Codesign and refinement of an optimised antenatal education session to better inform women and prepare them for labour and birth.

OBJECTIVE: Our objective was to codesign, implement, evaluate acceptability and refine an optimised antenatal education session to improve birth preparedness. DESIGN: There were four distinct phases: codesign (focus groups and codesign workshops with parents and staff); implementation of intervention; evaluation (interviews, questionnaires, structured feedback forms) and systematic refinement. SETTING: The study was set in a single maternity unit with approximately 5500 births annually. PARTICIPANTS: Postnatal and antenatal women/birthing people and birth partners were invited to participate in the intervention, and midwives were invited to deliver it. Both groups participated in feedback. OUTCOME MEASURES: We report on whether the optimised session is deliverable, acceptable, meets the needs of women/birthing people and partners, and explain how the intervention was refined with input from parents, clinicians and researchers. RESULTS: The codesign was undertaken by 35 women, partners and clinicians. Five midwives were trained and delivered 19 antenatal education (ACE) sessions to 142 women and 94 partners. 121 women and 33 birth partners completed the feedback questionnaire. Women/birthing people (79%) and birth partners (82%) felt more prepared after the class with most participants finding the content very helpful or helpful. Women/birthing people perceived classes were more useful and engaging than their partners. Interviews with 21 parents, a midwife focus group and a structured feedback form resulted in 38 recommended changes: 22 by parents, 5 by midwives and 11 by both. Suggested changes have been incorporated in the training resources to achieve an optimised intervention. CONCLUSIONS: Engaging stakeholders (women and staff) in codesigning an evidence-informed curriculum resulted in an antenatal class designed to improve preparedness for birth, including assisted birth, that is acceptable to women and their birthing partners, and has been refined to address feedback and is deliverable within National Health Service resource constraints. A nationally mandated antenatal education curriculum is needed to ensure parents receive high-quality antenatal education that targets birth preparedness.

Conhecimento de gestantes e puérperas sobre o atendimento na atenção primária do município de Ananindeua, estado do Pará / Knowledge of pregnant and postpartum women about care in primary care in the city of Ananindeua, state of Pará

Objetivo: Analisar o impacto das orientações médicas recebidas durante o pré-natal sobre o conhecimento adquirido de puérperas e gestantes, a respeito da importância dos principais exames solicitados para a assistência do pré-natal em uma Unidade Básica de Saúde (UBS). Métodos: Trata-se de um estudo observacional, descritivo, com grupo de comparação. A pesquisa foi realizada na UBS Júlia Seffer, localizada no município de Ananindeua, Pará, Brasil. A coleta de dados foi realizada mediante a aplicação de questionário a 50 mulheres, 25 gestantes e 25 mulheres pós-parto, que tinham entre 18 e 49 anos e fizeram o pré-natal de agosto de 2019 a agosto de 2020. Resultados: Entre os dados analisados, apenas 52% das gestantes e 44% das puérperas conseguiram descrever a medição da altura uterina. Em relação ao processo educativo durante o pré-natal, pode-se evidenciar que 88% das gestantes e 72% das puérperas não estavam envolvidas em nenhuma atividade educativa. Em relação à avaliação pré-natal, apenas 32% das gestantes e 44% das mulheres pós-parto avaliaram como excelente o atendimento realizado na UBS. Conclusão: Observou-se a presença de falhas no processo educativo, que indica a necessidade de maior cuidado e investimentos na atenção primária direcionada ao cuidado e orientação das mulheres no ciclo gravídico-puerperal.(AU)

Objective: To analyze the impact of medical guidance received during prenatal care on the knowledge acquired by postpartum and pregnant women regarding the importance of the main tests requested for prenatal care in a Basic Health Unit (BHU). Methods: This is an observational, descriptive study, with comparison group. The research was conducted at UBS Júlia Seffer, located in the municipality of Ananindeua, Pará, Brazil. Data collection was performed by applying a questionnaire to 50 women, 25 pregnant and 25 postpartum women, who were between 18 and 49 years old and had prenatal care from August 2019 to August 2020. Results: Among the data analyzed, only 52% of pregnant women and 44% of puerperal women were able to describe the measurement of uterine height. Regarding the educational process during prenatal care, it can be evidenced that 88% of pregnant women and 72% of puerperal women were not involved in any educational activity. Regarding prenatal evaluation, only 32% of pregnant women and 44% of postpartum women evaluated as excellent the care provided in the BHU. Conclusion: It was observed the presence of flaws in the educational process that indicate the need for greater care and investment in primary care directed to the care and guidance of women in the gravidic-puerperal cycle.(AU)

Birth preparedness and complication readiness practice and associated factors among pregnant women in Northwest Ethiopia: 2018.

BACKGROUND: Birth-preparedness and complication readiness is a comprehensive strategy aimed at promoting the timely utilization of skilled maternal and neonatal health care. Pregnancy-related complications both on the mother and the newborn could be largely alleviated if there is a well-consolidated birth preparedness and complication readiness plan developed during pregnancy and implemented at the time of delivery. OBJECTIVE: To determine the prevalence of birth preparedness and complication readiness practice (BPCR) and associated factors among pregnant women in North Gondar Zone, Northwest Ethiopia, 2018. METHODS: A community based cross-sectional study was conducted among pregnant women in North Gondar Zone from March 2017 to February 2018. A multistage clustered sampling technique was used to enroll a total of 1620 participants. The data were collected by face to face interviews using pretested and semi-structured questionnaires at baseline and following delivery. The data were entered using EPI-data version 3.1 and analyzed using STATA version 14 software. Bivariate and multivariable logistic regression model was fitted to assess factors with BPCR practice. Adjusted odds ratio (AOR) with 95% confidence interval was used to determine the association between covariates and the outcome variable. RESULTS: From a total of 1620 pregnant women only 1523 (94.0%) mothers were followed at the end line. The prevalence of BPCR plan during pregnancy was 66.1% [95% CI: 63.8, 68.5] and the practice at the time of delivery was 73.5% [95% CI 71.3, 75.7]. Of the total respondents who mentioned having a BPCR plan, 76.4% practiced at the time of delivery. Frequency of ANC visits [AOR = 1.97; 95% CI: 1.67, 2.32], larger number of family in the household [AOR = 1.14; 95%CI: 1.00, 1.30], highest wealth asset [AOR = 1.87; 95%CI: 1.16, 3.01], Multigravidity [AOR = 0.30; 95% CI: 0.15, 0.62], husband involvement in decision making [AOR = 2.2; 95% CI: 1.25, 3.82], counseled on BPCR [AOR = 2.35; 95% CI: 1.51, 3.68], were found to be significantly associated with BPCR practice. CONCLUSION: BPCR practice at the time of delivery was higher than previous studies conducted in the country. However, BPCR practice was found to be lower than the standard that every woman should practice the plan at the time of delivery. Intersectoral collaborative interventions required to improve the economic status and living standard of families in the community as well as various awareness creation strategies should be implemented to support women to attend ANC follow-up visits.

Psychometric properties of satisfaction with the childbirth education class questionnaire for Iranian population.

BACKGROUND: Childbirth preparation classes can reduce pregnant women's anxiety and fear for their childbirth. However, to evaluate women's feedback and their satisfaction with these classes, there is a need for a standard instrument that is suitable for Iranian context. This study is aimed to translate and conduct a psychometric analysis of the Satisfaction with the Childbirth Education Class Questionnaire (SCECQ) for Iranian population. METHODS: The questionnaire was translated from English into Persian through the forward-backward translation method. The cluster sampling method was employed to select 205 pregnant women with gestational age of 35-37 weeks from all health complexes of Tabriz, Iran. The face, content, and construct validity of the research instrument were assessed through exploratory and confirmatory factor analyses. Internal consistency and test-retest reliability were measured to evaluate the overall reliability of the questionnaire. RESULTS: The impact scores of all items were above 1.5. The content validity index (CVI) and content validity ratio (CVR) of the questionnaire were 0.88 and 0.94, respectively. The convergent construct validity of the whole questionnaire and those of its three subscales were confirmed through the exploratory factor analysis (EFA). The factor loadings of no items were below 0.3, and the X2/df ratio was smaller than 5. The overall model validity was confirmed by having the Root Mean Square Error of Approximation (RMSEA) smaller than 0.08. Cronbach's alpha and intraclass correlation coefficient (ICC) were 0.93 and 0.96, respectively, indicating the acceptable reliability of the questionnaire. CONCLUSION: The Persian version of this questionnaire, entitled SCECQ is a valid and reliable instrument for measuring Iranian women's satisfaction with childbirth education classes.

Birth preparedness complication readiness and determinants among pregnant women: a community-based survey from Ethiopia.

BACKGROUND: Maternal death related to obstetric complications remains a great challenge in developing countries. Since these complications are not consistently predictable, it is important to plan different preventive approaches to overcome them when. As the information on birth preparedness, complication readiness, and predictors were limited in the study area, we conducted this study. METHODS: A Cross-sectional study involving 396 pregnant women was conducted from 1st April to 1st May 2018. Data were collected using a pre-tested structured questionnaire. Descriptive, binary and multiple logistic regression analyses were conducted in SPSS for windows version 20. P values < 0.05 were considered significant. RESULTS: Of 361 women interviewed (91% response rate), birth preparedness and complication readiness were present in 24.10% (87/361) of women. Maternal factors, age 18-19 (AOR = 0.18; 95% CI (0.04,0.94)), 20-34 (AOR = 0.40; 95% CI (0.20,0.78)), education, not able to read/write (AOR = 0.36;95% CI (0.15,0.85),read/write (AOR = 0.41;95% CI (0.19,0.89)), Muslim religion (AOR = 0.40; 95% CI (0.18,0.85)) income ETB, < 1000 (AOR = 0.21; 95% CI (0.07,0.67)),1000-2000, (AOR = 0.38; 95% CI (0.19,0.76)), and the mothers' knowledge on key danger signs of postpartum (AOR = 0.48; 95% CI (0.26,0.90)) were independent predictors of birth preparedness and complication readiness. CONCLUSIONS: Educational status, age, religion, family income, and knowledge of obstetric danger signs were significantly associated with birth preparedness and complication readiness. The Government and other health sector partners should work to improve women's education, income, and focus on young age groups on pregnancy danger signs.

Predictors of optimal breastfeeding practices in Worabe town, Silte zone, South Ethiopia.

BACKGROUND: Studies in sub-Saharan Africa indicated the overall prevalence of optimal breast feeding ranged between a lowest of 17.63% in East Africa and a highest of 46.37% in West Africa. It's estimated that 823,000 deaths of children could be prevented every year through optimal breastfeeding practices. However optimal breastfeeding practices is low in most setting of Ethiopia. Therefore, this study aimed to assess optimal breastfeeding practices and associated factors in Worabe town. METHOD: A community-based analytical cross-sectional study was conducted from April 15th-25th, 2018. A systematic sampling technique was applied on 347 sampled mothers who had children greater than or equal to 2 years old. The data was entered into EpiData (version 3.1) and subsequently exported to SPSS Statistics (version 22) for analysis. Descriptive statistics were used for presenting summary data using tables and graph. Bivariate and multi variable logistic regression analysis to identify were used to identify associated factors. The statistical significance was declared at P<0.05. RESULT: Optimal breastfeeding was exhibited by 42.1% of mothers. Government employees (AOR = 8.0; 95% CI: 1.7, 36.4), families with a household income of 1,500-3,000 Ethiopian birr (AOR = 4.6; 95% CI: 1.0, 20.1), individuals knowledgeable about optimal breastfeeding practices (AOR: 5.5 95% CI: 1.6, 18.1), individuals counselled about breastfeeding practices during postnatal follow-ups (AOR = 4.940, 95% CI: 1.313, 10.195), and individuals that had a caesarean section delivery (AOR = 4.2, 95% CI: 1.2, 14.1) had a higher chance of practicing optimal breastfeeding. However, mothers who did not attend or have access to antenatal care follow-ups (AOR = 0.1, 95% CI: 0.04, 0.5) were less likely to practice optimal breastfeeding. CONCLUSIONS: Less than half of mothers breastfed their children optimally. Factors that influenced this included knowledge of optimal breastfeeding practices, total household income, the woman's occupation, access to breastfeeding counselling during postnatal care follow-ups, access to antenatal care follow-ups, and mode of delivery. It is strongly recommended that optimal breastfeeding awareness programs through health education be done in collaboration with health extension workers, and zonal health offices.

A mixed-methods assessment of disclosure of HIV status among expert mothers living with HIV in rural Nigeria.

BACKGROUND: Peer support provided by experienced and/or trained "expert" women living with HIV has been adopted by prevention of mother-to-child transmission of HIV (PMTCT) programs across sub-Saharan Africa. While there is ample data on HIV status disclosure among non-expert women, there is little data on disclosure among such expert women, who support other women living with HIV. OBJECTIVE: This study compared HIV disclosure rates between expert and non-expert mothers living with HIV, and contextualized quantitative findings with qualitative data from expert women. METHODS: We compared survey data on HIV disclosure to male partners and family/friends from 37 expert and 100 non-expert mothers living with HIV in rural North-Central Nigeria. Four focus group discussions with expert mothers provided further context on disclosure to male partners, extended family and peers. Chi square and Fisher's exact tests were applied to quantitative data. Qualitative data were manually analyzed using a Grounded Theory approach. RESULTS: Two-thirds of the 137 participants were 21-30 years old; 89.8% were married, and 52.3% had secondary-level education. Disclosure to male partners was higher among expert (100.0%) versus non-expert mothers (85.0%), p = 0.035. Disclosure to anyone (93.1% vs 80.8%, p = 0.156), and knowledge of male partners' HIV status were similar (75.7% versus 66.7%, p = 0.324) between expert and non-expert mothers, respectively. With respect to male partners, HIV serodiscordance rates were also similar (46.4% vs 55.6%, p = 0.433). Group discussions indicated that expert mothers did not consistently disclose to their mentored clients, with community-level stigma and discrimination stated as major reasons for this non-disclosure. CONCLUSIONS: Expert mothers experience similar disclosure barriers as their non-expert peers, especially regarding disclosure outside of intimate relationships. Thus, attention to expert mothers' coping skills and disclosure status, particularly to mentored clients is important to maximize the impact of peer support in PMTCT. CLINICAL TRIALS REGISTRATION: Clinicaltrials.gov registration number NCT01936753 (retrospective), September 3, 2013.

Assessment of childbirth preparation classes: a parallel convergent mixed study.

BACKGROUND: Women's fear from childbirth has been associated with increased medical interventions and traumatized birth experience. Although antenatal education is a crucial factor to empower and prepare women for their birth journey, it is not clear how Iranian childbirth classes can influence women's fear and prepare them positively towards childbirth. This research is designed to evaluate childbirth preparation classes and their impact on women's perception on their childbirth experiences. METHODS/DESIGN: This mixed method study with the parallel convergent design has two phases. The first phase will be a quantitative cohort study with 204 primiparous pregnant women at the gestational age of 35-37 weeks. The participants will be divided into three groups based on the number of their attendance into the childbirth preparation classes: a) regular participation (4 to 8 sessions), b) irregular participation (1 to 3 sessions), and c) no-participation. Participant will be followed-up to 1 month after birth. Antenatal data will be collected by using a demographic survey questionnaire, the Wijma Delivery Expectancy/Experience Questionnaire (W-DEQ, version A), the Van den Bergh Pregnancy-Related Anxiety Questionnaire, the Satisfaction with Childbirth Preparation Classes Questionnaire, the Edinburgh Postpartum Depression Scale (EPDS) and Knowledge regarding pregnancy and childbirth Questionnaire. Postnatal data will be collected by using an Obstetric and Labor Characteristics Questionnaire, EPDS, and Childbirth experience questionnaire (CEQ). The quantitative data will be analyzed using one-way ANOVA and the multivariate linear regression. The second phase of the study will be a qualitative study that will explore the women's perceptions on the impact of participation in childbirth preparation classes on their childbirth experience. The sampling in this phase will be purposeful and the participants will be studied individually by using in-depth, semi-structured interviews. The qualitative data will be analyzed through content analysis with conventional approach. DISCUSSION: Assessing the impact of childbirth preparation classes on women's childbirth experience in Iran will lead to developing recommendations about the content and quality of the childbirth classes that can improve women's' preparation towards positive childbirth.

Examining the effects of prenatal education

Prenatal education has expanded significantly over the past two decades, from its initial conception as an opportunity to teach pain management in labour and preparation for birth in the hospital environment to including broader public-health principles of preparing women and their families for pregnancy, labour and birth, care of the newborn and the adjustments to life as a family.(1) It also provides an opportunity to assist women in detecting warning signs in pregnancy, build confidence in self-care, and can act as an opportunity for early intervention in high-risk pregnancies.

Recommendations of physical activity and rest in a Colombian prenatal control program.

OBJECTIVE: To determine the frequency of the registry of physical activity and rest recommendations made to pregnant women and to explore their associated factors in a prenatal care program of primary care public institutions in Bucaramanga, Colombia. METHODS: An observational study was conducted. The sampling frame consisted of the medical records of the pregnant women who attended at least one prenatal care program between January 1 and December 31, 2012 (n = 2.932), in 21 primary care health centers. We analyzed sociodemographic variables, prenatal and clinical antecedents, and information related to health personnel and the organization of health centers as possible factors associated with the recommendations of physical activity and rest recorded in the clinical history. Logistic regression models were applied to explore associations with α = 0.10. RESULTS: There was a frequency of 26.1% of PA recommendations and 3.6% of rest recommendation on record, issued by nutrition (97.3%) and medical (86.7%) professionals, respectively. The factors associated with the registration of physical activity recommendations were: being nulliparous pregnant (OR = 1.7), attending more than four Prenatal Care Attention Programs (OR = 2.2), having high or medium obstetric risk in the first prenatal care program (OR = 0.6), and being attended in the western (OR = 0.5) and eastern (OR = 0.2) administrative areas health centers. CONCLUSIONS: The low frequency of physical activity recommendations found in the records makes it necessary to reinforce the management strategies of health centers and strengthen the monitoring and accompaniment to comply with the care protocols. In addition, it is necessary to train health teams on the benefits of physical activity and their proper prescription, considering the multiple benefits derived from their practice on the maternal-fetal health.

A survey of contemporary antenatal parental education in Sweden: What is offered to expectant parents and midwives' experiences.

OBJECTIVE: To explore how antenatal parental education is provided in southern Sweden and midwives' experiences of it. METHODS: A cross-sectional survey with data collection from 66 antenatal clinics and 189 midwives during 2016. Descriptive and comparative statistics, chi-square and t-tests, were used to present the findings. RESULTS: Antenatal parental education was most commonly offered in small parental groups and the number of hours provided varied between two and ten (mean 5.8) hours. A common and structured program for the sessions was used at 37.3% of the clinics. Normal birth, pain relief, partner role during birth, breastfeeding advantages and breastfeeding initiation were the topics most extensively covered. Topic coverage was in 12 topics, mostly related to the time after birth, lower than midwives' rated importance of the topic: p-values between 0.05 and <0.01. Only 14.2% of the midwives often provided guidance to websites. Although midwives enjoyed working with antenatal parental education, they expressed lack of organizational support and lack of personal skills in group leadership and teaching. Years of experience did not significantly affect their self-rated skills in group leadership or teaching. CONCLUSION: These results contribute to knowledge about contemporary antenatal parental education in Sweden. Our results showed that antenatal parental education is not always in accordance with parents' expectations, especially concerning early parenthood and guidance on the internet. To provide antenatal parental education tailored to the needs of expectant parents it is vital to develop evidence-based guidelines and to address midwives' needs for improved skills in group leadership and teaching.

Recommendations of physical activity and rest in a Colombian prenatal control program / Recomendaciones de actividad física y reposo en un programa de control prenatal colombiano

ABSTRACT OBJECTIVE To determine the frequency of the registry of physical activity and rest recommendations made to pregnant women and to explore their associated factors in a prenatal care program of primary care public institutions in Bucaramanga, Colombia. METHODS An observational study was conducted. The sampling frame consisted of the medical records of the pregnant women who attended at least one prenatal care program between January 1 and December 31, 2012 (n = 2.932), in 21 primary care health centers. We analyzed sociodemographic variables, prenatal and clinical antecedents, and information related to health personnel and the organization of health centers as possible factors associated with the recommendations of physical activity and rest recorded in the clinical history. Logistic regression models were applied to explore associations with α = 0.10. RESULTS There was a frequency of 26.1% of PA recommendations and 3.6% of rest recommendation on record, issued by nutrition (97.3%) and medical (86.7%) professionals, respectively. The factors associated with the registration of physical activity recommendations were: being nulliparous pregnant (OR = 1.7), attending more than four Prenatal Care Attention Programs (OR = 2.2), having high or medium obstetric risk in the first prenatal care program (OR = 0.6), and being attended in the western (OR = 0.5) and eastern (OR = 0.2) administrative areas health centers. CONCLUSIONS The low frequency of physical activity recommendations found in the records makes it necessary to reinforce the management strategies of health centers and strengthen the monitoring and accompaniment to comply with the care protocols. In addition, it is necessary to train health teams on the benefits of physical activity and their proper prescription, considering the multiple benefits derived from their practice on the maternal-fetal health.

RESUMEN OBJETIVO Determinar la frecuencia del registro de recomendaciones de actividad física y reposo realizadas a las gestantes y explorar sus factores asociados, en un programa de atención de control prenatal de instituciones públicas de primer nivel de atención en Bucaramanga, Colombia. MÉTODOS Se realizó un estudio observacional. El marco muestral estuvo conformado por los registros médicos de las gestantes que asistieron al menos a un programa de atención de control prenatal entre el 1º de enero y 31 de diciembre de 2012 (n = 2,932), en 21 centros de salud de primer nivel de atención. Se analizaron variables sociodemográficas, antecedentes prenatales, antecedentes clínicos, e información relacionada con el personal de salud y la organización de los centros de salud como posibles factores asociados con las recomendaciones de actividad física y reposo registrados en la historia clínica. Se aplicaron modelos de regresión logística para explorar las asociaciones con un α = 0.10. RESULTADOS Se observó una frecuencia de 26.1% de registro de recomendaciones de AF y 3.6% de reposo, emitidas por parte de profesionales de nutrición (97.3%) y medicina (86.7%), respectivamente. Los factores asociados al registro de las recomendaciones de actividad física fueron: ser gestante nulípara (OR = 1.7), asistir a más de cuatro Programas de Atención de Control Prenatal (OR = 2.2), tener riesgo obstétrico alto o medio en el primer programa de atención de control prenatal (OR = 0.6) y ser atendidas en los centros de salud de las zonas administrativas de occidente (OR = 0.5) y oriente (OR = 0.2). CONCLUSIONES La baja frecuencia del registro de recomendaciones de actividad física encontrada, genera la necesidad de reforzar las estrategias de gestión de los centros de salud y fortalecer el monitoreo y acompañamiento en el cumplimiento de los protocolos de atención. Adicionalmente, es necesario capacitar a los equipos de salud sobre los beneficios de la actividad física y su prescripción adecuada, atendiendo a los múltiples beneficios derivados de su práctica sobre la salud materno-fetal.

Women from racial or ethnic minority and low socioeconomic backgrounds receive more prenatal education: Results from the 2012 to 2014 Pregnancy Risk Assessment Monitoring System.

BACKGROUND: Racial or ethnic and socioeconomic disparities in adverse birth outcomes are well known, but few studies have examined disparities in the receipt of prenatal health education. The objectives of this study were to examine racial or ethnic and socioeconomic variations in receiving (1) comprehensive prenatal health education and (2) education about human immunodeficiency virus (HIV) testing, breastfeeding, alcohol, and smoking cessation from health care practitioners. METHODS: Data were drawn from the 2012 to 2014 Pregnancy Risk Assessment Monitoring System (PRAMS). Twenty-seven states were included with an analysis sample size of 68 025 participants. Receiving counseling on all listed health topics during prenatal care visits was denoted as comprehensive prenatal health education. Logistic regression was used to examine the association of racial or ethnic and socioeconomic variables with receiving comprehensive prenatal health education, and HIV testing, breastfeeding, alcohol, and smoking cessation advice separately. RESULTS: Multivariable results showed that racial or ethnic minorities and women with a high school degree or less; receiving Women, Infant, and Children (WIC) assistance; and on Medicaid during pregnancy have higher odds of receiving comprehensive prenatal health education (all P  ≤0 .001). Results were similar for receiving HIV testing, breastfeeding, alcohol, and smoking counseling. Low household income was associated with receiving counseling on HIV testing, alcohol, and smoking (all P ≤ 0.001). CONCLUSION: Despite reporting higher levels of prenatal health education on a variety of health-related topics, disadvantaged women continue to experience disparities in adverse birth outcomes suggesting that education is insufficient in promoting positive behaviors and birth outcomes.

Exploring antenatal education content for couples in Blantyre, Malawi.

BACKGROUND: Despite advocating for male involvement in antenatal education, there is unmet need for antenatal education information for expectant couples. The objective of this study was to gain a deeper understanding of the education content for couples during antenatal education sessions in Malawi. This is needed for the development of a tailor-made curriculum for couple antenatal education in the country, later to be tested for acceptability, feasibility and effectiveness. METHODS: An exploratory cross sectional descriptive study using a qualitative approach was conducted in semi-urban areas of Blantyre District in Malawi from February to August 2016. We conducted four focus group discussions (FGDs) among men and women independently. We also conducted one focus group discussion with nurses/ midwives, 13 key informant interviews whose participants were drawn from both health-related and non-health related institutions; 10 in-depth interviews with couples and 10 separate in-depth interviews with men who had attended antenatal clinics before with their spouses. All the interviews were audiotaped, transcribed verbatim and translated from Chichewa, the local language, into English. We managed data with NVivo 10.0 and used the thematic content approach as a guide for analysis. RESULTS: We identified one overarching theme: couple antenatal education information needs. The theme had three subthemes which were identified based on the three domains of the maternity cycle which are pregnancy, labour and delivery and postpartum period. Preferred topics were; description of pregnancy, care of pregnant women, role of men during perinatal period, family life birth preparedness and complication readiness plan, coitus during pregnancy and after delivery, childbirth and baby care. CONCLUSION: Antenatal education is a potential platform to disseminate information and discuss with male partners the childbearing period and early parenting. Hence, if both men and women were to participate in antenatal education, their information needs should be prioritized. Men and women had similar choices of topics to be taught during couple antenatal education, with some minor variations.

The effect of attending a prenatal childbirth preparedness course on labor duration and outcomes.

OBJECTIVE: To evaluate the effect of attending a prenatal childbirth preparation course (CPC) on labor duration and outcomes. METHODS: A cross sectional study of 53 primiparous women who attended and 54 women who did not attend a CPC was conducted. The state-trait anxiety inventory (STAI) score was used to diagnose anxiety. Clinical and obstetrical data were collected from the perinatal database of our center. Through post-partum interviews, coping strategies were assessed, patients graded their childbirth experience and breastfeeding was evaluated. Data were analyzed using description analyses and a P-value <0.05 was considered statistically significant. RESULTS: The STAI score was significantly lower in the study group compared with controls (P=0.025). The first stage and the entire duration of labor were significantly shorter (P=0.036 and P=0.026, respectively) in women who attended the CPC. No significant differences were found with regard to the mode of delivery, rate of episiotomy, use of analgesics and neonatal outcomes between the groups. Women in the study group rated their labor experience significantly higher (P=0.016) and exhibited significantly higher rates of breastfeeding (P<0.001) than controls. CONCLUSIONS: The knowledge acquired in the CPC has positive effects on the course of labor and delivery outcomes as well as higher rates of breastfeeding.

Characteristics of stepfamilies and maternal mental health compared with non-stepfamilies in Japan.

BACKGROUND: Stepfamilies remain poorly understood in Japanese society, and the support needs of stepfamily mothers are unclear. This study aimed to identify characteristics of stepfamilies and maternal mental health as compared with non-stepfamilies in Japan to utilize as a primary resource for providing effective support through community-based health care for stepfamilies. METHODS: From December 2011 to July 2012, we conducted this questionnaire survey with mothers at 3- and 4-month checkups for infants. The response rate was 75.1%. The sample for analysis included responses of 2246 mothers, excluding single mothers. RESULTS: Respondents comprised 47 (2.1%) stepfamilies and 2199 (97.9%) non-stepfamilies. There were significantly higher rates of parents with not more than a high school education and ≥3 children among stepfamilies compared with non-stepfamilies. Stepfamily mothers had significantly higher rates of feeling a lack of economic resources, absence of participation in childbirth education classes, smoking during pregnancy, and unplanned pregnancy. Furthermore, they also had significantly higher rates of depression and a lack of confidence in the parent role. Maternal depression was associated with factors such as maternal age, self-perceived health, stress level, confidence in breastfeeding, confidence in the parent role, and number of children. CONCLUSIONS: These findings suggest that stepfamilies exhibit many characteristics related to social disadvantage and problems with community-based health care in Japan. Healthcare providers should be aware of stepfamily mothers' support needs and should put in place a support system for stepfamilies. Moreover, compared with non-stepfamily mothers, stepfamily mothers have a significantly higher prevalence of depression. However, stepfamily composition does not necessarily increase the risk of maternal depression. Therefore, healthcare providers should put in place a system for obtaining more thorough information about stepfamilies and conduct an early assessment to identify their support needs.

Efectividad de intervención educativa en conocimientos de embarazadas sobre factores de riesgo maternos de bajo peso al nacer / Effectiveness of educational intervention in knowledge of pregnant women on maternal risk factors of under weight to be born

Introducción: el bajo peso al nacer guarda relación con la morbilidad, mortalidad y bienestar del binomio madre-hijo, el desconocimiento sobre sus factores de riesgo requiere de intervenciones educativas en las gestantes. Objetivo: evaluar la efectividad de intervención educativa en el nivel de conocimientos de embarazadas sobre factores de riesgo maternos de bajo peso al nacer. Métodos: estudio de intervención educativa con diseño preexperimental, con pre y post-test en gestantes del Policlínico Felipe Poey Aloy en Nueva Paz, Mayabeque, de abril 2013 hasta junio 2014. Universo de 32 gestantes con tiempo gestacional inferior a 26 semanas y factores maternos asociados, se aplicó un cuestionario inicial, se implementó la intervención y se evaluó su efectividad. Se utilizaron distribución de frecuencia absoluta y valor porcentual, la comparación de proporciones se realizó mediante medida de resumen para variables cualitativas. Se calculó la razón de las variables dependientes explicada por las diferencias entre los grupos. Resultados: el nivel de conocimientos sobre la edad óptima para el embarazo, el peso adecuado y la alimentación apropiada antes de la intervención eran insuficientes en 68,75 por ciento, 84,37 por ciento y 53,12 por ciento respectivamente, después de la intervención se elevó en 100 por ciento, 87,50 por ciento y 84,37 por ciento. Los conocimientos sobre las enfermedades maternas asociadas y los suplementos vitamínicos que se deben ingerir eran deficitarios en 59,37 por ciento y 62,50 por ciento elevándose en 68,75 por ciento y 90,62 por ciento en cada caso. Conclusiones: la intervención educativa fue efectiva en la modificación del nivel de conocimientos sobre factores de riesgo maternos de bajo peso al nacer de las embarazadas estudiadas(AU)

Introduction: Low birth weight is related to morbidity, mortality and welfare of mothers and children, the lack of knowledge about their risk factors requires educational interventions in pregnant women. Objective: evaluating the effectiveness of educational intervention in the level of knowledge of pregnant women on maternal risk factors of underweight when being born. Methods: study of educational intervention with pre experimental pre-test post-test in pregnant Polyclinic Felipe Poey Aloy" in Nueva Paz, Mayabeque, from April 2013 to June 2014. Universe less than 32 pregnant women with gestational time design with and 26 weeks and associated maternal factors, an initial questionnaire was applied, the intervention was implemented and its effectiveness was evaluated. Distribution of absolute frequency and percentage value was used; the comparison of proportions was performed using summary measure for qualitative variables. The reason for the dependent variables explained by differences between groups was calculated. Results: the level of knowledge on the optimal age for pregnancy, the adequate weight and the nutrition adapted before intervention were insufficient in 68.75 percent, 84.37 percent and 53.12 percent respectively, after intervention rose in 100 percent, 87.50 percent and 84.37 percent. The knowledge on the maternal correlated diseases and the vitamin supplements that should be taken in were showing a deficit in 59.37 percent and 62.50 percent rising in 68.75 percent and 90.62 percent in each case. Conclusions: the educational intervention was effective in the modification of the level of knowledge on maternal risk factors of underweight to be born of the studi ed pregnant women(AU)

Efectividad de intervención educativa en conocimientos de embarazadas sobre factores de riesgo maternos de bajo peso al nacer / Effectiveness of educational intervention in knowledge of pregnant women on maternal risk factors of under weight to be born

Introducción: el bajo peso al nacer guarda relación con la morbilidad, mortalidad y bienestar del binomio madre-hijo, el desconocimiento sobre sus factores de riesgo requiere de intervenciones educativas en las gestantes. Objetivo: evaluar la efectividad de intervención educativa en el nivel de conocimientos de embarazadas sobre factores de riesgo maternos de bajo peso al nacer. Métodos: estudio de intervención educativa con diseño preexperimental, con pre y post-test en gestantes del Policlínico Felipe Poey Aloy en Nueva Paz, Mayabeque, de abril 2013 hasta junio 2014. Universo de 32 gestantes con tiempo gestacional inferior a 26 semanas y factores maternos asociados, se aplicó un cuestionario inicial, se implementó la intervención y se evaluó su efectividad. Se utilizaron distribución de frecuencia absoluta y valor porcentual, la comparación de proporciones se realizó mediante medida de resumen para variables cualitativas. Se calculó la razón de las variables dependientes explicada por las diferencias entre los grupos. Resultados: el nivel de conocimientos sobre la edad óptima para el embarazo, el peso adecuado y la alimentación apropiada antes de la intervención eran insuficientes en 68,75 por ciento, 84,37 por ciento y 53,12 por ciento respectivamente, después de la intervención se elevó en 100 por ciento, 87,50 por ciento y 84,37 por ciento. Los conocimientos sobre las enfermedades maternas asociadas y los suplementos vitamínicos que se deben ingerir eran deficitarios en 59,37 por ciento y 62,50 por ciento elevándose en 68,75 por ciento y 90,62 por ciento en cada caso. Conclusiones: la intervención educativa fue efectiva en la modificación del nivel de conocimientos sobre factores de riesgo maternos de bajo peso al nacer de las embarazadas estudiadas(AU)

Introduction: Low birth weight is related to morbidity, mortality and welfare of mothers and children, the lack of knowledge about their risk factors requires educational interventions in pregnant women. Objective: evaluating the effectiveness of educational intervention in the level of knowledge of pregnant women on maternal risk factors of underweight when being born. Methods: study of educational intervention with pre experimental pre-test post-test in pregnant Polyclinic Felipe Poey Aloy" in Nueva Paz, Mayabeque, from April 2013 to June 2014. Universe less than 32 pregnant women with gestational time design with and 26 weeks and associated maternal factors, an initial questionnaire was applied, the intervention was implemented and its effectiveness was evaluated. Distribution of absolute frequency and percentage value was used; the comparison of proportions was performed using summary measure for qualitative variables. The reason for the dependent variables explained by differences between groups was calculated. Results: the level of knowledge on the optimal age for pregnancy, the adequate weight and the nutrition adapted before intervention were insufficient in 68.75 percent, 84.37 percent and 53.12 percent respectively, after intervention rose in 100 percent, 87.50 percent and 84.37 percent. The knowledge on the maternal correlated diseases and the vitamin supplements that should be taken in were showing a deficit in 59.37 percent and 62.50 percent rising in 68.75 percent and 90.62 percent in each case. Conclusions: the educational intervention was effective in the modification of the level of knowledge on maternal risk factors of underweight to be born of the studi ed pregnant women(AU)

Birth preparedness, complication readiness and male partner involvement for obstetric emergencies in rural Rwanda.

INTRODUCTION: Birth preparedness and complication readiness (BP/CR) promotes timely access to skilled maternal and neonatal services, active preparation and decision-making for seeking health care to prevent any adverse outcomes. The aim was to assess level of male partner (MP) involvement in the birth plan, the attitude of the women towards maternal care and factors associated with BP/CR among obstetric referrals in rural Rwanda. METHODS: This was a cross-sectional study among 350 pregnant women who were admitted as referrals at Ruhengeri hospital, between July 2015 and November 2015. Data was collected on socio-demographics, level of MP's participation in maternal health care and domestic activities, women's attitude towards involvement of men in maternal care and BP/CR. Any woman who arranged to have a birth companion, made a plan of where to deliver from, received health education on pregnancy and childbirth complications, saved money in case of pregnancy complication and had attended antenatal care (ANC) at least 4 times, was deemed as having made a birth plan. RESULTS: The mean age was 27.7 years, while mean age of the spouse was 31.3 years. Majority of the women (n=193; 55.1%) and their spouse (n=208; 59.4%) had completed primary education. Men's role was found to be mainly in the area of financial support. The level of men ANC attendance was low (n=103; 29.4%), while 78 (22.3%) women were accompanied to the labor ward. However, there was a strong opposition to the physical presence of MP in the labor room (n=178; 50.9%). The main reason cited by women opposing MP presence is that it is against their culture for a man to witness the delivery of a baby. On multivariable analysis, maternal education level of secondary or higher adjusted odds ratio [AOR] 1.4 95% CI (1.8-2.6), formal occupation of spouse, AOR 2.4 95% CI (1.4-4.2) and personnel checked during ANC being community health worker AOR 2.2, 95% CI; (1.3-3.7) were associated with being well prepared. CONCLUSION: Male involvement in pregnancy and antenatal care is low. To increase men involvement in birth plan addressing cultural barriers and refraining care-givers and health facility policies towards family delivery is paramount.

Birth Preparedness and Complication Readiness among Pregnant Women in Duguna Fango District, Wolayta Zone, Ethiopia.

BACKGROUND: Birth Preparedness and Complication Readiness is a strategy to promote the timely use of skilled maternal and neonatal care, especially during childbirth, based on the theory that preparing for childbirth and being ready for complications reduces delays in obtaining this care. OBJECTIVE: This study was conducted to assess birth preparedness and complication readiness and its associated factors among pregnant woman in Duguna Fango District in Wolayta Zone, South Ethiopia. METHODS: A community based cross-sectional study was conducted in 2013, on a sample of 578 pregnant women. Data were collected using pre-tested and structured questionnaire. The collected data were analyzed by SPSS for windows version 16.0. The women were asked whether they followed the desired five steps while pregnant: identified a trained birth attendant, identified a health facility, arranged for transport, identified blood donor and saved money for emergency. Taking at least three steps was considered being well-prepared. RESULTS: Among 578 pregnant women only one tenth (10.7%) of pregnant women identified skilled provider. Only 103 (18.1%) arranged transportation to health facility. Two hundred forty eight (43.6%) identified health facility for delivery and/or for obstetric emergencies. more than half (54.1%) of families saved money for incurred costs of delivery and emergency if needed. only few 17(3%) identified potential blood donor in case of emergency. Two hundred sixty four (46.4%) of the respondents reported that they intended to deliver at home, and more than half (53.6) planned to deliver at health facilities. Overall less than one fifth 18.3% of pregnant women were well prepared. The adjusted multivariate model showed that significant predictors for being well-prepared were maternal availing of antenatal services (AOR = 2.95, 95% CI: 1.62-5.37), being pregnant for the first time (AOR = 3.37, 95% CI: 1.45-7.82), having knowledge of at least two danger signs during pregnancy (AOR = 2.81, 95% CI: 1.69-4.67) and history of past obstetric complication (AOR = 2.98, 95% CI: 1.35-6.58). CONCLUSION: Birth preparedness practice in the study area was found to be low. Information, Education and Communication (IEC) on birth preparedness and complication readiness for young people should start early adolescence. The government officials and partners that are working in areas of maternal health should come up with strategies to improve birth preparedness at individual and community level.