Childbirth Classes Research Articles

All on Board? Changing the Culture of Couplet Care

Purpose for the Program For many years traditional couplet care has separated mothers and newborns shortly after birth. Studies have shown the detrimental effects on mothers and newborns when care is given in separate locations. Proposed Change Before the implementation of couplet care, this organization separated mothers from their newborns when providing care during transition and at night in the nursery. Using the Iowa model of evidence‐based practice to improve quality care, we developed evidence‐based practice changes that were guided by nurses that questioned the rational (which was not supported by the literature) for continued separation of mothers and newborns. The planning phase included development of an interdepartmental team, literature review, survey of comparable facilities, and piloting models of couplet care. Implementation, Outcomes, and Evaluation In 2011, the implementation process began with interdepartmental and interdisciplinary meetings lead by the clinical nurse specialist and staff development instructors to identify barriers and assist with the change process. Discussion at unit based committees provided staff input and feedback for the change. Education was provided for registered nurses, ancillary staff, and physicians. Verbal and written information also was provided to patients at childbirth classes and prenatal visits. Skin‐to‐skin contact began in the delivery room for all healthy term and late preterm newborns. After transfer to the maternity unit skin‐to‐skin contact was uninterrupted throughout the transition period. The journey to the standard of couplet and family‐centered care has had many challenges and rewards. Changing the nursing culture to embrace this new practice has been challenging. Some staff nurses are resistant to change their delivery of care. The mother's exhaustion often was sited as the reason for the newborn being returned to the nursery at night. Some staff members use pacifiers to comfort newborns. Difficulty in maintaining sustained practice changes contribute to the challenges. Positive outcomes related to the nonseparation of new mothers and newborns focus on both patients and staff. Increased patient satisfaction scores, decreased neonatal intensive care unit admissions, reduced incidences of hypoglycemia, as well as positive feedback from families about their experience validate the success of our care model. Staff satisfaction and interdepartmental teamwork related to bedside report for new admissions have improved. Though there have been many successes and challenges along the way, our organization is committed to evolve a culture of best practice for couplet care. Implications for Nursing Practice The nursing culture shifted from traditional care to evidence‐based care. For many years traditional couplet care has separated mothers and newborns shortly after birth. Studies have shown the detrimental effects on mothers and newborns when care is given in separate locations. Before the implementation of couplet care, this organization separated mothers from their newborns when providing care during transition and at night in the nursery. Using the Iowa model of evidence‐based practice to improve quality care, we developed evidence‐based practice changes that were guided by nurses that questioned the rational (which was not supported by the literature) for continued separation of mothers and newborns. The planning phase included development of an interdepartmental team, literature review, survey of comparable facilities, and piloting models of couplet care. In 2011, the implementation process began with interdepartmental and interdisciplinary meetings lead by the clinical nurse specialist and staff development instructors to identify barriers and assist with the change process. Discussion at unit based committees provided staff input and feedback for the change. Education was provided for registered nurses, ancillary staff, and physicians. Verbal and written information also was provided to patients at childbirth classes and prenatal visits. Skin‐to‐skin contact began in the delivery room for all healthy term and late preterm newborns. After transfer to the maternity unit skin‐to‐skin contact was uninterrupted throughout the transition period. The journey to the standard of couplet and family‐centered care has had many challenges and rewards. Changing the nursing culture to embrace this new practice has been challenging. Some staff nurses are resistant to change their delivery of care. The mother's exhaustion often was sited as the reason for the newborn being returned to the nursery at night. Some staff members use pacifiers to comfort newborns. Difficulty in maintaining sustained practice changes contribute to the challenges. Positive outcomes related to the nonseparation of new mothers and newborns focus on both patients and staff. Increased patient satisfaction scores, decreased neonatal intensive care unit admissions, reduced incidences of hypoglycemia, as well as positive feedback from families about their experience validate the success of our care model. Staff satisfaction and interdepartmental teamwork related to bedside report for new admissions have improved. Though there have been many successes and challenges along the way, our organization is committed to evolve a culture of best practice for couplet care. The nursing culture shifted from traditional care to evidence‐based care.

Protecting Our Littlest Patients: A Newborn Falls Prevention Strategy

Childbearing Poster Presentation Objective To reduce and prevent newborn falls at Huntsville Hospital for Women and Children. Design Evidence‐based quality improvement project. Sample Mother/baby patients and staff. Methods There were seven newborn falls during a 7‐month time period on the hospital's postpartum unit. After the first falls, the unit formed a committee to create a policy on newborn fall prevention and to develop education and tools for family members and staff to decrease the incidence of infant falls/drops. Committee members used information from review of the seven falls events, from a comprehensive literature review on newborn falls, and from information collected by the unit's Nurse Manager from other hospitals with similar numbers of deliveries. Implementation Strategies As a result of the committee's work, the following interventions targeting family members have currently been implemented: information on newborn falls added to safety instruction sheet read to, given to, and signed by parents at admission: new crib cards with information on falls prevention; room posters and mirror clings with falls information created; and falls information to be added as a crawl on unit's Newborn Channel. Parents are also educated on newborn falls during childbirth classes. Strategies targeting staff members include staff education on falls through a mandatory class, e‐mails, staff meetings, and unit flyers; a new Fall Risk Assessment Tool added to charting system; and a Newborn Post‐Fall Debriefing Form created for use after fall events. The Newborn Falls Policy is now in use and includes protocol for parental education, infant transport, placement of infant for sleeping, review of maternal medications, assessment of environment and mother's level of consciousness, and actions for preventing falls during infant feedings. In addition, Falls Committee staff members are meeting with pediatricians who see patients at Huntsville Hospital to plan a unified protocol for physician response to newborn falls. Results No newborn falls have occurred in the time period since the implementation of this comprehensive falls prevention strategy. Conclusion/Implications for Nursing Practice The issue of newborn falls (drops) in the hospital is one that has only been recognized as a problem in recent years. With little in the literature to provide evidence‐based guidelines for a uniform healthcare policy response, hospitals are developing their own strategies to reduce and prevent newborn falls. Other hospitals seeking to reduce and prevent newborn falls may learn from the experience of Huntsville Hospital in its newborn falls initiative.

Shhh! It's Quiet Time From 2 P.M. to 4 P.M.: Our Family is Bonding Beyond This Door

<h2>Poster Presentation</h2><h3>Purpose for the Program</h3> Creating a quiet environment in the mother–baby unit can be challenging. Literature suggests that implementing quiet time (QT) can increase patient satisfaction and promote healing. <h3>Proposed Change</h3> To initiate a QT program that would provide families and their new infants an uninterrupted period to rest, bond, and breastfeed. The scores related to a quiet environment from the Hospital Consumers Assessment of Health Providers and Systems (HCAHPS) and feedback from mothers who were discharged confirmed the need to reduce interruptions. QT was conceived after the Mother/Baby Shared Decision Making Council reviewed the literature and current practice and identified potential solutions. QT is a daily 2‐hour period in which no one may enter the patient's room unless requested by the patient. <h3>Implementation, Outcomes, and Evaluation</h3> The Iowa Model for evidence‐based practice and Kaizen quality improvement techniques guided the project. The typical number and timing of interruptions per day were observed to determine when the least amount of traffic was entering and leaving patient rooms. It was identified that the best time for QT was between 2 p.m. and 4 p.m. Implementation involved collaboration and coordination with several departments, and education about the benefits of QT and its effect on daily routines. Changes in work routines for several services were required to avoid interrupting patients during QT. Letters were sent to physicians to describe the program and purpose of the change. The maternal–child staff was educated and a date was set for implementation. QT signage was created and displayed. Flyers were given out during maternity tours and childbirth classes, and were also distributed to patients on admission. QT was also advertised on the facility's web site and in monthly publications. During implementation, meetings continued to discuss and resolve issues and promote full adoption. Since starting QT, positive feedback was obtained from follow‐up phone calls with patients who were discharged and no complaints about interruptions have been received. HCAHPS scores for "patients room always kept quiet" increased from 70% in the fourth quarter in 2011 to 78% in the second quarter in 2012. Though it is not possible to conclude that QT increased exclusive breastfeeding, it may contribute to the increase in rates from 33% in January 2012 to 63% in July 2012. <h3>Implications for Nursing Practice</h3> New mothers need time to rest, heal, and bond with their infants. Providing QT each day can contribute to improved patient satisfaction and increased rates of exclusive breastfeeding.

A Hospital‐Based, Healthy Pregnancy Promotion Program to Empower the Socially at Risk: The Healthy Beginnings Program

Paper Presentation Purpose for the Program The Healthy Beginnings Program provides education, support, counseling, and a link to community resources to socially high‐risk pregnant women who will give birth at Saint Joseph Medical Center. The purpose is to encourage a healthy lifestyle for every mother, so she will give birth to a full‐term, healthy newborn. Eligibility includes the following: Medicaid patient; limited finances; uninsured; single or without social support; teen; domestic violence; and drug/alcohol use. Proposed Change A registered nurse meets privately with the patient (four 1‐hour visits) and encourages her to write goals and attend childbirth and breastfeeding classes. Participants also are offered incentives, such as free books, maternity clothes, infant clothes, a breast pump, food vouchers, and a car seat. The following are topics covered in the program: Maternal/fetal growth and development, preterm labor, urinary tract infection prevention, nutrition, benefits of breastfeeding, seat belt use, smoking and secondhand smoke, healthy relationships, sudden infant death prevention, shaken baby syndrome awareness, and infant care and car seat usage. Implementation, Outcomes, and Evaluation The Healthy Beginnings Program was established in 1996 and has enrolled between 100 patients and 172 patients annually. The annual operating budget for the Healthy Beginnings Program is approximately $35,000 per year. The average cost per participant in 2012 was $203. Statistics, such as birth weight, birth length, number of neonatal intensive care days, gestational age, and hospital costs, are compiled and compared with those of infants whose mothers are not in the program, but who are similar demographically. The comparative outcomes show that enrolled women tend to have infants that are slightly larger and slightly longer than nonparticipants who come from a similar client base. The most remarkable facts are the number of days spent in the neonatal intensive care unit and the gestational age. Year after year, program participants have healthier infants that are closer to term than nonparticipants. In 2009, 8.8% of program participants gave birth to infants at 37 weeks of gestation or less. Comparatively, out of the women who qualified for the program but did not partake 15.2% gave birth to infants at 37 weeks of gestation or less. Implications for Nursing Practice Caring for the socially high‐risk pregnant patient and her infant is an ongoing nursing challenge because of the short hospitalization period at delivery. By establishing a rapport with families prenatally, the transition of a healthy mother and newborn from the hospital to the home is much easier and often times seamless, which saves both nursing time and energy.

Effect of educational software on self-efficacy of pregnant women to cope with labor: a randomized controlled trial

The aim of this study was to determine the effect of educational software on self-efficacy of Iranian pregnant women to cope with labor. This study was a randomized controlled trial which was carried out on 150 Iranian nulliparous pregnant women randomly assigned to two groups of 75 women each. The control group routinely did not receive any kind of childbirth education and the intervention group only received the childbirth educational software for 6-8 weeks. In order to determine self-efficacy, the Childbirth Self Efficacy Questionnaire (CBSEI) was used which measures the outcome expectancy and the self-efficacy expectancy of the first and second stages of labor separately. This questionnaire was completed at 28-32-week gestation as a pre-test and at 36-38 weeks as a post-test by the participants. Data were analyzed using Chi-square, Mann-Whitney U and Wilcoxon tests. After the intervention, the median and mean of CBSEI scores for the intervention and the control groups were 607, 604/20 ± 16/630 and 394, 392/51 ± 16/758, respectively. There was a statistical difference between the two groups (p = 0.001). Also, statistically significant differences existed in the median of outcome expectancy and self-efficacy expectancy after intervention in both stages of labor between the two groups (p = 0.001). The educational software program significantly increased self-efficacy of Iranian pregnant women to cope with labor. Despite lack of educational childbirth classes in Iran, the use of this method is recommended. However, to find whether this technique can be substituted for the educational classes, further studies are needed.

The Effectiveness of Childbirth Classes for Increasing Self-Efficacy in Women and Support Persons

PURPOSE: Determine the effectiveness of childbirth classes for increasing self-efficacy on expectant women and support persons.MATERIALS &amp; METHODS: This quasi-experimental study used an 18-question self-efficacy instrument to survey 115 expectant women and 103 support persons prior to and immediately following childbirth classes.RESULTS: Childbirth classes significantly increased self-efficacy scores of both the women (t[82] = 211.059, p &lt; 0.000) and the support person (t[77] = 11.673, p &lt; 0.000). Support persons had significantly higher self-efficacy scores after the childbirth class than the women (t[175] = 22.55, p = 0.012). Type of class attended did not significantly affect self-efficacy. Dealing with labor without pain medication continued to be an area of low self-efficacy for women following childbirth classes. Evaluation of childbirth classes will help educators refine content and methods for delivery of childbirth education. Ultimately, improved patient education will result in greater patient satisfaction and optimal birth outcomes.

Continuing Education Module Top 10: Tips on Teaching Lamaze Classes

Lamaze classes should help women think differently about birth, dispel myths, and ultimately make informed decisions that are right for them. In the current maternity care environment, this is a monumental task. In this column, the authors discuss 10 teaching tips that serve as a guide for teaching childbirth classes and ultimately facilitate learning.

Development and evaluation of ‘disaster preparedness’ educational programme for pregnant women

The objective of this study is the development and evaluation of the usability of an educational programme that teaches disaster preparedness to pregnant women. This intervention study examined an intervention group that attended an educational programme and a control group that did not. The subjects were pregnant women in their second trimester. The programme was developed with prior studies and evaluated by self-administered questionnaires that asked about disaster preparedness. The questionnaire was administered twice to the participants in both groups: to the intervention group just before the childbirth class and 1 month after the class, and to the control group at the time of their maternity examination and 1 month afterwards. Two hundred twenty-six members of the intervention group and 262 members of the control group responded to both questionnaires. Of these, 99 of the intervention group and 104 of the control group were primiparous without disaster experience, and the programme was evaluated by comparing these two groups. Effects due to the disaster experience were also analysed within the intervention group. Among primiparous without disaster experience, an intervention effect was found in items concerning awareness modification (five of six items) and behaviour modification (three of seven items). The intervention effect was particularly pronounced in a comparison of primiparous without disaster experience. An intervention effect was found among the pregnant women who took the programme. In particular, it was statistically significant among primiparous without disaster experience, which suggests that the programme should be shaped to reflect this subject demographic.

African American Women’s Preparation for Childbirth From the Perspective of African American Health-Care Providers

Preparation for birthing has focused primarily on Caucasian women. No studies have explored African American women's birth preparation. From the perceptions of 12 African American maternity health-care providers, this study elicited perceptions of the ways in which pregnant African American women prepare for childbirth. Focus group participants answered seven semistructured questions. Four themes emerged: connecting with nurturers, traversing an unresponsive system, the need to be strong, and childbirth classes not a priority. Recommendations for nurses and childbirth educators include: (a) self-awareness of attitudes toward African Americans, (b) empowering of clients for birthing, (c) recognition of the role that pregnant women's mothers play, (d) tailoring of childbirth classes for African American women, and (e) research on how racism influences pregnant African American women's preparation for birthing.

Patient Education to Reduce Elective Labor Inductions

To reduce elective inductions among nulliparous women in a community hospital by adding standardized education regarding induction risks to prepared childbirth classes. Elective induction rates were compared between class attendees and nonattendees before and after the standardized content was added to prepared childbirth classes. A survey of nulliparous women's decisions regarding elective induction was conducted. Elective induction rates of 3,337 nulliparous women were evaluated over a 14-month period (n = 1,694, 7 months before adding content to classes; n = 1,643, 7 months after). Rates did not differ between class attendees (35.2%, n = 301) and nonattendees (37.2%, n = 312, p = .37) before the content was included. However, after standardized education was added, class attendees were less likely to have elective induction (27.9%, n = 239) than nonattendees (37%, n = 292, p < .00). Sixty-three percent of women who attended the classes and did not have elective induction indicated that the classes were influential in their decision. Physicians offered the option of elective induction to 69.5% (n = 937) of survey participants. This was a factor in women's decisions; 43.2% (n = 404) of those offered the option had elective induction, whereas 90.8% (n = 374) of those not offered the option did not have elective induction. Education regarding elective induction offered during prepared childbirth classes was associated with a decreased rate among nulliparous women who attended classes when compared to those who did not attend. Patient education may be beneficial in reducing elective inductions.

Childbirth Education, the Internet, and Reality Television: Challenges Ahead

Childbirth Education, the Internet, and Reality Television: Challenges Ahead

How Much Does Low Socioeconomic Status Increase the Risk of Prenatal and Postpartum Depressive Symptoms in First-Time Mothers?

To examine socioeconomic status (SES) as a risk factor for depressive symptoms in late pregnancy and the early postpartum period. A secondary objective was to determine whether SES was a specific risk factor for elevated postpartum depressive symptoms beyond its contribution to prenatal depressive symptoms. Quantitative, secondary analysis, repeated measures, descriptive design. Participants were recruited from paid childbirth classes serving upper middle class women and Medicaid-funded hospitals serving low-income clients in Northern California. A sample of 198 first-time mothers was assessed for depressive symptoms in their third trimester of pregnancy and at 1, 2, and 3 months postpartum. Depressive symptoms were measured with the Center for Epidemiological Studies-Depression (CES-D) Scale. Low SES was associated with increased depressive symptoms in late pregnancy and at 2 and 3 months, but not at 1 month postpartum. Women with four SES risk factors (low monthly income, less than a college education, unmarried, unemployed) were 11 times more likely than women with no SES risk factors to have clinically elevated depression scores at 3 months postpartum, even after controlling for the level of prenatal depressive symptoms. Although new mothers from all SES strata are at risk for postpartum depression, SES factors including low education, low income, being unmarried, and being unemployed increased the risk of developing postpartum depressive symptoms in this sample.

Patients' perspectives on the role of prepared childbirth education in decision making regarding elective labor induction.

The purpose of our study was to explore reasons why nulliparous women chose to have an elective labor induction and to identify the influence of prepared childbirth classes on their decision. The study included 1,349 nulliparous women at term who participated in a survey regarding their choices for childbirth, their attendance at prepared childbirth classes, and their experience with labor and birth. Sixty-three percent of women who attended childbirth classes and did not have elective induction reported that classes provided helpful information to assist in their decision-making process. Study results suggest attendance at prepared childbirth classes can be an effective source of information regarding elective labor induction and influential in women's decisions regarding whether or not to have elective labor induction. Women perceive prepared childbirth classes positively and find the information provided valuable.

125: Randomized controlled trial of hypnobirthing versus standard childbirth classes: patient satisfaction and attitudes towards labor

125: Randomized controlled trial of hypnobirthing versus standard childbirth classes: patient satisfaction and attitudes towards labor

A Birth Education Program for Expectant Fathers in Taiwan: Effects on Their Anxiety

A father who does not know how to assist the mother in relieving labor pains may experience a sense of powerlessness and anxiety. The objective of this study was to evaluate how an education program for expectant fathers who attended their partners' labor and birth affected their anxiety. In a randomized controlled trial, 87 expectant fathers who attended their pregnant partners through labor and birth at a hospital in central Taiwan were allocated by block randomization to an experimental (n = 45) and a control (n = 42) group. The men completed their basic personal information, a childbirth expectations questionnaire, and a Trait Anxiety Inventory when they were recruited. Two hours after birth of their child, all the expectant fathers completed a State of Anxiety Inventory. Our results showed no statistically significant differences between the experimental and control groups of fathers in trait anxiety and their prenatal childbirth expectations. After analysis of covariance (ANCOVA) was applied to correct for education level, sources of childbirth information, attendance at Lamaze childbirth classes, and childbirth expectations at baseline, the effect of the childbirth program was significant for the postnatal level of anxiety (F = 3.38, p = 0.001). The study findings justify the clinical implementation of a birth education program based on the self-efficacy theory as an effective means of reducing anxiety among expectant fathers.

A Fine Line: Ethical Issues Facing Childbirth Educators Negotiating Evidence, Beliefs, and Experience

The trend toward evidence-based information in childbirth education has been ongoing for some time. Lamaze educators are encouraged to present evidence for the Six Care Practices That Support Normal Birth to pregnant women in their childbirth classes. In a previous article published in The Journal of Perinatal Education, my colleague and I provided an overview of the dilemmas facing American childbirth educators. Childbirth education is a domain in which many types of authoritative knowledge are used: evidence, beliefs, and experience. In our study, educators told us their goal is to provide class participants with unbiased information that allows women to choose what is best for them. In this article, I further analyze educators' dilemmas and challenges in presenting unbiased information, and I discuss some ethical considerations in educators' practices.

Paternal Fears of Childbirth: A Literature Review

To date, most studies on paternal childbirth fears have been exploratory or descriptive, conducted outside of the United States, and focused mainly on White, first-time fathers. Identified fears include harm to the mother or newborn, partner pain, feelings of helplessness, lack of knowledge, and fear of high-risk intervention. Fathers often report that childbirth classes are not helpful and, in some cases, even increase their fears. Some fathers view birth as traumatic, changing their perception of and relationship with their partner. Fathers also voice the need for more information and for reassurance that they are doing the right things for their partner during childbirth. This article summarizes the research findings on paternal childbirth fears and recommends topics for future study.

Postpartum depression and traditional postpartum care in China: Role of Zuoyuezi

Objective To determine the relationship between the traditional Chinese practice of postpartum care, known as zuoyuezi, and postpartum depression (PPD) in China. Methods A total of 342 Chinese women were surveyed 6- to 8-weeks post partum using the Edinburgh Postnatal Depression Scale (EPDS) and items assessing sociodemographics, health history, peripartum experiences, zuoyuezi, and social support. Results Prevalence of PPD was 15.5% (EPDS cutoff ≥ 13). PPD was associated with lower income, difficult pregnancy experience, poor infant health status, not attending childbirth classes, and low spousal involvement before and after delivery. Among the 96% of women who practiced zuoyuezi, those for whom the caregiver was her mother-in-law or who perceived zuoyuezi as unhelpful had twice the odds of PPD. Conclusion These data highlight the importance of the peripartum experience in assessing PPD risk. Zuoyuezi is still commonly practiced in urban China, and further research is needed to explore its role in the potential prevention of PPD.

Special features of health services and register based trials - experiences from a randomized trial of childbirth classes.

BackgroundEvaluating complex interventions in health services faces various difficulties, such as making practice changes and costs. Ways to increase research capacity and decrease costs include making research an integral part of health services and using routine data to judge outcomes. The purpose of this article is to report the feasibility of a pilot trial relying solely on routinely collected register data and being based on ordinary health services.MethodsThe example intervention was education to public health nurses (PHN) (childbirth classes) to reduce caesarean section rates via pre-delivery considerations of pregnant women. 20 maternity health centers (MHC) were paired and of each 10 pairs, one MHC was randomly allocated to an intervention group and the other to a control; 8 pairs with successful intervention were used in the analyses (1601 mothers). The women visiting to the study maternity centers were identified from the Customer Register of Helsinki City. A list of the study women was made using the mother's personal identification number, visit date, the maternity center code, birth date and gestation length. The mode of delivery and health outcomes were retrieved from the Finnish Medical Birth Register (MBR). Process data of the intervention are based on observations, written feedback and questionnaires from PHNs, and project correspondence.ResultsIt took almost two years to establish how to obtain permissions and to actually obtain it for the trial. Obtaining permissions for the customer and outcome data and register linkages was unproblematic and the cluster randomization provided comparable groups. The intervention did not succeed well. Had the main aim of the trial been to cause a change in PHNs behavior, we would have very likely intensified the intervention during the trial.ConclusionOur experiences encourage the use of trials that obtain their outcomes from registers. Changing the behavior of ordinary health service providers is a challenging intervention.Trial registration numbernot registered (see Results)

Using the Internet to Screen for Postpartum Depression

To examine the feasibility of using the Internet to screen for postpartum depressive symptoms. A total of 142 participants completed the Postpartum Depression Screening Scale (PDSS) and the Edinburgh Postnatal Depression Scale on the Internet, and these findings were compared with those administered in-person by the authors of the PDSS (Beck and Gable) in recruitment sources, demographic characteristics, psychometric properties, and prevalence of significant postpartum depressive symptoms. Participants were more likely to be recruited through Internet websites than mailing sources in the Internet study, and participants in the in-person study were recruited through prenatal childbirth classes. A higher proportion of Hispanic and Asian women participated on the Internet compared to the in-person study. The PDSS had excellent internal consistencies and construct validity across Internet and in-person studies. The Internet sample also reported more risk for major postpartum depression (PPD) compared to the community sample (23% vs. 12%). The Internet is a viable and feasible tool to screen for PPD. Implications for preventing and treating PPD on the Internet are discussed.