Dissertation: Antenatal Education Systematic Review

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[. . .] However, recently, studies have shown an increase in knowledge as a result of these antenatal education classes. These studies have also highlighted the importance of using a wide range of techniques in the classes to improve the health and well-being of the pregnant mother Su et al., 2007a ()

The impact of antenatal education classes on maternal emotional states as one of the psychological well-being factors is an important consideration in understanding the effect of these classes Schachman et al., 2004.

Maternal emotions can influence the health and social well-being of the mother and the baby thus is important in both the behavioral and psychological well-being of the fetus and the mother as well Malata et al., 2007.

One important question to understand is the effect of antenatal education classes on the psychological well-being of the mother and the baby during fetal development and infancy since it is a psychologically stressful time Dennis, 2005()

It is also important to understand the influence of antenatal education classes on the information and preparation that pregnant mothers make for parenthood Schmied et al., 2002.

Though studies have shown that antenatal education classes are among the main sources of information for parents-to-be, it is important to understand the extent of this effect Ahlden et al., 2012.

Policy makers have often questioned the purpose and justification for antenatal education classes since they require significant infrastructural and other resource investment Jaddoe, 2009.

Therefore, it is important to understand the purpose of these classes with suggestions of how they can positively influence the knowledge that parents-to-be have about parenthood Al-Shammari et al., 1994()

A review conducted by Svensson et al., 2007(Gagnon and Sandall (2007)

identified studies that conducted antenatal education program on individuals and groups. The authors found that structured antenatal educational programs promote positive outcomes for both childbirth and parenthood though majority of the studies reviewed found little no difference in majority of the outcomes. Other literature available bears the same conclusion by showing that many health care professionals and researchers around the world recommend antenatal education for pregnant women )

. Other authors assessed the effect of antenatal educational program in helping to handle labor, pain, and anxiety prior to childbirth Svensson et al., 2008()

Their review search strategy technique was by searching different electronic databases such as the Cochrane database, CINAHL for studies published between 1982 and April 2006, ERIC between 1984 and April 2006, EMBASE between 1980 and April 2006 and PsycINFO between 1988 and April 2006 Gagnon and Sandall, 2007.

The authors also searched the Journal of Psychosomatic Research for studies published between 1956 and April 2006. The review included randomized-controlled trials and found that antenatal education programs for either parenthood or childbirth have effects on:

anxiety;

knowledge acquisition;

general social support;

obstetrical interventions;

infant care abilities;

breastfeeding success;

self-confidence; and maternal sense of control.

The review authors used quantitative techniques for data analysis using the Cochrane statistical package, RevMan The Nordic Cochrane Centre and The Cochrane Collaboration, 2013()

, with 95% confidence intervals. The results reveal that antenatal educational program generally enhance the outcomes of childbirth.

1.3 Antenatal education in developing countries and emerging economies

Unlike the UK where the main providers of antenatal care are the National Health Service (NHS) and the National Childbirth Trust (NCT), developing countries have a long list of antenatal care providers Vieira et al., 2008.

These range from large providers such as private and government hospitals to smaller providers such as clinics Su et al., 2007b ()

. As a result of the fragmentation in provision of antenatal care services, formal deployment of antenatal education classes remains a challenge with most developing countries relying on an inefficient information dissemination channel Renkert and Nutbeam, 2001.

This is where the pregnant mothers rely on their mothers to provide them with information regarding childbirth and parenthood Al-Nasser et al., 1994.

This inefficient channel has several hindrances such as distortion of information and lack of benefits such as increased confidence and self-esteem of the pregnant mothers.

As argued by Nolan, 2012(

Nylander and Adekunle (1990)

, the problem of antenatal education in developing countries is twofold. The first aspect is that there are insufficient or highly fragmented sources of antenatal care for pregnant women and the second is that in areas where antenatal care is provided, these services are often underutilized possibly due to lack of knowledge about existence of these services "Nylander, 1990 #2171"

ADDIN EN.CITE )

. The authors propose solutions to these problems as follows. The first is for adequate facilities to be provided to ensure inclusiveness of antenatal education programs in the overall antenatal care landscape. This is an extremely difficult task especially where antenatal care centers are inadequate or highly fragmented Miquelutti et al., 2013

( ADDIN EN.CITE )

. The second solution proposed is for facilities that provide some form of antenatal care to be included in the list of facilities providing antenatal care Nigenda et al., 2003

( ADDIN EN.CITE )

. The challenge here will thus be to streamline the delivery of antenatal education services to ensure the classes are the same and make sure they are affordable May and Fletcher, 2013()

In Saudi Arabia, "at present, there is no established plan for antenatal education interventions in terms of content and delivery methods in Saudi Arabia," Otaiby and Bawazir, 2013: 14.

This is despite the fact that previous systematic reviews conducted by McMillan et al. (2009)

investigating the effect of antenatal education classes on the health care system show that they have a positive effect on the knowledge of expecting mothers and fathers as well. However, the review also note that the effect of antenatal education classes on other aspects of pregnancy and motherhood particularly in developing countries remains unknown due to the paucity of studies in developing countries.

Gagnon and Sandall (2007)

and Rosenberg, 2002(Habib et al. (2011)

showed that in Saudi Arabia, pregnant women who are not formally educated are three times less likely to receive antenatal care compared to educated women and the result could consequently lead to increase in anxiety during pregnancy, childbirth, and parenthood. Another study also shows that pregnant women who do not receive antenatal care face increased risk of poor outcomes of childbirth Al-Ateeq et al. (2013)

also conducted a study to evaluate the level of knowledge of 300 women in Saudi Arabia and the results reveal that nearly all the subjects had not received important information about pregnancy, childbirth and motherhood pointing at the ineffectiveness of the current antenatal education classes. The authors further point out that there is clear need of antenatal education classes in order to achieve a better outcome of childbirth and motherhood in Saudi Arabia. Another study conducted by )

Despite the importance of antenatal education for pregnant women being demonstrated in these studies and in practices in developed countries such as the UK and the U.S., there is still a scarcity of research focusing on the antenatal education interventions in Saudi Arabia and other developing countries. This study attempts to review the evidence on the effectiveness of antenatal education classes systematically. Lack of comprehensive antenatal education intervention in Saudi Arabia and other developing countries is a challenge due to the paucity of research and the review will focus on studies conducted in both developing and developed countries.

1.4 Research questions

The aim of this systematic review is to assess the effect of antenatal education programs on various outcomes for pregnant women. The specific research questions are:

1. In expectant mothers in Saudi Arabia, what are the effects of antenatal education compared to no antenatal education, or individual antenatal education on psychological and social well-being?

2. In expectant mothers in Saudi Arabia, what is the effect of antenatal education compared to no antenatal education, or individual antenatal education on the knowledge and preparation for childbirth and parenthood?

1.5 Objectives of the review

Objective of this systematic review of secondary research is to evaluate the literature research to assist in answering the following questions:

What is the effectiveness of antenatal education programs in promoting positive labor, childbirth, and parenthood outcomes?

What are the contents of the antenatal education program that should be used to educate the target population?

1.6 Summary of chapter 1

This section was an introduction to antenatal education programs. It highlighted the background of antenatal education programs and why the topic is chosen as the review topic. Antenatal education programs have been implemented in developed countries with scholars positing it has positive effects. This review will help to investigate the effectiveness of group-based antenatal education programs at promoting positive outcomes of labor, childbirth, and parenthood. The review is… [END OF PREVIEW]

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