age (Xgp = 27 6 and X c = 26 2). Social class was assessed by Congalton's 1969 classification of husband's occupation, which was coded from 1-4 An occupation rated I would typically be a higher managerial or professional occupation, while unskilled, 'bluecollar' occupations are rated 4 Table i presents the distribution of social class in the two groups As shown in Table 1, respondents m the control group were somewhat more likely to belong to lower status groups To test the significance of this association, a chi-square test was performed Due to the small observed frequencies, categories 1 and 2 were combined. The resulting chi-square was 9.80 which was significant at the 01 level (df-2). Management of Childbirth (Items 1-9) The Appendix presents percentage frequencies for discrete variables and means and standard deviations for continuous variables. An asterisk marks an item on which the two groups Birth Preparation (BP) and Control (C) differed significantly. 4
Table 1; Distribution of social class for mothers who had attended birth preparation classes (N = 92) and those who had not (N = 21) Group
Social Class
I II IN IV Birth Preparation 8 {8 7%) 44 (47 8%)38 (41 3%) 2 (2 2%) Control 0 9(42 9%) 8 (38 1%) 4 (19%) Note. 3 respondents
did not answer this question
Chi-square tests were performed to detect whether there were any significant relationships between having attended birth preparation classes and variables related to management of childbirth (items 1-4, 7-9). Only one relationship was statistically significant (x2 = 4 42, df- !,/?
