Women preparing for childbirth make use of many sources of information. These will typically include discussion with other women, magazine articles, books and classes. Classes may be run by the general practice or the maternity unit, or by external bodies such as the National Childbirth Trust (NCT). Antenatal education is beneficial, since it has been shown that the well-informed mother will cope better with labour, but it is important that the information provided should be accurate, well balanced and relevant to local services.
Problems and special considerations
Retention of information
The middle of a painful labour is the wrong time to attempt to provide quite complex information about regional analgesia. In addition to the pain itself and the inevitable tension, the mother may well be under the influence of powerful sedative or analgesic drugs. Theoretically, the antenatal period is the ideal time to educate mothers about pain relief and anaesthesia for caesarean section. Unfortunately, many studies have shown that the ability of patients to recall details of explanations is poor, and that such information tends to be retained for the short term only. This problem is exacerbated by the fact that many primigravidae who have epidural analgesia in labour were not originally planning to use it; these women would be especially unlikely to recall information given in the antenatal period.
Written information
Poor recall of verbal explanations implies that antenatal classes should be supplemented with written information that women can take home and read at leisure; audiotapes and videos can also be very helpful. When preparing these sources, it is important to target them at a relatively low level of comprehension; it is all too easy to slip into medical jargon and unnecessarily complicated language. Studies have shown that written information for patients should be set at a reading age of about 12 years. The needs of mothers whose first language is not English should also be considered, and the Obstetric Anaesthetists’ Association (OAA) has several translations of its information for mothers available on its website, including in smartphone/tablet format.
Content
Mothers need balanced information to enable them to make rational decisions; this is an essential element of the principle of consent. Talks, leaflets, videos and other information sources all need to present an unbiased view of the benefits and risks of the available alternatives, and they should be based on the best available evidence. Inevitably, material that is designed to inform a large number of women will be too complex for some and have insufficient detail for others; it is therefore essential that mothers should be able to discuss their concerns individually with an anaesthetist if necessary, and antenatal education should not be seen as a substitute for this facility.
Management options
Providing a regular antenatal class is a major (and almost certainly unpaid) commitment, often involving regular evening lectures. Equally, not every anaesthetist is suited to giving informal talks to large groups of mothers and fathers. In some circumstances, it is better to enlist the help of parentcraft teachers, who may be willing to put across the anaesthetist’s message themselves. If this is to be done successfully, however, it is essential that the teachers fully understand and agree with the content and emphasis of the information. The anaesthetist should still attend the classes on a regular basis, and must be available (not necessarily on the same day) to deal with any queries outside the teacher’s experience. Audiovisual aids are useful, particularly as a prompt if the talk is delegated to someone else, but slides must be kept simple, jargon-free and not gory.
The use of written or video material is worthwhile, but preparation to an acceptable standard is more difficult than might be imagined. Many hospitals have departments dedicated to providing patient information, and their help should be sought at an early stage. Presentation in an attractive format is also important, and this will almost certainly require professional input. Production of high-quality leaflets is not cheap, and it is tempting to seek sponsorship from a company with a commercial interest in pregnancy or labour; however, many midwives are reluctant to distribute information that appears to endorse products, and their views should be sought before embarking on such a course. In general, the cooperation of midwifery staff is important in ensuring that the target audience is reached, and they should therefore be involved at the preparation stage.
It is important to remember that antenatal education often misses the most socially deprived - and hence high-risk - mothers. The extent of this problem may be assessed by discussion with local community midwives, who may be willing to establish ‘outreach’ clinics for this vulnerable group.
Several national organisations, including the OAA, have produced leaflets, videos and smartphone applications about pain relief in labour. These provide an attractive way of informing mothers in the antenatal period, but care should be taken if using such material to ensure that the information given reflects local practice and experience.
Key points
• Antenatal education allows explanation of key facts in a low-stress environment.
• Retention of information given in the antenatal period is poor.
• Information should be accurate, locally relevant and carefully targeted.
• Leaflets and videos are useful supplements, but may be difficult to prepare.
Further reading
Bethune L, Harper N, Lucas DN, et al. Complications of obstetric regional analgesia: how much information is enough? Int J Obstet Anesth 2004; 13: 30-4.
Broaddus BM, Chandrasekhar S. Informed consent in obstetric anesthesia. Anesth Analg 2011; 112: 912-15.
Fortescue C, Wee MY, Malhotra S, Yentis SM, Holdcroft A. Is preparation for emergency obstetric anaesthesia adequate? A maternal questionnaire survey. Int J Obstet Anesth 2007; 16: 336-40.
Obstetric Anaesthetists’ Association. [Information for mothers.] www.labourpains.com (accessed December 2018).