Women who do not attend parental education classes during pregnancy or after birth

Abstract

This thesis focuses on childbirth and parenthood education during pregnancy and the year after childbirth, and investigates attendance rates and factors associated with non-attendance, and women's experiences and possible effects of antenatal education. Also, women with a non-Swedish speaking background are analysed: their uptake of care at the antenatal and child health centres, and their own and their child s physical and emotional well-being up to five years after birth.

For the purpose of Papers I-IV, data from a prospective cohort study in which about 3,000 women were followed by means of questionnaires in early pregnancy, and 2 months, 1 year, and 5 years after the birth were used (the KUB study: Women s Experiences of Childbirth). Women were recruited at their first scheduled antenatal visit in early pregnancy, during a period of three weeks evenly spread over one year (in May and September 1999, and January 2000). Of all antenatal clinics, 593 (97.5%) participated in the recruitment, and 4,600 women were eligible for the study according to the Medical Birth Register. The number of responders to the first questionnaire was 3,061, to the second 2,762, to the third 2,563 and to the fourth 1,721. The representativeness of the sample was assessed by comparing the background characteristics of the study sample with the total Swedish birth cohort in 1999.

Most primiparous women (93%) attended childbirth and parenthood education classes during pregnancy, and 19 per cent of the multiparas. The attendance rate after childbirth was 78 per cent in first-time mothers and 31 per cent in multiparas. Factors associated with non-attendance at both antenatal and postnatal classes were having a native language other than Swedish and an inconvenient timing of pregnancy. In primiparous women, smoking during pregnancy was also associated with non-attendance in classes both during and after pregnancy. Additional factors related to non-attendance at antenatal classes in primiparas was unemployment; and in multiparas age over 35 years, low education, having had counselling because of fear of childbirth or expressing a need of such counselling. After childbirth, additional factors in primiparas were maternal hospital admission and infant health problems (Papers I, III).

Seventy-four per cent of first-time mothers stated that antenatal education helped prepare them for childbirth, and 40 per cent for early parenthood. One year after childbirth 58 per cent of the mothers still met with other class participants. These outcomes were associated with the number of class sessions. However, antenatal education did not seem to affect memory of labour pain, mode of delivery, overall birth experience, duration of breastfeeding, and assessment of parental skills, but participants had a higher rate of epidural analgesia (Paper II).

Women with a non-Swedish speaking background from a poor country of origin did not differ from a reference group of women with a Swedish speaking background regarding number of antenatal and child health centre visits, but they had a lower attendance rate at antenatal and postnatal education classes. Depressive symptoms, parental stress and poor self-rated health were more common in these women, and they reported more psychological and behavioural problems in their five-year olds. Women with a rich country origin did not differ from the reference group regarding maternal and child health, but they had a lower uptake of all outpatient care, except parental classes after the birth (Paper IV).