Assessment of Childbirth Preparation Classes: A parallel Convergent Mixed Method Study

Abstract

Abstract Introduction: Increasing pregnant women's knowledge through prenatal education can reduce fear and anxiety of mothers and prepare them for childbirth and improve their health, The information received by women and the extent of their involvement in the decision-making process affect their childbirth experience. However, lack of awareness and/or provision of inconsistent or contradictory information in these classes can lead to negative childbirth experiences. Negative childbirth experiences can cause psychological stresses and, in extreme cases, may lead to postpartum depression. Despite holding classes since several years ago in Iran, we have not found a study to evaluate these classes. Therefore this study was conducted with the aim of evaluation of these classes and comparison fear of childbirth, anxiety and depression during pregnancy, postpartum depression, knowledge of pregnancy and childbirth and childbirth experience in three groups of primiparous pregnant women who were either not attending, irregularly attending and regularly attending childbirth preparation classes, and satisfaction with childbirth preparation classes in two groups of women with regular and irregular attending in childbirth preparation classes. also satisfaction with Childbirth Education Class Questionnaire was translated and its psychometric analysis was conducted for Iranian population. Methods: The present study was mixed methods parallel-convergent study, the quantitative phase of this study was a cohort type study, Cluster sampling was performed in this phase and a total of 204 primiparous pregnant women were selected by random sampling in three group: regularly attending, irregularly attending, not attending in classes from 29 health centers of Tabriz. The study groups were compared in terms of fear, anxiety and depression during pregnancy, postpartum depression, knowledge of pregnancy and childbirth and childbirth experience using the one-way ANOVA in the bivariate analysis and the general linear model with the adjustment of certain demographic variables in the multivariate analysis. Independent t-test was used to compare satisfaction with classes among two groups of women with regularly attending and irregularly attending. In psychometric analysis of satisfaction questionnaire, Content validity was assessed through qualitative and quantitative methods (determining CVR, CVI) and face validity (determining Impact Score) was assessed through quantitative method. construct validity were assessed through exploratory and confirmatory factor analyses. In qualitative phase of this study the women’s perceptions of the impact of participation in childbirth preparation classes on their childbirth experience were explored from perspective of 13 primiparous women. The sampling process was purposeful. Data were collected by using individual, in-depth, semi-structured interviews. Content analysis method was used for data analysis. Findings: The Persian version of this questionnaire, entitled SCECQ is a valid and reliable instrument for measuring Iranian women’s satisfaction with childbirth education classes.According to the general linear model, the scores of fear of childbirth (p<0.001), anxiety (p<0.001), depression during pregnancy (p=0.006) and postpartum depression (p<0.001) were significantly lower in the group of pregnant women regularly attending the classes compared to the non-attending group of women. No significant differences were observed between the regularly-attending and irregularly-attending groups in terms of fear of childbirth (p=0.066), anxiety (p=0.078), depression during pregnancy (p=0.128) and postpartum depression (P= 0.257).The mean score of knowledge was significantly higher in the regularly attending group compared to irregularly attending and non-attending group of women (P<0.001),the mean score of childbirth experience in women in the regular participation group was significantly higher than those of women in irregular participation (P= 0.032) and in no participation (P<0.001) groups. No significant differences were observed between the regularly-attending and irregularly-attending groups in terms of total Satisfaction (P=0.342). The Persian version of satisfaction with Childbirth Education Class Questionnaire is a valid and reliable instrument for measuring Iranian women’s satisfaction with childbirth education classes. The analysis of qualitative data resulted in the formation of 12 main categories that included: learning about pregnancy and childbirth, mother's participation to have the right labor, usefulness and validity of training, satisfaction with the class process, feeling of self-control, application of various methods of pain relief, elimination of contradictions in choosing natural childbirth, structural positive points in formation Class. Conclusion: Prenatal training reduce fear, anxiety, depression during pregnancy and postpartum depression and improve childbirth experience in primiparous women. Incorporating such training into prenatal care seem to improve mothers’ health by increasing their knowledge and awareness of their abilities to endure labor pain.