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Introduction

Historically, antenatal education programmes weredeveloped in an attempt to reduce the painexperienced in labour and improve birth outcomes,and were based on the theories ofLamaze (1956),Grantly Dick-Read (1944) and others (Simkin and

Enkin, 1989). Research investigating the effect ofantenatal education has, until recently, primarilyfocused on labour and childbirth outcomes andpatterns of attendance. This research suggests thatprogrammes rarely affect pain relief or childbirthoutcomes (Simkin and Enkin, 1989; Sturrock andJohnson, 1990; Lumley and Brown, 1993). Asystematic review of antenatal education statesthat more research is required to determine theeffectiveness of programmes (Gagnon, 2000).

By the 1990s, the preparation for the parenthoodcomponent of many antenatal education pro-

grammes had been strengthened and improved.Research suggested, however, that further changeswere required (Barclay et al., 1997; Polomeno,2000a,b; Schneider, 2001) and, over time, anincreasing number of recommendations for im-provement have been made (Corwin, 1998;Under-down, 1998; Polomeno, 1999; Matthey et al.,2002).

Research suggests that antenatal education oftenfails to provide women with a realistic account ofbirth and parenting to replace the lived experienceof earlier decades (Nolan, 1997;Parr, 1998). It alsoindicates that educators are not addressing some of

the problems encountered by couples during theiradjustment to their responsibilities and anxieties inthe early days after the birth (Kelly, 1998;Polomeno, 2000a, b).Kelly (1998)recommends thatthe content of parenting education programmeshould include aspects of health care, which notonly accent physical well-being, but which includefamily relationships, childrearing and harmonywithin the home (Kelly, 1998, p. 25). Gullandstates that midwives should be teaching prospec-tive parents about the psychological impact ofhaving a child (Gulland, 1998, p. 25). Nolan

recommends that, in aiming to help womenacquire greater confidence and autonomy, educa-tors need to ensure that attendees becomecompetent in baby care skills (Nolan, 1997,p. 1202).Kelly (1998)andSvensson (2001)caution,however, that midwives may require additionaltraining to be able to facilitate effective parentingsessions.

Corwin (1999) integrated parenting into anantenatal education programme and found thatparenting knowledge scores improved after theprogramme compared with before the programme.

Similar results were described by Rolls and Cutts(2001) who tested knowledge before and after anintervention in experimental and control groups.These researchers examined the effect of knowl-edge before the birth of the baby. The effect ofbaby care and parenting information provided inpregnancy on parenting knowledge, confidence,

worry and ability during the postnatal period hasnot been examined. The style of delivery of thecontent and how this might affect outcomes hasalso not been studied.

Information in pregnancy can be gained fromnumerous sources, but what is learnt and retainedas knowledge and skills is affected by many factors,including the method by which the learning occurs.In this study, we examined the effectiveness of anew antenatal education programme, called Hav-ing a Baby programme, compared with a regularprogramme. The Having a Baby programme was

developed from needs assessment data collectedfrom expectant and new parents, and their healthproviders. The findings of the needs assessment anddetail of the programme are described elsewhere(Svensson, 2005;Svensson et al., 2006). Importantfeatures of the Having the Baby programme wereas follows: a greater emphasis on parenting issues,the use of adult learning principles and theinclusion of problem-solving and skills-based activ-ities related to labour, birth, baby care andparenting. These were aimed at increasing partici-pants confidence in their innate problem-solvingskills and enhancing their own self-confidence.

Parenting self-efficacy, worry and knowledgewere selected as the outcome measures of thisstudy. According to social learning theory, self-efficacy is a measure of the confidence anindividual has in their ability to meet the demandsand responsibilities of a task (Bandura, 1977).Perceived self-efficacy can have important influ-ences on behaviour, such as influencing activitychoices of individuals, and perseverance and copingbehaviours once the activity is undertaken (Reece,1992). Parenting self-efficacy has been found to berelated to positive parenting behaviours and child

outcomes, and can be measured using well-vali-dated scales (Reece, 1992).Research shows that stress is inversely related to

self-efficacy (Reece and Harkless, 1998). Althoughmany women are perceived by health professionalsas having a normal pregnancy, some express worry(Homer et al., 2002), so there was a need tomeasure worry as an outcome in this study. Labourand birth outcomes were also examined to ensurethat a reduction in the focus on birthing issues inthe Having a Baby programme did not lead topoorer birth outcomes.

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J. Svensson et al.2

Please cite this article as: Svensson, J., et al., Randomised-controlled trial of two antenatal education programmes, Midwifery(2007), doi:10.1016/j.midw.2006.12.012
http://localhost/var/www/apps/conversion/tmp/scratch_6/dx.doi.org/10.1016/j.midw.2006.12.012http://localhost/var/www/apps/conversion/tmp/scratch_6/dx.doi.org/10.1016/j.midw.2006.12.012


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training programme provided by the hospital. On

completion, each educator was randomly assignedto either experimental or control programme. Thefive educators assigned to the experimental pro-gramme subsequently participated in a 4-hourtraining workshop facilitated by the researcher.During this training, each educator received amanual containing the objectives and session plansfor the programme, which they read and practised.An emphasis was placed on the learning strategiesspecific to the experimental programme. Theeducators facilitating the control programme werenot given additional training because the control

programme was the programme they already

facilitated.

Outcome measures

The primary outcome measure of this study wasmaternal parenting self-efficacy. Secondary out-come measures were maternal worry and perceivedknowledge.

Perceived maternal parenting self-efficacy wasmeasured before the birth programme and 8 weeksafter birth using the 25-item self-report Pre- and

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Table 1 Comparison of the experimental and control programmes.

Component of programme Experimental programme Control programme

ContentLabour, birth and earlyweeks with a baby

Integrated approach unifying the childbearingprocesses and this life transition. Birth not seenas an isolated event separated from other lifeissues

Preset topics throughoutthe programme with littleintegration of labour, birthand parenting

Skills developmentRelaxation strategies Presented as life skills Taught as labour skills

ProcessesBeginning of eachsession

Each session commenced with an ice-breaker orsmall group work. These activities added to thetotality of the programme

Sessions one and threecommenced with anicebreaker unrelated tosession content. The othersessions began with alecture

Mini lecture byfacilitator and use of

videos

20% of programme (e.g. physiological processes oflabour for mother and baby, and physiological

processes of breast feeding)

40% of programme (e.g.pre-labour and labour

time-line, characteristicsof a newborn baby, safetyin the home)

Large group learning 40% of programme. Discussions and experientialactivities are reality based and participative (e.g.discussion with new parents, observation of babybath and discussion with the mother)

30% of programme.Discussions anddemonstrations withmodels (e.g. bath of a dolland discussion of newbornbaby characteristics,practise of positions forlabour)

Small group learning 40% of programme. Discussions focused onpsychosocial and emotional issues, and problem-solving activities (e.g. fears and concerns of

labour and birth, fears and concerns of being amother and a father, parenting scenarios)

30% of programme.Discussions focused onpsychosocial issues, and

decision-making activities(e.g. role of supportperson in labour and birth,card games such as painrelief in labour andpostnatal depression)

Take home activities Provided at the end of each session (e.g.resources in your community for a new parent,roles and responsibilities of a mother and father)

Nil take home activities

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Postnatal Parent Expectations Survey (PES) (Reece,1992). This instrument examines perceived parent-ing self-efficacy in relation to tasks they willperform in caring for their baby and their role asa parent. Each item is rated using a 10-point Likertscale (0 cannot do to 10 certain can do). Thetotal score is calculated by summing the rating on

each statement. The PES has demonstrated relia-bility and validity (Reece, 1992). The internalconsistency of the Reece Scale was evaluated andthe Cronbachs a was 0.936.

The Cambridge Worry Scale (CWS) (Strathamet al., 1992, 1997) was used before the programmeand 8 weeks after birth to measure maternal worry.It measures concerns and fears related to preg-nancy, labour, caring for a baby, relationships andsocio-economic issues. This scale has demonstratedreliability and validity, and has been used prena-tally and postnatally (Stratham et al., 1997;Ohman

et al., 2003). Participants rate 10 items on a five-point Likert scale from 0 (not a worry) to 5 (a majorworry). The rating they give to each item issummed to give the total score. The internalconsistency of the CWS was evaluated and theCronbachs a was found to be 0.81.

An assessment of perceived knowledge scaledeveloped by the researcher and used for qualityassurance in the hospital, and subsequently bycolleagues across New South Wales, was used tomeasure knowledge related to labour, baby care andthe role of a parent. Participants were asked to ratetheir perceived knowledge on 11 topics covered in

the programmes on a five-point Likert scale from 1(very poor) to 5 (very good). The rating given to eachitem was summed to give the total score. Perceivedknowledge was measured before the programme, oncompletion of the programme (before birth) and 8weeks after birth. The reliability and validity of thisscale, the only one suitable for the study at the timeit was conducted, had not been tested.

Demographic information (e.g. country of birth,level of education, family income) was collectedbefore the start of the programme. Self-reportlabour, birth and postnatal outcomes (e.g. length of

labour, use of pain relief, type of birth, breastfeeding, length of hospital stay) were collected inthe postnatal survey.

Programme process evaluation data (e.g. whatdid you like most about the programme and whatdid you like least) were also collected in this study.

Sample size

This study sought to test whether the experimentalprogramme made adjustment to parenthood easier.

The primary and most important variable was theparenting self-efficacy score obtained from thePES.

No published studies had used the PES (Reece,1992) to measure outcomes from an antenataleducation programme. The measure had, however,been used in previous research to determine

differences between men and women in theirperceived self-efficacy as a parent (Reece andHarkless, 1998). Therefore, the effect size fordifferences between men and women was usedas an estimate of an effect size of practicalsignificance. The sample size was calculatedusing a power of 80 and a 0.05. This calcu-lation indicated that sample size of 140was required to detect significant effects inperceived parenting self-efficacy scores. To obtainthis sample size, about 230 women had to berecruited. This estimate was based on an expected

dropout rate of 40% by the third survey at 8 weeksafter birth.

Data analysis

The statistical software package SPSS (Version 11)was used for data analysis. Only data from womenwho had completed all questions in the threesurveys were analysed. Repeated measures analysisof variance was used to examine differencebetween the groups on perceived parenting self-efficacy, perceived parenting knowledge and worry

about the baby. The w2 analysis was used todetermine if there was any difference in groupdemographics and birth outcomes. Fishers exacttest was used for cells that had a count of less thanfive, and Yates continuity correction was used for2 2 tables. Continuous data was examined usingindependentt-tests. Statistical significance was setat a 0.05. The assumptions of normality andhomogeneity of variance were tested and notviolated.

Findings

A total of 248 women were recruited to the study(Fig. 1). Ninety-one (73%) women completed thethree surveys in the experimental group and 79(64%) of the control group completed the threesurveys. Women in the final sample of both groupswere included irrespective of whether they re-ceived the whole programme. The response ratesfor the groups were tested and found not to besignificant.

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Randomised-controlled trial of two antenatal education programmes 5



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Maternal demographic details and pregnancycharacteristics

No significant differences were found in age,country of birth, level of education, family incomeor pregnancy complications between women inexperimental and control groups. Frequencies,proportions, means and test of significance arepresented inTable 2. The age range of the womenin the study was 1941 years (mean 30.26 years,sd 4.26), with all women expecting their firstbaby. Most of the women were educated, with 84%(142/170) having a tertiary level of education, and73% (123/170) had a family income greater than$60,000 per annum. Demographic details of an-tenatal programme participants who did not parti-cipate in this study, and of those who attendedantenatal education at the hospital, were similar.

Labour and birth outcomes

No significant difference was found betweenexperimental and control groups in the proportionof women who had induction of labour, spontaneousvaginal birth, instrumental delivery, length oflabour, perineal trauma, satisfaction with birth,feeling in control during labour and use of medicalpain relief during labour. Frequencies, proportions,means and test of significance are presented inTable 3.

Postnatal outcomes

No significant difference was found in the length ofpostnatal hospital stay, method of baby feeding,health problems of mother or baby, or paid workhours of women in experimental and control groups(Table 4).

Maternal perceived parenting self-efficacy

A repeated measures analysis of variance analysis(ANOVA) was used to determine change in parentingself-efficacy across time (before the programmeand 8 weeks after birth) and groups (experimentaland control). No statistically significant differencewas found between the pre-programme parentingself-efficacy mean scores for women in experi-mental and control groups (pre-programme experi-

mental mean 172 (sd 32.46): control mean 174 (sd 29.13): t 0.527, p 0.596).A statistically significant difference between the

postnatal mean scores of women in experimentaland control groups (postnatal experimentalmean 206 (sd 21.02): control mean 190 (sd 22.28): t 4.84, po0 .001).

Perceived parenting self-efficacy increased overtime for both groups (df 1.168, f 98.914,po0.001), as shown in Fig. 2, with the differencein perceived parenting self-efficacy scores betweenthe antenatal and postnatal period being greater

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Women recruited to the study (n= 248)

Random allocation

Experimental programme

Women (n = 124)

Control programme

Women (n= 124)

Completed survey 1

Women (n= 118; 95%)

Completed survey 1

Women (n = 112; 90%)

Completed survey 2

Women (n= 112; 90%)

Completed survey 2

Women (n = 107; 86%)

Final sample = completed survey 3

Women (n= 91; 73%)

Final sample = completed survey 3

Women (n= 79; 64%)

Total sample for analysis

Women (n= 170)

Figure 1 Sample size from recruitment to final sample.

J. Svensson et al.6



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for women in the experimental group than thecontrol group (df 1.168, f 13.35, po0.001).This showed that the Having a Baby programmehad an increased beneficial effect on maternalperceived parenting self-efficacy.

Maternal worry about the baby

The mean prenatal scores for worry about the baby

were 5.66 (sd 3.2) for the experimental group and5.99 (sd 3.23) for the control group. Mean post-natal scores were 2.04 (sd 2.49) experimental and2.14 (sd 2.51) for the control group (Fig. 3).

A repeated measure ANOVA showed that the twogroups did not differ in scores for worry about thebaby (df 1.168, f 0.173, p 0.678). Worryscores for both experimental and control groupssimilarly and significantly decreased after theprogramme (df 1.168, f 117.804, po0.001).The difference between groups was not statisti-cally significant, the experimental and control

programmes did not differ in their effect on worryabout the baby.

Assessment of parenting knowledge

No statistically significant difference was foundbetween the pre-programme mean scores forwomen in the experimental groups (mean 12.41,sd 2.78) and control groups (mean 13.21,

sd 2.95: t

1.84,p 0.068).Perceived parenting knowledge scores for bothgroups increased after the programme (experimen-tal mean 16.79, sd 2.06: control mean 16.07,sd 2.31). Perceived parenting knowledge in-creased over time for both groups before and afterthe programme (df 1.168,f 219.551,po0.001),with the increase for women in the experimentalgroup being greater than for those in the controlgroup (df 1.168,f 9.710,po0.001).

The mean postnatal score for each group showedthat perceived knowledge for women in the

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Table 2 Maternal demographic details and pregnancy characteristics by allocated group.

Totalsample,n 170

Experimental,n 91

Control,n 79

Statisticalsignificance

Mean age in years (sd) 30.26 (4.26) 30.08 (4.33) 30.47 (4.19) t 0.596Range in years 1941 2141 1939 p 0.55

Frequency % Frequency % Frequency %Nulliparous 170 100 91 100 79 100English spoken at home 166 97.6 87 95.6 79 100 Fishers exact 3.09

p 0.25

Country of birthAustralia and NZ 112 65.9 59 64.8 53 67.1 w2 3.02United Kingdom 25 14.7 13 14.3 12 15.2Asia 15 8.8 11 12.1 4 5.1 p 0.39Other 18 10.6 8 8.8 10 12.7

Highest level of educationDegree 80 47.1 43 47.3 37 46.8 w2 0.33Diploma 62 36.5 34 37.4 28 35.4 p 0.95Apprentice 15 8.8 7 7.7 8 10.1Secondary 13 7.6 7 7.7 6 7.6

Family incomeo40,000 13 7.6 7 7.7 6 7.6 w2 0.09940,00160,000 34 20 19 20.9 15 19 p 0.95460,000 123 72.4 65 71.4 58 73.4

Major stress in last 12 months 59 34.7 31 34.1 28 35.4 w2 .001p 0.98

Pregnancy characteristicsMultiple pregnancy 2 1.2 2 2.2 0 0Pregnancy complication 49 28.8 27 29.7 22 27.8 w2 0.008

p 0.93Mean gestation 39.7 39.82 39.56 t 1.27

Labour-weeks range (sd) 35

42 (1.37) 37

42 (1.3) 35

42 (1.43) p 0.21




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experimental group remained above the pre-pro-gramme score (Fig. 4), whereas, for the women inthe control group, it decreased (postnatal experi-mental mean 13.20 sd 3.60: controlmean 12.38, sd 3.90). Perceived parenting

knowledge scores for both groups decreased afterthe birth compared with before the programme. Arepeated measures ANOVA conducted on the pre-programme and postnatal scores showed a signifi-cant interaction between group and time(df 1.168, f 5.152, po0.001). That is, womenin the experimental group significantly increasedtheir perceived parenting knowledge 8 weeks afterthe birth of the baby compared with pre-pro-gramme levels, whereas women in the controlgroup decreased their perceived parenting knowl-edge during this period such that they perceived

they knew less about parenting than they didbefore the programme.

Programme process evaluation

The use of different learning strategies in theexperimental and control programmes has made itdifficult to make between-group comparisons forthe question what did you like most about theprogramme. Nevertheless, the two strategies mostliked by women in the control programme were, inorder of frequency, the hospital tour and meetingothers. Women in the experimental programmepreferred the session with the baby bath and thesession with the new parents discussing theirexperience. These women preferred sessions that

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Table 3 Maternal labour and birth outcomes by allocated group.

Total Sample(n 170)

Experimental(n 91)

Control (n 79) Statisticalsignificance

Frequency % Frequency % Frequency %

Induction of labour 56 32.9 27 29.7 29 36.7 w2 0.657

p 0.42Birth outcome w2 0.317

Spontaneous vaginal 91 53.5 49 53.8 42 53.2 p 0.96Assisted vaginal 36 21.2 18 19.8 18 22.8Emergency caesareansection

31 18.2 17 18.7 14 17.7

Elective caesareansection

12 7.1 7 7.7 5 6.3

Drugs used in labour

Nitrous oxide 87/158 55.1 46/84 54.8 41/74 55.4 w2 0.000p 1.00

Pethidine 61/158 38.6 29/84 34.5 32/74 43.2 w2 0.921p 0.34

Epidural 66/158 41.8 34/84 40.5 32/74 43.2 w2 0.036p 0.85

No drugs in labour 21/158 13.3 9/84 10.7 12/74 16.2 w2 0.61p 0.43

Perineal traumay 36/127 28.3 18/67 26.9 18/60 30 w2 0.038p 0.85

Mean length of labour(sd)y

10.43 5.27 10.13 5.08 10.77 5.51 t 0.673p 0.502

Range in hours 227 2 22 327Mean satisfactionchildbirth (sd)

6.54 2.40 6.60 2.34 6.67 2.47 z 0.085p 0.932

Control in labourMost of the time 126 74.1 67 73.6 59 74.7 w2 0.000

p 1.00Hardly at all 44 25.9 24 26.4 20 25.3

Sample excluded women who had an elective caesarean section. Women were asked to identify all drugs used.ySample excluded women who had a caesarean section.

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focused on parenting issues and those that usedmore experiential processes.

In relation to what did you like least about theprogramme, a greater proportion of womenwho attended the experimental programme (68%)stated there was nothing they disliked aboutthe programme compared with those who attended

the control programme (54%). The programmebeing too birth-focused was most frequentlyidentified by all women as the most dislikedelement. However, 22% of women in the controlprogramme stated they disliked the birth focuscompared with 12% of women in the experimentalprogramme.

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Table 4 Postnatal outcomes by allocated group.

Total sample(n 170)

Experimental(n 91)

Control(n 79)

Statisticalsignificance

Frequency % Frequency % Frequency %

Length of hospital stay w2 0.004o48 hours 33 19.4 17 18.7 16 20.3 p 0.95448 hours 137 80.6 74 81.3 63 79.7

Baby feeding in hospital w2 0.082p 0.77

Breast feeding 155 91.2 84 92.3 71 89.9Bottle feeding 15 8.8 7 7.7 8 10.1

Health problem withbaby

27 15.9 13 14.3 14 17.7 w2 0.16p 0.69

Mother health notreturned

20 11.8 12 13.2 8 10.1 w2 0.144p 0.71

Returned to paid work 21 12.4 11 12.1 10 12.7 w2 0.000p 1.00

Work hours420 hours

per week

4 2.4 4 4.4 0 0 w2 1.90

p 0.168

Time of assessment

PostnatalPre-program

Meanscore

210

200

190

180

170

GROUP

Experimental

Control

Figure 2 Maternal perceived parenting self-efficacy by group and time of assessment.




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Discussion

The aim of this randomised-controlled trial was totest whether women who attended the Having aBaby programme would have higher perceived

parenting self-efficacy and parenting knowledgescores 8 weeks after the birth, and lower babyworry scores compared with the women whoattended the regular programme used as thecontrol. The Having a Baby programme wasdesigned from the needs assessment data primarilyobtained from expectant and new parents. Theprogramme was the same length as the regularprogramme, but the structure and process weresignificantly different.

The women in this study were predominantlymiddle class, English-speaking, educated women

with a male partner. Although they constituted themajority population attending the Royal Hospitalfor Women for the birth of their first baby, thegeneralisability of these findings is limited. Thereare many groups within our multicultural societythat may have special needs, but have not beenidentified in this research (e.g. adolescents, single

women, and women from minority cultures). Theteaching and learning methods and topics coveredin the Having a Baby programme may or may notbe suitable for such groups. It is recommended thatthe needs of significantly minority groups beexamined, and the programme modified accord-ingly, to encourage these women both to attendand benefit from education or health promotionprogrammes. Further research is required todetermine if the programme is appropriate andeffective for such groups.

The findings indicated that the women who

attended the Having a Baby programme hadimproved perceived parenting self-efficacy andparenting knowledge about 8 weeks after the birthof their first baby compared with the women whoattended the regular programme. Women in boththe Having a Baby programme and the regularprogramme had similar decreased levels of worryabout their baby after birth. The reduction in worryscores of the women in the control group was,however, not sufficient to boost their parentingself-efficacy.

Knowledge, skills and experience are related toconfidence, which in turn is related to self-efficacy.

A strong sense of self-efficacy is necessary for asense of personal well-being and for persisting inefforts towards success. People with greater self-perceptions of efficacy are able to channel theirattention and resources to mastering the situationat hand. The results from this evaluative researchindicate that the Having a Baby programme, withinnovative learning strategies such as problem-solving and experiential strategies, had a beneficialeffect on maternal parenting self-efficacy. Theconsiderable distress currently being experiencedby new mothers may have been reduced for these

women by providing them with the problem-solvingskills to adapt and adjust to their new life situation.Further research is, however, required to deter-mine whether improving parenting self-efficacythrough childbirth and parenting education canhave an effect on family distress and associatedhealth and social outcomes.

This research adds to previous research byidentifyng specific strategies proven to be effectiveduring the childbearing year, and also arguing theneed to refocus regular antenatal education,in particular the labour and birth component.

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Time of assessment

PostnatalPost-programPre-programme

Meanscore

18

17

16

15

14

13

12

GROUP

Experimental

Control

Figure 4 Maternal assessment of perceived parentingknowledge by group and time.

Time of assessment

PostnatalPre-programme

Mean

score

7

6

5

4

3

2

1

GROUP

Experimental

Control

Figure 3 Maternal worry about baby by group and timeof assessment.

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Pregnancy, labour, birth and the early weeks witha baby can and should be regarded as a lifetransition or life journey. Labour skills can, andshould, be presented as life skills. Antenataleducation needs to assume a parenting focus andthere must be a commitment to making sessionsand topics relevant to the participants for whom

they are intended.The structure and learning activities specific to

the Having a Baby programme were well acceptedby the women in the experimental group. Indeedmany thought that the parenting componentcould be increased further. This research hasconfirmed that new parents are interested in babycare and parenting issues during pregnancy. Thefindings of this study also indicate that refocusingof labour and birth content in the programme didnot have a detrimental effect. The labour and birthoutcomes such as length of labour and use of pain

medication and type of birth for both groups weresimilar.The process of evaluation also indicated that

most programme participants in both programmeswould like some component of the programme tobe offered during the postnatal period, a findingthat has been suggested by others (Chalmersand McIntyre, 1994). The dip in perceived knowl-edge scores from post-programme levels to thelevel after the birth of the baby suggests thatthere is a need to design a birth and parentingprogramme straddling the birth experience, sothat parents can build on their knowledge and

practise their parenting skills in a supportiveenvironment, when the learning curve is steepestand problem-based learning can be usefully em-ployed.

At the time of this research, consideration wasindeed given to designing the Having a Babyprogramme so that it straddled the birth experi-ence (i.e. it would have had five or six sessionsbefore birth and two or three sessions after birth).This structure proved to be difficult for logisticaland financial reasons so it did not proceed. Thefindings of this research demonstrate that further

work is required with this concept.Finally, the validity of using a randomised-ontrolled trial to measure the outcomes of antena-tal education must be questioned, as it should befor any educational programme. With the emphasison adult learning principles in the experimentalprogramme, each programme would be different.This would not be such an issue with the controlprogramme owing to its pre-set topics and moredidactic approach. The randomisation process andthe sample size in this research were effective, somerit can be given to the design.

Implications for practice

This research was an attempt to improve con-fidence and decrease the level of distress experi-enced in the early postnatal period by improvingantenatal education and support. With increasingrates of labour intervention (Roberts et al., 2000),

depression (OHara and Swain, 1996), and decreas-ing self-efficacy and breast-feeding rates (NSWCentre for Public Health Nutrition, 2004), regularantenatal education, primarily in the third trime-ster of pregnancy, and based on psycho-physicaltheory of childbirth pain, was deemed ineffective.

The fact that the Having a Baby programmewas the same length as the regular programme,and that it was conducted within the sameresources, suggests that it may be applicable inhospitals with similar demographic profiles. Itshould be noted, however, that the training of

educators who facilitated the Having a Babyprogramme was an important component of theprogramme, and this would have to be consideredin future cost analysis.

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