This is the final week in our series on working with clients at high-risk. In this week’s post, we’re going to examine the results of a recently published study. In this study, women who were one-month postpartum were asked, “Was there anything that you would have liked to have known before your delivery that you were not told?” I was part of the research team for this study, so I’ve had a year to think about the results and what they mean for childbirth education. You can read the full article in Birth (doi/10.1111/birt.12854).

The reason this particular paper can inform our discussion of educating women at high-risk is that the women who answered yes were more likely to experience maternal complications during birth. The women who answered yes were also more likely to report experiencing high stress during pregnancy, which agrees with last week’s discussion that anxiety is higher during a high-risk pregnancy.

The overall finding of this study was that women felt they did not know their options. Two of the sub-themes directly relate to our work as childbirth educators. First, nearly half of the women reported that they didn’t know the impact interventions like induction of labor, epidural analgesia, or cesarean surgery would have on their body and were unaware of the processes for these interventions. Second, nearly a quarter of the women reported gaps in information that prevented them from participating in shared decision-making.

As we consider these results, one point of context is that attending childbirth education classes was not associated with whether the woman answered yes or no. This means women who attended childbirth education were no more likely to have received the information they wanted than women who didn’t. Information about options and interventions are a common subject for childbirth education classes, so I don’t think it would be accurate to interpret these results as meaning the information was not covered in childbirth education. What else could be going on?

I propose the results of this study indicate that the way we provide childbirth education doesn’t meet the needs of women experiencing a high-risk pregnancy. I suspect that we need specialized curriculum for women at high-risk. As I shared in week one of this series, women at high-risk are making different decisions than women at low-risk. In week two, I shared how women experiencing a high-risk pregnancy rated information about labor and delivery as the least important for them to understand. Last week, I shared how the fragmented care women at high-risk receive results in contradictory recommendations from providers. The combination of these three factors provides strong support for developing a different childbirth education curriculum for women at high-risk to ensure the material covers the information they both need and want.

There are multiple challenges to achieving a specialized childbirth program for women at high risk. First, only 6–8% of women are high-risk during pregnancy, meaning some communities may not have the population to support such a specialized class. Second, while we have ample evidence of childbirth education strategies to reduce anxiety, these are not tested for completeness of content to ensure participation in shared decision-making for women at high-risk. To overcome these challenges, we need childbirth educators willing to create and test innovative solutions.

If you have already developed a curriculum for women at high-risk, share about the content and the outcomes on the on the Lamaze blog. Contact Content Manager Morgan Manghera at mmanghera@lamaze.org for more information. If you have already tested curriculum changes or innovative solutions, be sure to share your results in The Journal of Perinatal Education.

References

Levett, K. M., Sutcliffe, K. L., Vanderlaan, J., & Kjerulff, K. H. (2024). The First Baby Study: What women would like to have known about first childbirth. A mixed-methods study. Birth (Berkeley, Calif.), 10.1111/birt.12854. Advance online publication. https://doi.org/10.1111/birt.12854

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