Perinatal Education Research Articles

Effects of a Mindfulness-Based Intervention Delivered by Mobile Phone on Perinatal-Specific Stress and Neonatal Outcomes: A Randomized Controlled Trial

ObjectivesWhereas some women may perceive pregnancy as a welcome challenge and a source of satisfaction, self-development, and maturity, others may experience perinatal-specific stress (PSS). Emerging evidence has demonstrated the efficacy of mindfulness-based interventions (MBIs) for perinatal women. Given the debate about the effects of MBIs on PSS reduction, as well as the limitations of existing studies, such as practical concerns and small sample sizes, the current study aimed to contribute further evidence by utilizing a randomized controlled trial (RCT) to investigate the effects of mobile-delivered MBIs on women’s PSS and neonatal outcomes, compared with outcomes from a mobile-delivered psychoeducation intervention.MethodOne hundred and seventy-eight adult pregnant women were randomized into two groups––one to receive a mobile-delivered eight-session MBI (n = 93) and the other to receive a web-based perinatal education program (n = 85). Outcomes included perinatal distress, mindfulness, and neonatal outcomes.ResultsWomen in the MBI group showed a significantly greater reduction in their PSS levels from baseline to the follow-up-timepoint (T2) compared with the control group. The MBI group had a significant enhancement of mindfulness, and their newborns had higher Apgar scores compared with the control group. Mindfulness improvement levels after the intervention significantly mediated the intervention effect in reducing the participating women’s PSS levels.ConclusionsWith a reasonably high participation rate (approximately 75%), the MBI delivered by mobile phone can be a feasible, desirable, and efficacious intervention for reducing perinatal-specific stress throughout pregnancy and enhancing neonatal outcomes.

Strategies to Integrate Content on Consensual Nonmonogamy and the Transition to Parenthood Into Perinatal Education Practice.

The aim of this clinical article is to provide perinatal educators with strategies on integrating content on consensual nonmonogamy (CNM) and parenthood into their perinatal education practice. The strategies are based on both authors' research programs and clinical practices. The article is divided into six sections: an overview of CNM and parenthood, perinatal education and CNM, perinatal educators' preparation for this integration, the three guiding principles underlying this integration, the nine strategies to adapt perinatal education for CNM and parenthood, and getting support and collaboration from different levels of associations for a successful integration curriculum outcome. Acknowledging and including all partners and family members in CNM-related perinatal education programs are part of providing inclusive and comprehensive education.

Perceptions of game-based education among parents during the perinatal period: A mixed studies review.

Experiential education, particularly through game-based approaches, has gained recognition for effectively addressing the myriad challenges faced by expectant parents. To consolidate and synthesize the available evidence regarding expectant parents' experiences of game-based perinatal education. A mixed studies review. Six electronic databases were searched from their inception until March 2024: PubMed, Embase, CINAHL, Web of Science, Scopus, ProQuest Dissertations and Theses Global. This review observed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines and was guided by Pluye and Hong's (2014) framework for mixed studies review. Quality appraisal of included studies was conducted using the Mixed Methods Appraisal Tool. A convergent qualitative synthesis design for mixed studies review was adopted to analyse all findings and thematic analysis was conducted. Three themes and 10 subthemes were generated from the eight included studies. The main themes were: (1) Exploring novel frontiers to deliver perinatal education, (2) Empowerment through play: Unveiling key insights and (3) Insights and recommendations. The findings suggest that game-based education holds promise as a valuable tool for equipping expectant parents with the necessary knowledge and skills in an engaging and immersive manner to navigate the challenging perinatal period. The findings suggest that game-based education holds promise as a valuable tool for equipping expectant parents with the necessary knowledge and skills to navigate the challenging perinatal period. Nurses should consider incorporating or developing a game-based curriculum to supplement current educational classes to encourage parental participation and enhance learning for perinatal education. This study adhered to the PRISMA reporting guidelines. No Patient or Public Contribution. A protocol was submitted to PROSPERO (CRD42023447527).

Analysis of the current situation and demand for perinatal education in pregnant women in general grade A tertiary hospitals in China: a cross-sectional survey

ObjectivesThis study aimed to assess the factors influencing pregnant women’s participation in perinatal education and their demand for educational courses.DesignA cross-sectional study.SettingTertiary hospital in Suzhou, China, July–September 2022.ParticipantsPregnant women from...

The Impact of Prenatal or Perinatal Education by Primary Healthcare Providers on Traumatic Birth Experiences

The Impact of Prenatal or Perinatal Education by Primary Healthcare Providers on Traumatic Birth Experiences

Description of the culture of childbirth and parenting classes in Cyprus: An ethnographic approach.

Childbirth and parenting classes are very important because they potentially help couples to make the right decisions during pregnancy, childbirth, and the postpartum period, which has a direct effect on the health of the mother and neonate. However, in Cyprus, the culture of childbirth and parenting classes has not been previously explored. An ethnographic study design was adopted, specifically non-participant observation was undertaken of 19 classes. Semi-structured telephone interviews were employed to collect data in addition to field notes and a reflective diary. Inductive content analysis was undertaken to analyze the data. Four main thematic categories emerged from data analysis: 1) Views and opinions about the course, 2) Important perinatal topics, 3) Usefulness and reasons for attending the classes, and 4) The journey of learning. The importance of antenatal classes has not been given sufficient attention in Cyprus. There is a clear need for a standardized curriculum within the current configuration of national maternity healthcare in Cyprus. Policymakers must implement a standardized curriculum, integrating diverse pedagogical methods to provide in-depth information for expectant parents and parents. While emphasizing the crucial role of midwives in perinatal education, this study also advocates for collaboration with other healthcare professionals emphasizing the imperative need for a comprehensive, standardized approach to perinatal education within the national healthcare system of Cyprus.

A Perinatal Education Initiative on Local Anesthetic Systemic Toxicity

A Perinatal Education Initiative on Local Anesthetic Systemic Toxicity

Life Course Epidemiology of Hip Osteoarthritis in Japan: A Multicenter, Cross-Sectional Study.

The incidence of developmental dysplasia of the hip (DDH) in Japanese newborns has reduced drastically following a primary prevention campaign initiated around 1972 to 1973; this perinatal education campaign promoted maintaining the hips of newborns in the naturally flexed-leg position. The purpose of the present study was to describe the life course epidemiology of hip osteoarthritis (OA) in adolescent and adult patients and to assess its association with exposure to the primary prevention campaign for DDH. We included new patients with hip OA diagnosed from January 1, 2022, to December 31, 2022, at 12 core hospitals (8 special-function hospitals and 4 regional medical care support hospitals). The trend in the percentage of hips with a history of DDH treatment in childhood was estimated with use of a centered moving average using the birth year of the patient. We compared the prevalence of severe subluxation (Crowe type II, III, or IV) between patients with secondary hip OA due to hip dysplasia who were born in or before 1972 and those who were born in or after 1973. Overall, 1,095 patients (1,381 hips) were included. The mean age at the time of the survey was 63.5 years (range, 15 to 95 years). A total of 795 patients (1,019 hips; 73.8% of hips) were diagnosed with secondary OA due to hip dysplasia. Approximately 13% to 15% of hips among patients born from 1963 to 1972 had a history of DDH treatment in childhood; however, the percentage decreased among patients born in or after 1973. The prevalence of severe subluxation (Crowe type II, III, or IV) among patients born in or after 1973 was 2.4%, which was significantly less than that among patients born in or before 1972 (11.1%; odds ratio, 0.20; p < 0.001). As of 2022, secondary hip OA due to hip dysplasia is still responsible for most new cases of adolescent and adult hip OA seen in core hospitals in Japan. However, the perinatal education campaign initiated 50 years ago, which utilized a population approach and advocated for maintaining the hips of newborns in the naturally flexed-leg position, may have improved the environmental factors of DDH, as indicated by the apparently reduced need for treatment of DDH in childhood and the associated severe subluxation. This may result in a reduced need for challenging hip surgery later in life. Prognostic Level III . See Instructions for Authors for a complete description of levels of evidence.

Midwives as Adult Educators: An investigation of midwives’ perceptions about the educational dimension of their profession

This article deals with the educational dimension of Midwifery, as manifested in the context of perinatal education programmes in Greece. Despite the internationally recognized value of childbirth education in reducing perinatal mortality and morbidity, and despite the rich activity of midwives in terms of perinatal education, their role as adult educators has received limited scientific attention and support. The purpose of this study is to investigate whether and to what extent midwives teaching in perinatal programmes perceive their role as educators, as well as whether and in what way they are prepared for this role. It also investigates whether and what form of training midwives receive to their role in perinatal education. The study followed the specifications of qualitative design and data was collected through in-depth semi-structured interviews with twelve (12) midwives - trainers in perinatal education, as well as with eight (8) women and men who have participated in childbirth classes in Greece. The findings highlight the need to further support midwives in their educational role and to enhance their educational practice by integrating the principles of Adult Education.

Remembering Judy….

In the last issue of The Journal of Perinatal Education (JPE 32.4), we dedicated a special column "In Memoriam: Judith Lothian, PhD, RN, LCCE, FAAN, FACCE," the associate editor of JPE. In this issue of the journal, our dedication continues with the editor and a number of Judy's close friends and colleagues sharing some special reflection to remember Judy.

General practitioner perceptions and experiences of managing perinatal mental health: a scoping review

BackgroundGeneral Practitioners (GPs) are involved in preconception, pregnancy, and postnatal care. Overall, mental health remains a significant contributor to disease burden affecting 1 in 4 pregnant women. Psychotropic medication prescribing occurs in almost 1 in 12 pregnancies, and appears to be increasing, along with the prevalence of mental health disorders in women of reproductive age. Perinatal mental health management is therefore not an unlikely scenario within their clinical practice. This scoping review aims to map current research related to GPs perceptions and experiences of managing perinatal mental health.MethodA comprehensive search strategy using nine electronic databases, and grey literature was undertaken between December 2021 and February 2023. Relevant studies were sourced from peer review databases using key terms related to perinatal mental health and general practitioners. Search results were screened on title, abstract and full text to assess those meeting inclusion criteria and relevance to the research question.ResultsAfter screening, 16 articles were included in the scoping review. The majority focused on perinatal depression. Findings support that GPs express confidence with diagnosing perinatal depression but report issues of stigma navigating a diagnosis. Over the last two decades, prescribing confidence in perinatal mental health remains variable with concerns for the safety profile of medication, low level of confidence in providing information and a strong reliance on personal experience. Despite the establishment of perinatal guidelines by countries, the utilisation of these and other existing resources by GPs appears from current literature to be infrequent. Many challenges exist for GPs around time pressures, a lack of information and resources, and difficulty accessing referral to services.ConclusionRecommendations following this scoping review include targeted perinatal education programs specific for GPs and embedded within training programs and the development of practice guidelines and resources specific to general practice that recognises time, services, and funding limitations. To achieve this future research is first needed on how guidelines and resources can be developed and best delivered to optimise GP engagement to improve knowledge and enhance patient care.

Revealing the hidden impact: Exploring the influence of paternal perinatal depression on father-infant bonding and strategies for enhanced support

This paper examines the significance of Paternal Perinatal Depression (PPND) during the perinatal period, highlighting its impact on newborn infants. It discusses factors contributing to PPND, including labor and societal expectations, and the interconnectedness of maternal depression. Furthermore, it explores the consequences of paternal stress on infant bonding and long-term child development.Empowering fathers is a central theme, with strategies proposed to raise awareness, screen for PPND, promote communication and provide support. Involving both parents in perinatal education and offering tailored treatment options for fathers are recommended to strengthen family dynamics and mitigate long-term consequences. Recognizing and addressing fathers' mental health needs are crucial for overall family well-being. Further research and evidence-based programs are essential to support this endeavor.

Association between nonbirthing parent's perinatal education and mental health support desires and perinatal anxiety among either parent

Although perinatal anxiety is common in birthing and nonbirthing parents, little is known about the mental health or educational needs of nonbirthing parents during the perinatal period and whether perinatal anxiety in the birthing parent is associated with nonbirthing parent educational preferences. This study aimed to examine the desired digital perinatal educational preferences of nonbirthing parents and whether these preferences differed by (1) endorsement of high parenthood-related anxiety in the nonbirthing partner and (2) mental health of the birthing parent (including both identified mental health conditions and presence of pregnancy-related anxiety). In this cross-sectional study, nonbirthing and birthing parents using Maven, a digital perinatal health platform, selected the areas in which they wanted education or support from a list of options. In addition, the participants reported their experience of parenthood or pregnancy-related anxiety through a 5-item Likert scale in response to the prompt, "On a scale of 1 (not at all) to 5 (extremely), how anxious are you feeling about parenthood or pregnancy?" High parenthood or pregnancy-related anxiety was defined as being very (scale: 4) or extremely (scale: 5) anxious. Furthermore, birthing parents reported whether they had a current or previous mood disorder, but this information was not reported by nonbirthing parents. Survey responses for birthing and nonbirthing parents were linked through the digital platform. Descriptive analyses were used to assess nonbirthing parent demographics and perinatal support interests, stratified by high parenthood-related anxiety, high pregnancy-related anxiety in their partner, and perinatal mood disorders or high pregnancy-related anxiety in their partner. Among 382 nonbirthing parents, most (85.6%) desired to receive digital support during their partner's pregnancy: the most commonly endorsed support interests were infant care (327 [85.6%]) and understanding their partner's emotional (313 [81.9%]) or physical (294 [77.0%]) experience during pregnancy. Overall, 355 nonbirthing parents (93.9%) endorsed any parenthood-related anxiety, and 63 nonbirthing parents (16.5%) were categorized as having high parenthood-related anxiety. Those with high parenthood-related anxiety were more likely to desire digital support for each topic. Among birthing parents, 124 (32.4%) had a mental health condition, and 45 (11.8%) had high pregnancy-related anxiety. When nonbirthing parents were stratified by the presence of their partner having a mental health condition or high pregnancy-related anxiety alone, no difference in desired perinatal education was identified. Although nonbirthing parents had higher rates of high parenthood-related anxiety if the birthing parent reported high pregnancy anxiety (17 [27.0%] vs 28 [8.8%]; P<.001), no difference was found with other conditions within the mental health composite. In this cross-sectional study, many nonbirthing parents who engaged with a perinatal digital platform desired education on their or their partner's emotional health during the perinatal period, and most endorsed parenthood-related anxiety. Our findings suggest that perinatal mental health support is needed for nearly all parents and that nonbirthing parents who use digital health platforms are amenable to receiving comprehensive perinatal education via these platforms.

In This Issue: Perinatal Education in a Post-COVID World

In this column, the editor ofThe Journal of Perinatal Educationdiscusses how the world has changed since the beginning of the COVID-19 pandemic and the lasting impact it has had on how we provide perinatal education. The editor also describes the contents of this issue, which offer a broad range of resources, research, and inspiration for childbirth educators in their efforts to promote, support, and protect natural, safe, and healthy birth and postpartum.

Determinants of stillbirths in sub-Saharan Africa: A systematic review.

Sub-Saharan African (SSA) countries have high stillbirth rates compared with high-income countries, yet research on risk factors for stillbirth in SSA remain scant. To identify the modifiable risk factors of stillbirths in SSA and investigate their strength of association using a systematic review. CINAHL Plus, EMBASE, Global Health and MEDLINE databases were searched for literature. Observational population- and facility-level studies exploring stillbirth risk factors, published in 2013-2019 were included. A narrative synthesis of data was undertaken and the potential risk factors were classified into subgroups. Thirty-seven studies were included, encompassing 20 264 stillbirths. The risk factors were categorised as: maternal antepartum factors (0-4 antenatal care visits, multiple gestations, hypertension, birth interval of >3 years, history of perinatal death); socio-economic factors (maternal lower wealth index and basic education, advanced maternal age, grand multiparity of ≥5); intrapartum factors (direct obstetric complication); fetal factors (low birthweight and gestational age of <37 weeks) and health systems factors (poor quality of antenatal care, emergency referrals, ill-equipped facility). The proportion of unexplained stillbirths remained very high. No association was found between stillbirths and body mass index, diabetes, distance from the facility or HIV. The overall quality of evidence was low, as many studies were facility based and did not adjust for confounding factors. This review identified preventable risk factors for stillbirth. Focused programmatic strategies to improve antenatal care, emergency obstetric care, maternal perinatal education, referral and outreach systems, and birth attendant training should be developed. More population-based, high-quality research is needed.

Antenatal mobile-delivered mindfulness-based intervention to reduce perinatal depression risk and improve obstetric and neonatal outcomes: A randomized controlled trial

ObjectivesOne in five mothers will experience perinatal depression (PND) during pregnancy and within their first year following childbirth. Current evidence suggests the short-term efficacy of Mindfulness-based interventions (MBI) for perinatal women, but the extent to which this positive impact remains the early postpartum period is unclear. This study investigated the short- and maintenance efficacy of a mobile-delivered four-immeasurable MBI on PND, and obstetric and neonatal outcomes. MethodsSeventy-five adult pregnant women suffering from heightened distress were randomized to receive a mobile-delivered four-immeasurable MBI (n = 38) or a web-based perinatal education program (n = 37). PND was measured by Edinburgh Postnatal Depression Scale at baseline, post-intervention, 37th-week gestation, and 4–6 weeks postpartum. Outcomes also included obstetric and neonatal outcomes, trait mindfulness, self-compassion, and positive affect. ResultsParticipants reported an average age of 30.6 (SD = 3.1) years with a mean gestational age of 18.8 (SD = 4.6) weeks. In intention-to-treat analyses, women in the mindfulness group showed a significantly greater reduction in depression from baseline to post-intervention (adjusted mean change difference [β] = −3.9; 95%CI = [−6.05, −1.81]; d = −0.6), and the reduction sustained until 4–6 weeks postpartum (β = −6.3; 95%CI = [−8.43, −4.12]; d = −1.0), compared with control. They had a significantly reduced risk of emergent cesarean section (relative risk = 0.5) and gave birth to infants with higher Apgar scores (β = 0.6;p = .03; d = 0.7). Depression reduction before giving birth significantly mediated the intervention effect on lowering the emergency cesarean risk. ConclusionsWith a reasonably low dropout rate (13.2 %), the mobile-delivered MBI can be an acceptable and effective intervention for reducing depression throughout pregnancy and postpartum. Our study also suggests the potential benefits of early prevention for mitigating emergent cesarean section risk and enhancing neonatal health.

Factors Associated With Stress Urinary Incontinence and Diastasis of Rectus Abdominis in Women at 6-8 Weeks Postpartum.

In recent years, pelvic-abdominal dynamics has become a research topic in the field of pelvic floor dysfunction (PFD), and the relationship between diastasis of the rectus abdominis (DRA) and stress urinary incontinence (SUI) has been controversial. The study is helpful to further strengthen perinatal education, accurately identify the risk factors of SUI and DRA, and improve the quality of life of puerperae. This study aimed to investigate the association of SUI and DRA in women with PFD as measured by vaginal palpation or pelvic floor biofeedback machine testing. A total of 301 patients diagnosed with female PFD who were 6-8 weeks postpartum at The Fifth People's Hospital of Zhuhai between May 2018 and April 2021 were enrolled. The prevalence rates and potential influencing factors of SUI and DRA were analyzed. A total of 29.5% (89 of 301) of the patients were diagnosed with SUI, and 31.9% (96 of 301) were diagnosed with DRA. Binary logistic regression showed that a history of delivery ( P = 0.012; odds ratio [OR], 1.982) and vaginal delivery with perineal lacerations or episiotomy ( P = 0.016; OR, 2.187) were risk factors for SUI. High birth weight (weight>4.0 kg, P < 0.001; OR, 14.507) was a risk factor for DRA. A history of delivery and vaginal delivery with perineal lacerations or episiotomy increased the risk of SUI, and high birth weight was an independent risk factor for DRA. Early intervention, including exercise therapy, manual therapy, and neuromuscular electrical stimulation, may be important for patients with PFD having these risk factors.

Creating an Alianza: Group Perinatal Education for Newly Immigrated Latinx Pregnant People.

Pregnant people who are recent immigrants often face barriers navigating the health care system and establishing a support network to sustain them through pregnancy and new parenthood. The Cultivando una Nueva Alianza (CUNA) program from the Children's Home Society of New Jersey was created to address these obstacles. For over 20 years, CUNA has collaborated with local midwives to develop a program for newly immigrated, Spanish-speaking Latinx pregnant people. The curriculum, facilitated by trained members of the community, provides education around pregnancy, birth, and early parenting and connects participants with prenatal care and community resources while cultivating a social support network. The program's success is seen in improved clinical outcomes, ongoing involvement by graduates, and strong continued support from community stakeholders. The CUNA program has been replicated in nearby communities and offers a blueprint for a low-tech intervention to improve the health and wellness of this population.

Psychosocial interprofessional perinatal education: Design and evaluation of an interprofessional learning experience to improve students’ collaboration skills in perinatal mental health

BackgroundPerinatal mental health disorders are one of the leading causes of maternal illness and suffering and care and services need to be well coordinated by an interprofessional team who are skilled in working collaboratively. AimThe aim of this paper is to describe the design and evaluation of an innovative interprofessional education initiative to increase midwives and other health professional students’ knowledge and skills in caring collaboratively for women with psychosocial issues in the perinatal period, including women experiencing domestic and family violence. MethodsThe Psychosocial Interprofessional Perinatal Education workshop was designed for midwifery, psychology, social work and medical students. It provided a simulated learning experience with case studies based on real life situations. Students undertook pre and post surveys to measure changes in students’ perceptions of interprofessional collaboration and their experiences of participating in the interprofessional simulation-based learning activity. Quantitative survey data were analysed using paired t-tests and a qualitative content analysis was undertaken on the open-ended questions in the survey. FindingsComparison of pre and post surveys found students from all disciplines reported feeling more confident working interprofessionally following the workshop. The following categories were generated from analysis of the open ended survey data: Greater understanding of each others’ roles; Recognising benefits of interprofessional collaboration; Building on sense of professional identity; Respecting each other and creating a level playing field; and Filling a pedagogical gap. ConclusionThrough this innovative, simulated interprofessional education workshop students developed skills essential for future collaborative practice to support women and families experiencing psychosocial distress.

Exploring blog narratives of parental loneliness: A thematic network analysis

UK-based national surveys and international longitudinal studies have shown that around a third of parents experience chronic or persistent loneliness. There is limited research about the experience of loneliness in parenthood, however blogs authored by parents, sharing their personal experiences about loneliness offer a potential rich data source. The purpose of this study was to identify and analyse blog narratives written by parents who had experienced loneliness to increase understanding of their experiences. One hundred and ninety-six relevant blog posts were identified, of which 157 had contact details to request permission to use the blog post in the study. Twenty-two parent bloggers gave their permission. Thematic network analysis was used to open code the blogs and 4 organising themes and subthemes emerged, which centred on a global theme of disconnection. Disconnection underpinned themes relating to a sense that being a parent was overwhelming, changes in identity linked to becoming a parent, difficulties in sharing feelings of loneliness with others, and a need for social connection. Findings point to parents being unprepared for the transition to parenthood, with implications for perinatal education and support, including further opportunities for parents to connect to reduce social isolation.