Abstract
Effective childbirth preparation has been found to increase confidence and consequently childbirth self-efficacy. A randomised controlled trial examined the effectiveness of a skills-based self-teach childbirth preparation programme to determine its impact on childbirth self-efficacy for mothers and fathers. Secondarily, the trial examined whether the intervention modified pregnancy anxiety, birth satisfaction, parenting self-efficacy, family life satisfaction, and postpartum depression. Qualitative analyses were also planned to examine comments. Lastly, this research project planned to examine whether the midwife, as an independent practitioner, benefited when clients undertook skills-based childbirth preparation.
Method
A sample of 137 first-time mothers and 116 of their partners was recruited from throughout New Zealand from beginning of May 2011 until the beginning of April 2013. Mothers 18 years or over and 42 years or less were eligible. Fathers were aged 18 years or over with no upper age limitation. Couples needed to be living together with both intending to parent a first child. Marriage was not a requirement. Couples required sufficient competency with the English language to be able to complete the questionnaires.
Traditional and online recruitment strategies were used. Eligible participants were randomly assigned to one of three groups – Intervention, Active Control, or Passive Control on completion of questionnaire one at 24 weeks gestation. After randomisation, participants in the Intervention Group were sent a childbirth/childbirth coaching preparation programme and those in the Active Control Group were sent a book of curated birth stories. The Control Group received nothing extra. All groups were asked to continue with their original plans. Participants completed three further questionnaires at 36 weeks gestation, post birth, and at six months postpartum, plus other questions and comments sections developed for the study.
Quantitative data was analysed using one-way ANOVAs, repeated measure ANOVAs, and hierarchical multiple regression. A post hoc analysis was also conducted to test for potential prognostic variables for birth satisfaction, parenting self-efficacy, family life satisfaction, and postpartum depression irrespective of group assignment. Comments were analysed, using thematic methodology informed by Interpretative Phenomenological Analysis (IPA), to give a detailed examination of personal lived experience. Analyses were completed separately for men and women.
One hundred and four midwives acting as Lead Maternity Carers (LMCs) elected to complete a brief three question survey regarding their stress levels when working with the participants in this project.
Results
A 3X2 repeated measures ANOVA revealed that mothers in the Intervention Group changed differently over time, reporting a higher increase in childbirth self-efficacy over time and a lowering in family life satisfaction over time compared to both the Active and Passive Control Groups. One-way ANOVAs revealed that mothers in the Intervention Group reported significantly higher childbirth self-efficacy compared to the other two groups at 36 weeks gestation. However, a one-way ANOVA did not find a significant difference in family life satisfaction between groups at six months postpartum. A one-way ANOVA revealed that mothers and fathers in the Intervention and Active Control Groups reported higher birth satisfaction compared to the Passive Control Group.
For mothers three major themes emerged from the phenomenological thematic analysis of the data. When she felt she owned her process, had good care/carers and support/supporters, and had a safe delivery, the mother reported higher birth satisfaction. For fathers four major themes emerged. When he felt confident of the safety of mother and baby throughout the process, that he had an understanding of his support role, that he saw mother in control and managing the pain of childbirth, and that care and communication during and after birth met his expectations, the father reported higher birth satisfaction.
A post-hoc regression analysis found there were many significant associations with other factors for the outcomes of birth satisfaction, parenting self-efficacy, family life satisfaction and postpartum depression for both mothers and fathers.
An ANCOVA correcting for unexpected complications (these introduce new circumstances and professionals which may increase stress levels for midwives as well as participants) determined that midwives working with the Intervention Group experienced less work-related stress than they generally experienced when working with their clients who delivered without complications compared to the midwives working with the other two groups.
Conclusions
The skills-based childbirth preparation in the intervention was effective in increasing mothers’ childbirth self-efficacy and decreasing work-related stress generally experienced by midwives. Mothers and fathers in both the Intervention and Active Control Groups experienced greater birth satisfaction suggesting that having something that they felt prepared them for childbirth may have had a positive impact. The exploration for themes indicating what impacted on birth satisfaction highlighted the issues which influenced each parent’s perception of his/her experience of the birth of their child. Birth satisfaction, parenting self-efficacy, family life satisfaction and postpartum depression were found to be influenced by a complex array of factors. In its totality, this research project provides evidence for offering women and their partners further ways to prepare for childbirth.