Last week I shared about why my research team thinks we should consider developing childbirth education specifically for people at high-risk. This week, I want to share about childbirth educators who created programs for people at high-risk, and what they found. I conducted a literature search, but only found four articles published over 40 years. It appears that childbirth education for high-risk clients has been an under-developed focus area for childbirth education.

The earliest program I could find was in a 1987 report of a childbirth education program for people hospitalized during pregnancy. The course was taught over a series of six weeks, one class per week, with rotating topics so a person can join the class at any time. The topics were mostly the standard childbirth education curriculum, but offered more discussion about tests, medications, interventions, and breastfeeding a preterm infant. The authors shared that using a flipped classroom — asking clients to watch videos on their own and then discuss in class — helped to reinforce content and increased the time available for discussing client questions.

I also found a 1997 report of a bedside tutoring childbirth education program for people hospitalized during the antepartum. In this program, the educator took on the role of a tutor. A teaching plan was developed for each person after an assessment of their learning needs. Education included conversation and reading material which remained with the client. The most important thing to learn from this article is that the clients rated information about fetal development and prematurity as most important, followed by antenatal procedures, medications, and high-risk conditions. Preparation for childbirth was rated as the least important topic by these clients.  

I found a 2024 report of a project expanding the use of group prenatal care. This group prenatal care was not designed specifically for people with gestational diabetes or hypertension, but the design of the education with group prenatal care provided unique opportunities for discussing pregnancy complications. The reason I include it in this list is because they found no increased risk for preterm birth, low birth weight, or NICU admission with group prenatal care for people at high-risk. In fact, they found evidence that good outcomes with group care can be experienced by people with pregnancy complications. That means group prenatal care may be an effective childbirth education strategy for people at high risk.  

Finally, a 2023 paper compared an interactive online education platform to usual education for people at high-risk with high anxiety. These authors only published an abstract, so we don’t know if the usual education was completed by a childbirth educator or the healthcare provider. What I found interesting was that they found that people who had access to the interactive online education platform had fewer visits to the ED during pregnancy and had a decrease in their anxiety. There were no differences in delivery outcomes or breastfeeding, but they did find the clients felt more satisfied with their education.

I have two big ideas after reading these four reports. First, childbirth education designed for people at high-risk is often covering topics outside the scope of the standard childbirth education curriculum, like how to breastfeed if you have a premature baby who needs to spend time in the NICU. This makes sense given the unique decisions and challenges these families are likely to face. Second, childbirth educators working with people at high-risk maximized the time available to address client concerns by offering a variety of self-paced educational resources and spreading out the education sessions. Reading the articles, I got the impression they were using what we would call a flipped-classroom, where the families explored the content on their own and the class time was spent working through difficult questions. As childbirth educators, we can use these two strategies to help us design courses and learning activities specific to the needs of people at high-risk.

Next week I’ll examine care from the client perspective to share what people at high-risk expected, and what happened.

References

Avery, P., & Olson, I. M. (1987). Expanding the scope of childbirth education to meet the needs of hospitalized, high-risk clients. Journal of obstetric, gynecologic, and neonatal nursing: JOGNN, 16(6), 418–421. https://doi.org/10.1111/j.1552-6909.1987.tb01603.x

Brown, C. (1997). At the Bedside: Childbirth Education Tutoring for High-Risk Hospitalized Antenatal Women. International Journal of Childbirth Education, 12(3), 20-21.

Heberlein, E. C., Smith, J. C., LaBoy, A., Britt, J., & Crockett, A. (2024). Birth Outcomes for Medically High-Risk Pregnancies: Comparing Group to Individual Prenatal Care. American Journal of Perinatology, 41(4), 414–421. https://doi.org/10.1055/a-1682-2704

Zafman, K. B., Riegel, M. L., Levine, L. D., & Hamm, R. F. (2023). An interactive childbirth education platform to improve pregnancy-related anxiety: a randomized trial. American journal of obstetrics and gynecology, 229(1), 67.e1–67.e9. https://doi.org/10.1016/j.ajog.2023.04.007

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