Implementation of a childbirth preparation program in the maternal and child health centres in Jordan

Abstract

ObjectiveTo investigate the feasibility and outcomes of introducing childbirth preparation programs in a sample of Maternal and Child Health centres in Jordan. DesignAn exploratory, descriptive design, and practice- research engagement was used to implement and evaluate the proposed childbirth preparation program. Face to face interviews and field notes were used to collect data. Outcomes of pregnancy and birth were collected from interviews with women using a structured format. Setting and participantsThree Maternal and Child Health centres were randomly selected from the three main regions of Jordan. A convenience sample of 107 primigravid women was recruited for the implementation process. Six health staff (3 doctors and 3 midwives) also participated. FindingsThe practice- research engagement approach assisted the researchers and care providers in dealing with problems that arose during the implementation of the program. Out of the 107 women initially recruited, only 36 women completed the implementation program, with attrition rate of 65%. The main reasons for poor attendance included: difficulty in keeping contact with participants, transportation difficulties, duration of the program, health problems, antenatal follow up at a private clinic, and not having permission from husbands to attend. The effectiveness of the program was noticed through some improved pregnancy outcomes for the participants and the high satisfaction of the health professionals and women who participated.The program was effective in increasing knowledge and understanding of women regarding the different aspects of pregnancy, birth, and postnatal periods. It helped promote a trusting relationship between health professionals and women; and increased staff self confidence in providing specific and essential information to women. Women seemed to have an increased sense of control over the childbirth process, and it reinforced benefits and duration of breastfeeding and knowledge of family planning. Challenges identified by health professionals and women included: women's commitment and capacity to attend the scheduled sessions and shortage of qualified staff. Key conclusionsImplementing a childbirth preparation program in a developing country appears possible, successful, and effective if logistical and cultural requirements can be better addressed. This was evidenced with a high rate of participants’ satisfaction (women and health care providers), and suggestions of improved pregnancy outcomes. Implications for practiceIt is necessary to address some logistical issues of delivery and recognise the importance and limitations of current human resources. Policy makers in the Ministry of Health should consider implementation of a childbirth preparation program, as there are no existing programs. Clinical leaders, supported by researchers, should jointly consider reframing the program into a shorter more logistically acceptable delivery mode. This could be tested and evaluated.