Antenatal Group Research Articles

Holoprosencephaly: antenatal and postnatal diagnosis and outcome.

The objectives of this study are to ascertain the clinical outcome and overall survival of holoprosencephaly (HPE) patients diagnosed antenatally and postnatally, to determine the accuracy of antenatal diagnosis and to determine the role of neurosurgical intervention in HPE. This is a retrospective review over a 10-year period. Sixty-three patients were included in the study, 45 were diagnosed by antenatal radiological imaging and 18 were diagnosed by postnatal radiological imaging. Patient data was drawn from Temple Street Children's University Hospital (the national paediatric neurosurgery centre), the National Maternity Hospital in Holle's Street, Dublin, and Our Lady of Sick Children Hospital, Dublin. The study was carried out through a review of antenatal and postnatal radiological imaging and reports, clinical charts, GP letters from patient follow-up and telephone conversations with parents of HPE patients. Four patients in the antenatal diagnosis group had follow-up foetal MRI confirming HPE. Twelve in this group had radiological follow-up postnatally, and in five of these, HPE was confirmed. The remaining seven were identified as false positive. Alobar HPE constituted 55% (21/38) of patients with 95% mortality. Fifty-one percent had a normal karyotype. The overall survival in the antenatal diagnosis group was 13%. In the postnatal group, 18 patients were identified, 67% (12/18) lobar and 33% (6/18) semilobar. Normal karyotype was found in 72% (13/18), with an overall survival rate of 56% (10/18). Neurosurgical intervention in both groups mainly consisted of CSF diversion in the form of ventriculoperitoneal (VP) or cystoperitoneal shunt (CP) (13/67). Foetal MRI should be routinely performed in suspected cases of HPE, and reliance on ultrasound alone in the antenatal period may not be sufficient. In our study, there is a high early mortality noted in severe cases of HPE, while milder forms of HPE in children tend to survive beyond infancy albeit with associated complications that required neurosurgical intervention and medical management for other associated systemic anomalies.

Reasons for use and non-use of the pertussis vaccine during pregnancy: an interview study.

INTRODUCTION In New Zealand, pertussis vaccination is recommended and government-funded during every pregnancy to protect the infant after birth. However, uptake is low and needs to be increased. AIM To investigate enablers and barriers for uptake of the pertussis vaccination by pregnant women in New Zealand, and explore the acceptability of provision in pharmacies. METHODS Women with infants were recruited in selected pharmacies and interviewed using abrief structured interview. Transcripts were analysed using a framework approach. RESULTS Thirty-seven women aged 18-43 years provided data for analysis. Seventeen women reported receiving a pertussis vaccination during their pregnancy. Information from health professionals appeared important to encourage vaccination, but other sources of information (eg antenatal groups and media) were also cited. Non-vaccination arose from being unaware of the need for pertussis vaccination during pregnancy, concerns about safety, and misinformation. Participants supported pertussis vaccination in pharmacies to help access or increase the opportunity for health professionals to inform women. DISCUSSION The information received by participants affected their uptake of the pertussis vaccine during pregnancy. Education of the public and health professionals about the pertussis vaccine during pregnancy is necessary.

Efficiency of Screening for the Recurrence of Antenatal Group B Streptococcus Colonization in a Subsequent Pregnancy: A Systematic Review and Meta-analysis with Independent Patient Data.

The objective of this study was to evaluate the risk of recurrent group B streptococcus (GBS) colonization in a subsequent pregnancy and to assess clinical characteristics that influence this risk. A systematic review and meta-analysis was performed. Databases were searched from inception through June 2015 using PubMed, Embase, Scopus, Central, and ClinicalTrials.gov. Studies were eligible if they assessed antenatal GBS colonization in two successive pregnancies. The quality of included studies was evaluated. Independent patient data was requested from the authors of the included trials. Unadjusted odds ratios (OR) were pooled using the Mantel-Haenszel fixed effect model. In the five studies identified, two studies lacked a nonexposed cohort. GBS colonization in the index pregnancy was associated with a higher risk of recurrence of GBS colonization in a subsequent pregnancy (three studies: 50.2 compared with 14.1%; pooled fixed effects OR, 6.05; 95% confidence interval [CI], 4.84-7.55). When heavy colonization with GBS was compared with colonization by vaginal culture only, an increased risk of recurrence was shown (four studies: 52.0 compared with 45.1%, pooled fixed effects OR, 1.54; 95% CI, 1.02-2.31). Women colonized with GBS are at significantly higher odds for recurrent colonization in a subsequent pregnancy when compared with women who were not colonized in an index pregnancy. If the individual is considered heavily colonized with GBS, there appears to be an association with an increased risk compared with conventional culture. Subgroup analysis of the variables time interval ≤ 12 months between subsequent pregnancies, body mass index ≥ 30 kg/m(2), race, ethnicity, and primiparous in the subsequent pregnancy showed no effect.

Prenatal interventions for congenital diaphragmatic hernia for improving outcomes.

Prenatal interventions for congenital diaphragmatic hernia for improving outcomes.

Effects of antenatal education on fear of childbirth, maternal self-efficacy and parental attachment

Objectiveto examine the effects of antenatal education on fear of childbirth, maternal self-efficacy, and maternal and paternal attachment. Designquasi-experimental study, comparing an antenatal education group and a control group. Participants63 pregnant women and their husbands. Measurementsdemographic data forms, the Wijma Delivery Expectancy/Experience Questionnaire, the Childbirth Self-Efficacy Inventory, the Maternal Attachment Inventory and the Postnatal Paternal–Infant Attachment Questionnaire were used for data collection. Findingsantenatal education was found to reduce the fear of childbirth and to increase childbirth-related maternal self-efficacy. However, antenatal education was found to have no effect on parental attachment. Key conclusionsit is recommended that widespread antenatal education programmes should be provided in developing countries, and the content of the education programme about parental attachment should be increased. Implications for practicethis study found that antenatal education has no influence on maternal and paternal attachment. As such, there is a need to increase the content of the education programme about parental attachment.

Antenatal Taurine Improves Intrauterine Growth-Restricted Fetal Rat Brain Development Which Is Associated with Increasing the Activity of PKA-CaMKII/c-fos Signal Pathway.

This study aimed to explore whether antenatal supplement of taurine can improve the brain development of fetal rats with intrauterine growth restriction (IUGR) via protein kinase A (PKA)-Ca(2+)/calmodulin-dependent protein kinase II (CaMKII)/c-fos pathway. A total of 30 pregnant rats were randomly divided into the following three groups: control, IUGR, and IUGR with antenatal taurine supplementation groups. The expression of PKA, CaMKII, and c-fos mRNA and proteins in fetal rat brain tissues were detected by quantitative real time (qRT)-polymerase chain reaction (PCR) and Western blot, respectively; and the number of PKA-, CaMKII- and c-fos-positive cells was measured by immunohistochemistry. Western blot and qRT-PCR revealed that antenatal taurine supplementation significantly increased PKA, CaMKII, and c-fos protein and mRNA levels in fetal rats brain with IUGR (p < 0.05). Immunohistochemistry results showed that the numbers of PKA-, CaMKII-, and c-fos-positive cells were significantly decreased in the IUGR groups compared with the controls; while antenatal taurine could significantly increase the positive cell numbers (p < 0.05). So, we conclude that antenatal taurine improves IUGR fetal brain development which is associated with increasing the activity of PKA-CaMKII/c-fos signal pathway.

Self-hypnosis for intrapartum pain management in pregnant nulliparous women: a randomised controlled trial of clinical effectiveness.

Objective(Primary) To establish the effect of antenatal group self-hypnosis for nulliparous women on intra-partum epidural use.DesignMulti-method randomised control trial (RCT).SettingThree NHS Trusts.PopulationNulliparous women not planning elective caesarean, without medication for hypertension and without psychological illness.MethodsRandomisation at 28–32 weeks’ gestation to usual care, or to usual care plus brief self-hypnosis training (two × 90-minute groups at around 32 and 35 weeks’ gestation; daily audio self-hypnosis CD). Follow up at 2 and 6 weeks postnatal.Main outcome measuresPrimary: epidural analgesia. Secondary: associated clinical and psychological outcomes; cost analysis.ResultsSix hundred and eighty women were randomised. There was no statistically significant difference in epidural use: 27.9% (intervention), 30.3% (control), odds ratio (OR) 0.89 [95% confidence interval (CI): 0.64–1.24], or in 27 of 29 pre-specified secondary clinical and psychological outcomes. Women in the intervention group had lower actual than anticipated levels of fear and anxiety between baseline and 2 weeks post natal (anxiety: mean difference −0.72, 95% CI −1.16 to −0.28, P = 0.001); fear (mean difference −0.62, 95% CI −1.08 to −0.16, P = 0.009) [Correction added on 7 July 2015, after first online publication: ‘Mean difference’ replaced ‘Odds ratio (OR)’ in the preceding sentence.]. Postnatal response rates were 67% overall at 2 weeks. The additional cost in the intervention arm per woman was £4.83 (CI −£257.93 to £267.59).ConclusionsAllocation to two-third-trimester group self-hypnosis training sessions did not significantly reduce intra-partum epidural analgesia use or a range of other clinical and psychological variables. The impact of women's anxiety and fear about childbirth needs further investigation.Tweetable abstractGoing to 2 prenatal self-hypnosis groups didn't reduce labour epidural use but did reduce birth fear & anxiety postnatally at < £5 per woman.

Hepatitis C seroprevalence and HIV co-infection in sub-Saharan Africa: a systematic review and meta-analysis

An estimated 150 million people worldwide are infected with hepatitis C virus (HCV). HIV co-infection accelerates the progression of HCV and represents a major public health challenge. We aimed to determine the epidemiology of HCV and the prevalence of HIV co-infection in sub-Saharan Africa. We searched Medline and Embase (Ovid) from Jan 1, 2002, to Dec 31, 2014, for studies containing data for HCV seroprevalence in different population groups in WHO-defined regions of sub-Saharan Africa. We estimated pooled regional prevalence estimates with a DerSimonian-Laird random-effects model. Data were further stratified by risk factor and HIV status. We included 213 studies from 33 countries in sub-Saharan Africa, comprising 287 separate cohorts with 1 198 167 individuals. The pooled HCV seroprevalence from all cohorts was 2·98% (95% CI 2·86-3·10). The pooled HCV seroprevalence was 2·65% (95% CI 2·53-2·78) across all 185 low-risk cohorts, 3·04% (2·23-3·84) in antenatal clinic groups, 1·99% (1·86-2·12) in blood donors, but 6·9% (6·1-7·5) in other general population cohorts. The pooled seroprevalence of HCV was 11·87% (95% CI 7·05-16·70) across all high-risk groups and 9·95% (6·79-13·11) in patients with liver disease. 101 cohorts included HIV-positive samples tested for HCV (42 648 individuals), with a pooled seroprevalence of 5·73% (95% CI 4·90-6·56). We recorded a high seroprevalence of HCV across populations of sub-Saharan Africa, including in HIV-positive adults, with evidence of regional variation in the general population. Monitoring of antenatal HCV prevalence might be a helpful indicator of population trends in HCV infection; however, larger population surveys are needed to monitor these trends. Access to prevention and treatment needs to be improved for both monoinfected and co-infected individuals. None.

Evaluation of antenatal group b streptococcal screening

Evaluation of antenatal group b streptococcal screening

Cystic Enteric Duplication: Prenatally and Postnatally Diagnostic Group

Purpose: The duplication of gastrointestinal tract has been known to be a rare condition and two different forms, cystic and tubular type. This study was conducted to examine its clinical characteristics, especially cystic enteric duplication which was detected antenatally or postnatally. Methods: There were 13 patients, who confirmed as cystic enteric duplication after operation between July 1996 and June 2015. Clinical data, including a gender, age at operation, presenting symptoms, diagnostic modalities, locations of lesion, and results of surgical treatment, were reviewed retrospectively according to cases detected antenatally and postnatally. Results: Five cases were included in antenatal diagnosis group and 8 cases in postnatal diagnosis group. Both groups show slightly common in female and the lesion most common in ileum. Antenatal diagnosis group shows 2 males and 3 females and the mean age at operation was 12±52 days (range, 5 to 90 days). They received operation regardless of symptom. Postnatal group shows 3 males and 5 females and the mean age at operation was 462.5±777.0 days (range, 4 days to 6 years). Moreover, 6 patients (75.0%) were age before 2 years. They usually presented abdominal pain with vomiting. Conclusion: Cystic enteric duplication could present symptoms at any time during childhood, mainly before 2 years old, and so a proper management should be considered when suspect it. Although it is uncommon, surgical management including a minimal invasive procedure could be attempted despite the neonatal period.

Erratum to: Pilot early intervention antenatal group program for pregnant women with anxiety and depression

Erratum to: Pilot early intervention antenatal group program for pregnant women with anxiety and depression

Pilot early intervention antenatal group program for pregnant women with anxiety and depression.

This study aims to examine the acceptability and effectiveness of an antenatal group intervention designed to reduce the severity of depression and anxiety symptoms and improve maternal attachment in pregnant women with current or emerging depression and anxiety. Women who participated in the program completed pre- and posttreatment measures of depression (Centre of Epidemiological Studies Depression Scale) and Edinburgh Postnatal Depression Scale), anxiety (State-Trait Anxiety Inventory) and maternal attachment (Condon Maternal Antenatal Attachment Scale). Participants also completed a satisfaction questionnaire and provided general feedback about the group intervention and experience. A total of 48 women (M = 26weeks of gestation) commenced and 37 (77%) completed at least 80% of the six session group intervention. Significant improvements with moderate to large effect sizes were observed for depression as measured on the Centre of Epidemiological Studies Depression Scale (CES-D) (p < 0.001), Edinburgh Postnatal Depression Scale (EPDS) (p < 0.001), state anxiety (p < 0.001) and maternal attachment (p = 0.006). Improvements in posttreatment depression scores on the EPDS were maintained at 2months postpartum. Participants reported that the program had met their expectations. Partners (n = 21) who completed evaluation forms indicated that their attendance had improved their awareness of their partner's mental health issues and resources available to their family and would recommend the program to other fathers. These preliminary findings suggest that our antenatal group program is an effective and acceptable intervention for a clinical sample of women and partners. It is a feasible addition or alternative treatment option to perinatal mental health care. Future directions could involve more comprehensive randomised controlled trials (RCT) to examine the effectiveness of the group intervention.

Antenatal taurine supplementation increases taurine content in intrauterine growth restricted fetal rat brain tissue

This study aimed to determine the influence of antenatal taurine supplementation on taurine content in the brains of fetal rats with intrauterine growth restriction (IUGR). Experiments were performed at the Central Laboratory of Bayi Children's Hospital Affiliated to Beijing Military General Hospital in China from January to June 2013. Fifteen pregnant rats were randomly divided into three groups: normal controls, an IUGR group and an IUGR + antenatal taurine supplement group (Taurine group) (n = 5). The IUGR model was induced using a low-protein diet throughout gestation. Rats in the taurine group were fed a diet supplemented with 300 mg/kg/day taurine for 12 days after conception until natural delivery. Two fetal rats were randomly selected in every litter, and taurine levels in the brains of rats were detected using high-performance liquid chromatography-mass spectrometry. Results showed that (1) the mean body weight of the fetal rats in the normal control, IUGR and IUGR + antenatal taurine supplement groups was 6.619 ± 0.4132, 4.509 ± 0.454, and 5.176 ± 0.436 g (F = 429.818, P < 0.01), respectively, and (2) that taurine levels in the brains of the fetal rats in the normal control, IUGR and taurine groups were (2.399 ± 0.134) × 10(5), (1.881 ± 0.166) × 10(5) and (2.170 ± 0.191) × 10(5) μg/g (F = 24.828, P < 0.01), respectively. Overall, our results indicated that taurine levels in IUGR fetal rat brains were lower than in the control animals, and that antenatal taurine supplementation could significantly increase taurine levels in the brains of fetal rats with IUGR.

Postpartum change of blood pressure and its risk factors in patients with hypertensive disorders in pregnancy

To investigate the change of blood pressure in patients with hypertensive disorders in pregnancy after delivery and the risk factors. In a retrospective cohort study, we collected subjects from villages and towns in Liuyang by cluster sampling method. Before enrolling in this cohort, all had established health records from January 2010 to December 2011. We collected the medical records and maternal health care manuals of this cohort as our data materials, focusing on the blood pressure records as well as related features. We compared the differences of recovery rate of postpartum blood pressure in different kinds of antenatal blood pressure groups with χ2 test. In order to explore the main factors influencing the recovery rate of blood pressure of patients with hypertensive disorders in pregnancy, we conducted univariate and multivariate analysis by χ2 test and unconditional logistic regression analysis. Among the 460 women with hypertensive disorders in pregnancy in our analysis, the recovery rate of postpartum blood pressure reached 88.7%. Multivariate analysis showed that the risk factors influencing the recovery rate of postpartum blood pressure included advanced age (OR=0.436), higher degree of hypertensive disorders in pregnancy (OR=0.436), and hypertension with simultaneously high systolic and diastolic blood pressures (OR=0.192). For most patients with hypertensive disorders in pregnancy, the blood pressure may decrease to normal level 42 days after delivery. Women with advanced age, higher degree of hypertensive disorders in pregnancy and hypertension with simultaneously high systolic and diastolic blood pressures should be given more attention.

BCSH guideline for the use of anti-D immunoglobulin for the prevention of haemolytic disease of the fetus and newborn.

BCSH guideline for the use of anti-D immunoglobulin for the prevention of haemolytic disease of the fetus and newborn.

An exploration of pregnant teenagers' views of the future and their decisions to continue or terminate their pregnancy: implications for nursing care

To explore teenagers' views of the future in relation to their choices to continue or terminate pregnancy. Despite recent decreases in the numbers of teenage pregnancies, across the world, the teenage pregnancy rate remains high. Consideration of views of the future (future orientation) appears to play an important part in teenage girls' decisions to continue with pregnancy. To date, no study has explored this in teenage pregnant girls at the time they make their decision to continue with or terminate their pregnancy. Cross-sectional mixed methods design. Three groups were included: termination of pregnancy (n=19), antenatal (n=9) and never pregnant (n=23). Participants were 13-18years old. The termination of pregnancy and antenatal groups were interviewed, and the never pregnant group completed postal questionnaires. Groups differed in individual aspects of future orientation, that is, education, career and family, and reasons for pregnancy resolution choice. The termination group had more clearly developed and longer-term plans for the future with a focus on career. The never pregnant group shared aspects of their future orientation with both the antenatal and termination of pregnancy groups. The impact of negative discourses about teenage pregnancy from others was identified as a significant issue. How pregnant teenage girls view the future has a relationship with their decision to terminate or continue with their pregnancy. The findings suggest that working with teenage girls to clarify their views of the future may be useful both in preventing future unwanted pregnancy and in supporting teenagers in making pregnancy decisions. Supporting pregnant teenagers in distancing themselves from negative stereotypes of teenage mothers may also be beneficial.

Venous Thromboembolism (VTE) Risk Assessment & Prophylaxis In Irish Hospitalized Obstetric Patients: A Nationwide Cross-Sectional Study

BackgroundPulmonary embolism continues to be the second leading cause of mortality in pregnancy and the puerperium. VTE complicates 1 - 2/1000 pregnancies, and the risk increases with age, mode of delivery, and presence of co-morbidities. Literature has shown that the use of low molecular weight heparin (LMWH) is safe in this patient cohort. AimsAssessment of the prevalence of VTE risk in hospitalised women in both the antenatal and postnatal groups to determine the proportion of at-risk patients who receive LMWH prophylaxis appropriately. MethodsThe study period was September 2011 to November 2012. All inpatients in the participating hospitals on the day of investigation were assessed for risk of VTE on the basis of hospital chart review. Risk profile was assessed in accordance with the 2009 Royal College of Obstetricians and Gynaecologist Guidelines. Patients undergoing procedures or on the labour ward at the time of review were excluded. Ethical approval was obtained from the ethics committees governing all centres. Results610 pregnancies were reviewed across 19 centres. The average age of was 31+/- 5.65yrs (Range 16-47), with 21.87% aged over 35. 22% had a parity of 3 or more. The average weight was 71.51kg (Range 42-134kg, SD 14.482kg). Data on BMI was available for 77% - 34% were overweight and 21% were obese. 1% had a BMI>40. 31% were antenatal and 69% were postnatal.63% of antenatal patients were low risk (<2 risk factors), 35% were intermediate risk (2 or more risk factors, prophylaxis should be considered) and 2% were high risk. All the high risk patients were on prophylaxis at an appropriate dose. 4% of the low risk patients were on prophylaxis unnecessarily. Only 7% of the intermediate risk patients were on correctly dosed prophylaxis.Among postnatal patients, 41% were low risk (<2 risk factors), 58% were intermediate risk (2 or more risk factors, require prophylaxis) and <1% were high risk. 80% were appropriately risk stratified and put on LMWH if necessary. 59% of patients should have been on LMWH but only 42% were (92% Tinzaparin and 8% Enoxoparin). This included 8 patients who were on LMWH unnecessarily. 38% were on too low a dose. ConclusionVTE prophylaxis remains a central issue in obstetric care given its prominent role in maternal morbidity and mortality and the increasing prevalence of risk factors such as obesity and increasing maternal age. It is clear that while there is good awareness of the risk in the postnatal period, there is less emphasis on risk assessment in antenatal patients where prophylaxis is rarely used. Those on prophylaxis are also likely to be on an incorrect dose. There is a clear role for a national guideline to standardize care for all pregnant women. On the basis of these findings, we have authored a guideline and this is now in use as a reference in all Irish maternity units. Disclosures:No relevant conflicts of interest to declare.

Antenatal taurine supplementation improves cerebral neurogenesis in fetal rats with intrauterine growth restriction through the PKA-CREB signal pathway

ObjectiveThis study seeks to explore whether antenatal supplement of taurine may improve the brain development of fetal rats with intrauterine growth restriction (IUGR) via the protein kinase A-cyclic adenosine monophosphate (cAMP) response element protein (PKA-CREB) pathway.MethodsFifteen pregnant rats were randomly divided into control group, IUGR model, and IUGR with antenatal taurine supplement group. Brain tissues were obtained immediately after rats were born. PKA-CREB signal pathway activity and glial cell line-derived neurotrophic factor (GDNF) mRNA and protein levels were measured by reverse transcription polymerase chain reaction and immunohistochemistry stains, whereas immunoreactive cells of neuron-specific enolase (NSE) and proliferating cell nuclear antigen (PCNA) were detected by immunohistochemistry stains.ResultsThe results showed that: (1) In the IUGR group, a greater number of PCNA and NSE immunoreactive cells were found in brain tissues compared with controls, and prenatal taurine supplementation led to a further increase. (2) Expression of PKA, CREB, and GDNF were increased in mRNA and protein levels due to taurine supplementation.DiscussionAntenatal taurine supplementation shows effects of promotion of cell proliferation and activation of neurotrophic factors on fetal rat brain in a model of IUGR by activating the PKA-CREB signal pathway, increasing expression of neurotrophic factors, and promoting cell proliferation to counteract neuron loss caused by IUGR.

Effect of antenatal taurine supplementation on the taurine levels in brain of fetal rat with intrauterine growth restriction

Objective To examine the taurine levels and determine the influence of antenatal taurine on the taurine content in the brains of fetal rats with intrauterine growth restriction(IUGR). Methods Fifteen pregnant rats were randomly divided into 3 groups: normal control group, IUGR group and the IUGR+antenatal taurine supplement group(taurine group)(n=5). IUGR models were induced by low protein diet throughout gestation period. Taurine was added to the diet of the taurine group with a dose of 300 mg/(kg·d) from 12 days after conception until natural delivery. Two fetal rats were randomly selected from each nest and were sacrificed to obtain the brains, and the taurine levels in fetal rat brains were detected by high performance liquid chromatography-mass spectrometry. Results The average weight of fetal rats in the normal control group, the IUGR group and the taurine group were (6.619±0.413) g, (4.509±0.454) g, (5.176±0.436) g, there was a significant difference among the 3 groups(F=429.818, P<0.01). The taurine levels in fetal rat brain in the normal control group, the IUGR group, and the taurine group were(2.399±0.134)×103 μg/g, (1.881±0.166)×103 μg/g and(2.170±0.191)×103 μg/g, there was a significant difference among the 3 groups(F=24.828, P<0.01). Conclusion Antenatal taurine supplementation can significantly increase the taurine level in fetal rat brain with IUGR. Key words: Intrauterine growth restriction; Taurine; Brain; High performance liquid chromatography-mass spectrometry; Fetal rat

Antenatal education and the birthing experience of Brazilian women: a qualitative study

BackgroundInformation is still scarce on the birthing experience of women who participate in antenatal systematic education programs. The objective of the study was to report the experience of labor as described by nulliparous women who participated and who did not in a systematic Birth Preparation Program (BPP).MethodA qualitative study was conducted with eleven women who participated in a BPP and ten women attending routine prenatal care selected through purposeful sampling. The BPP consisted of systematized antenatal group meetings structured to provide physical exercise and information on pain prevention during pregnancy, the role of the pelvic floor muscles, the physiology of labor, and pain relief techniques. A single, semi-structured interview was conducted with each participant. All interviews were recorded, transcribed verbatim and thematic analyses performed. The relevant themes were organized in the following categories of analysis: control of labor, positions adopted during labor, and satisfaction with labor.ResultsWomen who participated in the systematic educational activities of the BPP reported they maintained self-control during labor and used breathing exercises, exercises on the ball, massage, baths and vertical positions to control pain. Also they reported satisfaction with their birthing experience. Women who did not participate in systematic educational activities referred to difficulties in maintaining control during labor and almost half of them reported lack of control. Also they were more likely to report dissatisfaction with labor.ConclusionsWomen who participated in the BPP reported self-control during labor and used non-pharmacological techniques to control pain and facilitate labor and expressed satisfaction with the birthing experience.