Birth Preparation Classes Research Articles

Analysis of Mother's Pregnancy Knowledge at Az-Zahra Primary Clinic Tangerang

The prevalence of cesarean sections as much as 80% have exceeded the figure recommended by WHO, about 10-15%, supported by several factors. One of them is self-autonomy which is not owned by the mother causing a lack of knowledge about pregnancy. Knowledge has an effect of 1.8 times on readiness for pregnancy, childbirth, and postpartum. Antenatal education is a service requested by most pregnant women worldwide such as childbirth education programs or birth preparation classes. This research uses a qualitative research design. Data collection was done through in-depth interviews using a sample of 9 main informants (pregnant women). The primary and secondary qualitative data were collected through data processing and analysis techniques, imported into NVivo and classified according to the type of data to facilitate the processing and analysis of data in NVivo 12 Plus. Knowledge of the pregnancy process of pregnant women with low results; Knowledge of pregnancy signs of pregnant women with low results; Knowledge of the benefits of pregnancy examination with high results; Knowledge of the examination schedule of pregnant women is high; Knowledge of physical changes of pregnant women with low results; Knowledge of gestational age with high results; Knowledge of pregnancy danger signs with low results. Knowledge of pregnant women about pregnancy with results is still lacking, namely the knowledge of the pregnancy process, signs of pregnancy, physical changes, and signs of danger of pregna Therefore, it is necessary to provide educational services at Pratama Az-Zahra Tangerang Clinic.
 Keywords: section caesarea, knowledge, pregnant women, pregnancy

The Effect of Birth Preparation Classes on Knowledge, Attitude, and Preference of Delivery Type in Primiparous Mothers in Kaboudar Ahang City 2020

The Effect of Birth Preparation Classes on Knowledge, Attitude, and Preference of Delivery Type in Primiparous Mothers in Kaboudar Ahang City 2020

Manifestation and Associated Factors of Pregnancy-Related Worries in Expectant Fathers.

Background: During the last decades, fathers have increasingly participated in prenatal care, birth preparation classes, and childbirth. However, comparably little is known about the prenatal emotional well-being of fathers, particularly content and extent of broader paternal concerns that may arise during pregnancy beyond those focusing on childbirth. Thus, the aims of this study were to investigate the manifestation of paternal pregnancy-related worries in a population-based sample and to identify relevant associated factors.Materials and Methods: As part of a longitudinal pregnancy cohort at the University Medical Center Hamburg-Eppendorf, Germany, N = 129 expectant fathers were assessed once during pregnancy. Pregnancy-related worries centering around medical procedures, childbirth, health of the baby, as well as socioeconomic aspects were assessed with the Cambridge Worry Scale (CWS). Additionally, paternal socioeconomic background and maternal obstetrical history, symptoms of generalized anxiety and depression, and level of hostility were investigated, as well as perceived social support. The cross-sectional data were analyzed based on multiple regression analyses.Results: The level of reported worries was overall low. Some fathers reported major worries for individual aspects like the health of a significant other (10.9%) and the baby (10.1%), as well as the current financial (6.2%) and employment situation (8.5%). Pregnancy-related worries were negatively associated with household income and positively associated with anxious and depressive symptoms and low perceived social support. Associations varied for specific pregnancy-related worries.Limitations: Due to the cross-sectional data examined in this study, a causal interpretation of the results is not possible. The sample was rather homogeneous regarding its socioeconomic background. More research needs to be done in larger, more heterogeneous samples.Conclusion: Though overall worries were rather low in this sample, specific major worries could be identified. Hence, addressing those fathers reporting major worries regarding specific aspects already in prenatal care might support their psychosocial adjustment. Fathers with little income, those with elevated levels of general anxious and depressive symptoms, and those with less social support reported higher pregnancy-related worries. Our results indicate the relevance of concerns beyond health- and birth-related aspects that could be relevant for fathers. Measurements developed specifically for expectant fathers are needed to properly capture their perspective already during pregnancy.

Stress perceived by pregnant and decision-making factors of maternal caesarean section request

Abstract Background Pregnancy is a time of psychological vulnerability which can generate intense stress. This represents a maternal and child public health problem. Prenatal stress has harmful impacts on the foetus, the newborn and can cause an increased maternal request for caesareans sections, with nonmedical grounds. The perceived level of prenatal stress factors was assessed in women, as well as mothers’ incentives and decision-making factors for a caesarean section on maternal request. Methods A descriptive study on 203 pregnant women, then a comparative study between primiparas (n = 72) and multiparas (n = 131) were carried out with the Antenatal perceived stress inventory. Incentives and decision-making factors for a caesarean on the mother’s demand were studied by in-depth interviews with primiparas mothers (n = 16) who had made this choice. Results The perception of stress level during pregnancy is higher at the first quarter regarding the foetus’ health, medical and obstetric risks and reverses with the perception of projections linked to giving birth at the last quarter. Primiparas are significantly (p < 0.001) more stressed. All the elements of the three assessed factors are very significantly (p < 0.001) correlated for the whole population. Among them, 75% choose a caesarean section on maternal request during the first quarter. This choice is confirmed at the end of the second quarter or during the third one for 50% of them, with a one-month time to think for 58.3% of them. The main incentives are tokophobia (66.7%) and preserving the baby’s health (50%). Conclusions Pregnancy causes important stress, which is pronounced in primiparas. In France, these results speak in favour of screening tokophobia and an earlier start of birth and parenthood preparation classes in order to handle stress from the first quarter of pregnancy, when medical and prenatal exams are initiated. Birth preparation should be taken on at the last quarter. Key messages Investigate stress perceived and identification incentives and decision-making factors of maternal caesarean section request it’s a solution to building bridge for solidarity with tokophobic women. The relation enter stress perceived by pregnant women and decision-making factors of maternal caesarean section request, represents a maternal and child public health problem.

Couples’ prenatal bonding to the fetus and the association with one's own and partner's emotional well-being and adult romantic attachment style

ObjectiveDeveloping an emotional bond to the fetus is a highly relevant task for both parents. However, research on the influence of emotional well-being and relationship dynamics on parental-fetal bonding is limited, especially regarding the paternal experience. Additionally, the roles of prenatal anxiety and hostility in parental bonding need further investigation. The aim of this study was to investigate the importance of one's own anxiety and hostility, adult romantic attachment style and one's partner's anxiety and hostility for parental-fetal bonding quality and intensity. DesignData were assessed cross-sectionally and analyzed using linear regression models. SettingThe study took place at the University Medical Center Hamburg-Eppendorf, Germany. ParticipantsNinety-three pregnant women and their partners (total n = 186). Measurements and findingsParticipants completed questionnaires in mid to late pregnancy. For mothers, higher levels of hostility and attachment-related avoidance were associated with lower bonding quality. Unexpectedly, higher levels of partner hostility were associated with higher bonding quality. Fathers with higher attachment-related avoidance reported lower bonding intensity. Neither maternal bonding intensity nor paternal bonding quality was associated with the predictor variables. Key conclusionPrenatal bonding is individually influenced by emotional well-being and romantic attachment styles, with different effects in mothers and fathers. Implications for practicePotential negative emotional states and couple dynamics in the peripartum period should be addressed in prenatal care. Birth preparation classes might be an ideal context to generally inform parents about these topics. Distressed parents might benefit from interdisciplinary support focusing on perinatal mental health and parental-fetal bonding.

Evaluation of the effect of hypnobirthing education during antenatal period on fear of childbirth

Objectives: The objective of this research was to analyse the effect of hypnobirthing education given to pregnant women during antenatal period on fear of childbirth. Methods: This is an educational interventional case-control study. A total of 51 pregnant women were studied together during the 12th week of pregnancy. Ethical Committee and related consents were taken. Data was evaluated by using descriptive statistics. Results: The age average of the pregnant in the control group was 28.70 ± 5.42 years while it was 25.74 ± 5.16 years for the case group. Women's gestational week averages were 20.87 weeks for study and 24.10 weeks for control group. In the study, the pre-training scale scores of the cases and control groups were compared with the average level of birth fear of the groups (t = 1.848, p = 0.073). There was a significant difference between pre- and post-hypnotic scale scores in the birth preparation class (t = -5.329, p < 0.001). Before the training; 48% of the case group. Fifty-two percent of the control group is adequately informed about the hypnobirthing problem. Conclusions: It was found that among the pregnant women who had attended birth preparation classes, positive labour perception of the intervention group pregnant women was higher than that of the control group pregnant women who hadn’t had hypnobirthing education and there was a significant difference between them.

Effect of Child Birth Preparation Classes on Empowering Iranian Pregnant Women: A Systematic Review

Effect of Child Birth Preparation Classes on Empowering Iranian Pregnant Women: A Systematic Review

Birth experiences in adult women with a history of childhood sexual abuse

ObjectiveAlthough childhood sexual abuse (CSA) may seriously impair childbirth experiences, few systematic evaluations on associations, mediating influences, risk and protective factors are available. As such information is mandatory to improve obstetric care, the present study aimed to provide such data. MethodsThe study compared childbirth experiences from 85 women after CSA and at least one pregnancy resulting in a life birth with those from 170 control women matched for nationality, personal age and children's age. Trained specialists from support centers investigated CSA. Obstetrical data were collected from the official personal clinical record of each pregnancy (Mutterpass) and data on CSA as well as childbirth experiences were examined by questionnaires. ResultsChildbirth was more often highly frightening (24.7 vs. 5.3%; p<0.01) and a negative experience (40.7 vs. 19.6%, p<0.01) in women with a history of CSA than in controls. Multivariate regression models support the hypothesis that at least part of this association was mediated by covariates (specifically, birth preparation classes, presence of a trusted person, participation in medical decision-making, pain relief, emergency during labor and extreme duration of labor), which represent important resources in improving obstetric care. In 41% of women with CSA, memories of traumatic experiences intruded during childbirth, whereas about 58% experienced dissociation. While dissociation may result in loss of contact with obstetric staff, it was also used to reduce labor pain. ConclusionChildbirth following a history of CSA is associated with particular challenges. Creating a trusting environment by evaluating and integrating individual needs could ameliorate birth experiences.

Frequency of tetanus vaccination in pregnant women attending to the child birth preparation classes and influencing factors

Frequency of tetanus vaccination in pregnant women attending to the child birth preparation classes and influencing factors

Factors associated with antenatal depression and obstetric complications in immigrant women in Geneva

Objectiveimmigrant women are at increased risk for health problems during pregnancy, and for antenatal and postnatal depression. This study aimed to identify sociodemographic and specific psychosocial risk factors of antenatal depression and obstetric complications in an economically and culturally heterogeneous sample. Designprospective cross-sectional design. Settingthe study was conducted in a midwifery office. Participantsthe community sample included 228 immigrant pregnant women with low French proficiency referred to birth preparation classes between 2006 and 2014 in Geneva, Switzerland. Measurementdepressive symptoms were measured during the third trimester of pregnancy using the Edinburgh Postnatal Depression Scale. A cut-off score ≥12 was considered to be indicative of antenatal depression. Findingsmore than half of the participants had been living in Switzerland for less than five years and had a short-term residence permit. Thirty-seven per cent of women scored above the clinical cut-off score. Women with several risk factors, such as a precarious legal status, lack of marital support, difficult living conditions and being a newcomer to Switzerland, were at higher risk of depression. Women who encountered difficult living conditions were at higher risk of obstetric complications. Implications for practicethese results confirm the findings of previous research, and highlight the need for early detection. Public health prevention policies should consist of multidimensional programmes to address simultaneously psychosocial, cultural and obstetric issues in pregnant immigrant women.

Predictors of Women's Intentions to Be Screened for HIV During Pregnancy

Detection of HIV during pregnancy and consequent treatment may reduce harm to the fetus. We examine whether the combination of Health Belief Model and Theory of Planned Behavior predicts women's intentions to be screened for HIV during pregnancy. Two hundred Israeli women who participated in birth preparation classes completed e-mailed questionnaires. The results of a multiple linear regression reveal that perceived susceptibility to HIV, perceived benefits of screening, perceived severity of the illness, health motivation, and normative beliefs predicted women's intentions to be screened, while normative beliefs (beliefs about the extent to which significant others think they should be screened for HIV during pregnancy) was the most significant factor. Strategies to increase women's decision to be screened should address "significant others." Additionally, strategies should include promoting women's awareness of the risk of contracting HIV while emphasizing the benefits of the test and promoting a healthy lifestyle.

Prevalência e fatores condicionantes do aleitamento materno - Estudo ALMAT

PREVALENCE OF BREASTFEEDING AND ASSOCIATED FACTORS - ALMAT STUDY Objective: To determine the prevalence of breastfeeding at 6 months of age and to determine if the early cessation of breastfeeding is associated with maternal age, parity, education, employment status, smoking, alcohol consumption and knowledge of the benefits of breastfeeding. Study Type: Cross-sectional study. Location: USF Mais Saude and USF Lethes, Local Health Unit of Alto Minho. Population:Women giving birth in 2009 in these regions. Methods: Between September 1 and October 15, 2010, we conducted telephone interviews with 163 mothers (106 from USF Lethes and 57 from USF Mais Saude) selected from a list of the women giving birth in 2009 identified in the electronic medical record. The information was gathered using a questionnaire developed by the authors. The data collected were analyzed using descriptive and inferential statistics. Results: The prevalence of breastfeeding at 6 months was 36% (29% - 43%, CI 95%). The mean duration of breastfeeding was 5 months. The prevalence of breastfeeding was higher in older women. The prevalence of breastfeeding was high in women in lowest and highest level of education. It was lower in women who attended birth preparation classes. In a multivariate analysis, age was found to be a confounding variable, so these variables (education and pre-natal classes) were found not to be associated with breastfeeding. Conclusions: The prevalence of breastfeeding at 6 months of age in this population was found to be similar to that found in other studies, but lower than the goal by set by the World Health Organization. The association between breastfeeding and age is similar to that found in the literature. We believe that this study contributes to our knowledge of the factors associated with the prevalence of breastfeeding at 6 months of age in Portugal.

Women's experience of giving birth with their husband's support in Nepal

The purpose of this qualitative study was to explore women's experiences of giving birth with their husband's support in urban Nepal. The study was conducted in July 2009 at a midwife-led birthing centre in the capital of Nepal. In-depth, semi-structured interviews were conducted among twelve first-time expectant mothers who gave birth with the support of their husband. Each interview was audio-taped. The recorded data was analysed using thematic analysis. Three themes were identified: (1) feeling in control of the labour process, (2) concern for their husband and (3) emotional discomfort. Most of the time, the women, with support from their husband, felt in control of the childbirth process, but they were also periodically in discomfort. Moreover, they were concerned that their husband had to witness their labour pain. Educational and birth preparation classes for expectant couples would help to reduce women's emotional discomfort and alleviate their concern for their husband.

Non-clinical interventions for reducing unnecessary caesarean section

Caesarean section rates are steadily increasing globally. The factors contributing to these observed increases are complex. Non-clinical interventions, those applied independent of patient care in a clinical encounter, may have a role in reducing unnecessary caesarean sections. To evaluate the effectiveness and safety of non-clinical interventions for reducing unnecessary caesarean sections. We searched the following electronic databases: the Cochrane Effective Practice and Organisation of Care (EPOC) Group Specialised Register (29 March 2010), the Cochrane Pregnancy and Childbirth Group Specialised Register (29 March 2010), the Cochrane Central Register of Controlled Trials (The Cochrane Library 2010, Issue 2); MEDLINE (1950 to March 2010); EMBASE (1947 to March 2010) and CINAHL (1982 to March 2010). We included randomised controlled trials (RCTs), quasi-experimental studies, controlled clinical trials (CCTs), controlled before and after studies (CBAs) with at least two intervention and control sites, and interrupted time series analyses (ITS) where the intervention time was clearly defined and there were at least three data points before and three after the intervention. Studies evaluated non-clinical interventions to reduce unnecessary caesarean section rates. Participants included pregnant women and their families, healthcare providers who work with expectant mothers, communities and advocacy groups. Three review authors independently assessed the quality and abstracted data of all eligible studies using a standardised data extraction form, modified from the Cochrane EPOC checklists. We contacted study authors for additional information. We included 16 studies in this review.Six studies specifically targeted pregnant women. Two RCTs were shown to be effective in reducing caesarean section rates: a nurse-led relaxation training programme for women with a fear or anxiety of childbirth and birth preparation sessions. However, both RCTs were small in size and targeted younger mothers with their first pregnancies. There is insufficient evidence that prenatal education and support programmes, computer patient decision-aids, decision-aid booklets and intensive group therapy are effective.Ten studies targeted health professionals. Three of these studies were effective in reducing caesarean section rates. A cluster-RCT of guideline implementation with mandatory second opinion resulted in a small, statistically significant reduction in total caesarean section rates (adjusted risk difference (RD) -1.9; 95% confidence interval (CI) -3.8 to -0.1); this reduction was predominately in intrapartum sections. An ITS study of mandatory second opinion and peer review feedback at department meetings found statistically significant results at 48 months for reducing repeat caesarean section rates (change in level was -6.4%; 95% CI -9.7% to -3.1% and change in slope -1.14%; 95% CI -1.9% to -0.3%) but not for total caesarean section rates. A cluster-RCT of guideline implementation with support from local opinion leaders increased the proportion of women with a previous caesarean section being offered a trial of labour (absolute difference 16.8%) and the number who had a vaginal birth (VBAC rates) (absolute difference 13.5%). The P values are, however, not reported due to unit of analysis errors. There was insufficient evidence that audit and feedback, training of public health nurses, insurance reform, external peer review and legislative changes are effective. Implementation of guidelines with mandatory second opinion can lead to a small reduction in caesarean section rates, predominately in intrapartum sections. Peer review, including pre-caesarean consultation, mandatory secondary opinion and postcaesarean surveillance can lead to a reduction in repeat caesarean section rates. Guidelines disseminated with endorsement and support from local opinion leaders may increase the proportion of women with previous caesarean sections being offered a trial of labour in certain settings. Nurse-led relaxation classes and birth preparation classes may reduce caesarean section rates in low-risk pregnancies.

Post‐traumatic stress disorder related to birth: a prospective longitudinal study in a French population

The objective of the current study is to determine the prevalence of post‐traumatic stress disorder (PTSD) following birth in a French sample, as well as to examine predictive variables. This study collected data from women at four different times: 48 h, 1 month, 4 months and 9 months post‐partum. PTSD symptoms were measured using the Impact of Events Scale‐Revised (IES‐R). Predictive variables were examined with four questionnaires: the Labor Agentry Scale (LAS), the Multidimensional Scale of Perceived Social Support (MSPSS), the Edinburgh Postnatal Depression Scale (EPDS) and a researcher‐designed personal information form. PTSD rates varied from 5% (1 month post‐partum) to 2.9% (9 months post‐partum). Primiparity, birth preparation classes, transfer to a tertiary care centre, perception of external control, feeling of pain during birth and depressive symptoms were significant predictors of the global IES‐R score. Results provide a basis for considering changes in healthcare delivery and prevention programs within the French perinatal healthcare system.

Breastfeeding duration is determined by only a few factors

According to a representative German study prepared between 1996 and 1998 (SuSe-Study) 90% of the mothers were willing to breastfeed, but only 33% (10%) of the babies were exclusively breastfed up to 4 (6) months of age. Bearing in mind that the period currently recommended for breastfeeding is 6 months, this discrepancy highlights the need for action to identify the causes. The present study investigates the behavioural pattern of mothers 4-5 months after delivery. The investigation was carried out as a cross-sectional study of mothers who intended to breastfeed their babies (n = 52). All mothers delivered in a hospital, with maximum medical care, and were interviewed later by telephone using a semi-standardised questionnaire. The differences between actual breastfeeding mothers (BF, n = 30) and non-breastfeeding mothers (not BF, n = 22) were identified. The factors influencing decision-making were determined. Significant differences between the two groups tested (BF and not BF) were identified as the perception of the simplicity of breastfeeding, planned pregnancy, marital status, as well as participation at birth preparation classes. If only factors known prior to birth are applied, the decision to breastfeed can be correctly forecast as being 81%. In order to allocate consulting resources more effectively, appropriate concepts need to be developed and promoted. If the present results could be verified by a study with a larger sample, the practical use for resource optimisation in breastfeeding consultations would be very beneficial.

Geburtsängste in der Schwangerschaft - Frauenfelder Geburtenstudie

Fragestellung: In der westlichen Industriegesellschaft sind im 20. Jahrhundert die perinatale Morbidität und Mortalität von Mutter und Kind auf sehr tiefe Werte gesunken. Die Geburtsschmerzen können mit moderner Analgesie - vor allem Periduralanästhesie - und Komplementärmedizin bekämpft werden. Die vorliegende Arbeit geht der Frage nach, welche Ängste Schwangere trotz der allseits bekannten medizinischen Fortschritte heute noch begleiten. Die Art der Geburtsängste sowie deren Intensität werden untersucht und Erst-, Zweit- und Mehrgebärende miteinander verglichen. Material und Methodik: In einer prospektiven Beobachtungsstudie konnten an der Frauenklinik Frauenfeld/CH vom 1. November 1991 bis 31. Oktober 2004 bei 13 362 Schwangeren die Art und Intensität der Geburtsängste erfasst und verglichen werden. Die Schwangeren erhielten zwischen der 24. und 28. SSW einen standardisierten Fragenbogen. Ergebnisse: Die nach Parität getrennte Auswertung der Intensität der Geburtsschmerzen ergeben folgendes: Mit steigender Parität verspüren immer mehr Schwangere „keine Angst“, immer weniger haben „etwas Angst“. „Sehr große Angst“ vor der Geburt haben ca. 6 % aller Schwangeren, unabhängig von der Parität. Am häufigsten wurde die Angst, ob das Kind gesund ist (59,7 %), und die Angst vor Schmerzen (50,3 %) genannt. Ängste vor medizinischen Eingriffen, wie Kaiserschnitt oder Narkose, und Angst vor dem Ausgeliefertsein liegen zwischen 17 % und 20 %. Schlussfolgerung: Die heutige Schwangere hat trotz moderner, sicherer und natürlicher Geburtshilfe weiterhin Ängste vor der bevorstehenden Geburt. Der mögliche Nutzen von geburtsvorbereitenden Kursen konnte nicht nachgewiesen werden.

Evaluation of the Impact of Birth Preparation Courses on the Health of the Mother and the Newborn

This study was carried out to evaluate the impact of birth preparation courses on the health of the mother and the newborn. A randomized clinical trial study was carried out on 200 primigravid women younger than age 35 years with gestational age of 20 weeks. Subjects were randomly divided into two groups: control and trial. Birth preparation classes were introduced to the trial group in eight sessions during pregnancy, whereas the control group received only routine care. Measurable clinical, obstetrical, and neonatal advantages were monitored and compared in two groups. Patients in the trial group suffered from back and pelvic pain and headache significantly less often than patients in control group (two-tailed p(2) < 0.05). Preparation is significantly related to reduction in dystocic deliveries and cesarean section ( p(2) = 0.044). Antenatal preparation could play a major role in the health of mother and newborn during labor and postpartum. In addition, antenatal preparation should be introduced to all women during pregnancy as a national health policy in Iran.

Fear of childbirth during pregnancy: A study of more than 8000 pregnant women

In today's modern obstetrics, perinatal morbidity and mortality of mother and neonate have become extremely rare. Despite these advances, are pregnant women still afraid of childbearing and, if so, what - and how intense - are their fears7 Are these fears influenced by previous birthing experiences and by birth preparation classes? Data from more than 8000 expectant mothers (collated via a prenatal questionnaire distributed between Novemeber 1, 1991 and October 31, 1999) are evaluated. This study examines and discusses the answers concerning quantity and quality of childbirth-related fear among women of differing parity and its possible relation to attended birth preparation classes. The women delivered in a hospital setting that practices modern obstetrics combined with alternative delivery methods. The most frequent fears mentioned are fear for the child's health (50%) and fear of pain (40%). Fears dealing with medical intervention, such as operative delivery, anesthesia, nerve blockage and of being at the mercy of obstetrics all lie at around 12%. It is difficult to establish a clear-cut benefit of birth preparation classes in reducing childbirth fears.

Couple relationship, birth preparation and pregnancy outcome: a prospective controlled study

In a prospective, controlled trial we assessed correlations between couple structure, birth preparation and fetal outcome in 158 couples (316 individuals). 88 couples (study group, SG) attended 8 hours of birth preparation classes (BPC). 70 couples served as controls. For couple diagnostic, we used OLSON's two dimensional circumplex model with the FACES III questionnaire, which evaluates the dimensions cohesion and adaptability. In the SG "structured-connected" couples prevailed as compared to the CG, which showed more variability (p less than 0.01). Within the SG, the before-after BPC comparison revealed a tendency toward more functional couple structures. Fetal outcome and complication rate did not differ between groups. In the SG Cesarean section rate correlated positively, premature birth negatively with age and socio-economic status; complication rate in general correlated positively with couple satisfaction. Couple structure should be recognized in routine pregnancy care, BPC ought to be organized in a way that all different types of couples feel invited. Methodologically, the circumplex model proved to be applicable in obstetrics.