In many countries, maternal education aims to influence health behavior, increase women’s confidence in their ability to give birth, prepare women and their partners for childbirth, develop social networks of support, promote parental safety, and reduce perinatal morbidity and mortality. Therefore, maternal education comprises a range of educational and support services that help parents to understand their own social, emotional, psychological, and physical needs during pregnancy.1 In Spain, maternal education programs can be carried out by both midwives and nurses within the national health system, with universal and free access offered at all health centers. Most of the program is carried out in group sessions in the third trimester of pregnancy, and includes appropriate information about life styles, theory about pregnancy, physical and psychological preparation for delivery, and care of the newborn (there are conferences and physical exercise classes).2 Studies from a number of countries have evaluated the effectiveness of maternal education programs.3–6 However, less than 50% of women attend a maternal education program in Spain.7–10 The World Health Organization recommends changing the perinatal health care model towards more user-orientated assistance.11
To our knowledge, no study as yet has assessed the effect of type of educator on maternal health education. In Spain, midwives have the same training as nurses, but also receive postgraduate training in theory and practice focused on the process of pregnancy, childbirth, and the postpartum period, which is not routinely received by general nurses. Nurses participating in the program are taught previously by midwives. The program of maternal education is standardized for all the Andalusian public health system, and midwives and nurses use the same units. In theory, teachers (midwives) have better training than students (nurses) and could achieve better delivery outcomes. The present study evaluates this assumption.
Materials and methods
A prospective cohort multicenter study was conducted between January 2011 and January 2012 in four hospitals in the public health system (University Hospital of Jaén, Hospital of Ubeda, Hospital of El Ejido, and University Hospital Virgen de las Nieves of Granada) across three provinces of Andalusia, Spain. The reference population was comprised of women who gave birth and met the study inclusion criteria of being primiparous, having a single pregnancy, and aged ≥18 years. The study was approved by the ethics committee of each center. All women provided their informed consent. Women who did not speak Spanish were excluded.
A total of 539 women were approached and 19 refused to participate. Of the 520 remaining women (number of cases collected at each hospital was proportional to the number of births, ie, 201 at the University Hospital Virgen de las Nieves of Granada, 132 at the Hospital of Jaén, 127 at the Hospital de Poniente of El Ejido, and 60 cases in the Hospital of Ubeda), 354 attended a maternal education program. Women meeting the inclusion criteria were selected consecutively.
Information was collected on the sociodemographic characteristics of the mother, living conditions during pregnancy, obstetric variables, anthropometric measurements for the newborn (weight, height, head circumference), Apgar score at 1 and 5 minutes, need for neonatal hospital admission (and length of stay), and neonatal illness in the first 2 months of life. Spain-appropriate growth curves published by Delgado Beltrán et al were used to identify small for gestational age newborns.12,13 Neonates weighing <2,500 g were considered to be low birth weight.14 Data were also gathered on the women’s satisfaction with their health care during pregnancy, with the attention they received during delivery, and with the maternal education program. The women were followed for up to 3 months after delivery to collect data on breastfeeding. The Spanish version of the Hospital Anxiety and Depression scale developed by Zigmond and Snaith15 was used to assess the level of maternal anxiety before delivery. The data were collected from clinical charts and personal interviews. A 140-item questionnaire (130 closed and ten open items) was applied by 24 trained interviewers.
For data analysis, odds ratios and 95% confidence intervals (CIs) were estimated for categorical variables. In multivariate analysis, logistic regression was applied to obtain adjusted odds ratios (aORs), retaining variables that altered the coefficient of the main exposure in more than 10% as confounding variables. Sociodemographic characteristics and the presence of pathology during pregnancy were considered to be potential confounders. Means and standard errors were computed for continuous variables. Analysis of covariance was applied in multivariate analysis, adjusting for the same variables.
Most of the women were Caucasian (98.6%) and of Spanish nationality (94.6%), with a mean age of 30.7±4.9 years. Most were married (68.8%), 38.7% had completed university studies, 25.24% worked in the public service, 45.4% had an indefinite contract with an employer, 49.4% had an average income of 1,000–1,999 Euros per month, 85.6% had no underlying diseases, and 92.1% had planned the pregnancy.
The relationship between the characteristics of the program and midwives is shown in Table 1. Midwives achieved more sessions and provided more hours of maternal education than other health professionals. The level of antepartum anxiety and reasons for seeking emergency obstetric care were not different between the two groups.
Table 1 Relationship between type of educator teaching the maternal education program and program characteristics, emergency care, and antepartum anxiety
The relationship between maternal education programs conducted by midwives and characteristics of delivery is shown in Table 2. The only significant relationships observed were a higher frequency of perineal lesions and more active maternal participation in delivery when maternal education was conducted by midwives compared with other health professionals.
Table 2 Relationship between type of educator teaching the maternal education program and characteristics of delivery
The relationship between maternal education programs conducted by midwives and the outcome for the newborn is shown in Table 3. Midwives achieved a lower frequency of low birth weight neonates and fewer admissions to intensive care or neonatal units than other health professionals. The maternal education given by midwives also increased early initiation of breastfeeding and early skin-to-skin contact between the mother and newborn.
Table 3 Relationship between type of educator teaching the maternal education program and newborn characteristics
The relationship between maternal education programs conducted by midwives and several continuous variables is shown in Table 4. The only relevant associations were more satisfaction with the maternal education program and a higher opinion of the utility and benefits of the program when it was conducted by midwives than by other health professionals.
Table 4 Association between the type of educator teaching the maternal education program and continuous variables
To the best of our knowledge, no other report has compared midwives and other health professions in regard to the outcomes of maternal education programs. However, several studies have noted that women positively value the activities of midwives.16–18 This positive evaluation may be responsible for the differences seen in the present study, which imply that a maternal education program run by a midwife achieves the best outcome.
An indicator of the greater success achieved by midwives is that women attended more sessions when midwives conducted the program rather than other health professionals, which allows the benefits of the program to increase. Midwives achieved more active involvement of the women during delivery, reduced the incidence of low birth weight, and decreased the number of newborn hospital admissions. Midwife-conducted programs also resulted in more frequent early skin-to-skin contact between the mother and newborn and early breastfeeding. Another Spanish study16 concluded that breastfeeding is favored by women who attend maternal education programs with midwives, although a comparison with other health professionals was not conducted. This early initiation of breastfeeding was not accompanied by a higher rate of breastfeeding 2 months after delivery.
However, maternal education by midwives has the disadvantage of an association with more perineal lesions during delivery. This may be due to the fact that midwives favor a policy of restrictive episiotomy, decreasing the number of surgical incisions; it may lead to the side effect of an increase of perineal lesions in women needing episiotomy who indicated her preference for avoiding the use of episiotomy. No effect was observed on the use of emergency obstetric care, degree of satisfaction with prenatal care and delivery, antepartum anxiety, type of delivery, duration of the different periods of delivery, gestational age, use of medication during dilation, complications after delivery, pain level reported during delivery, or use of epidural analgesia or alternative methods of pain relief.
Some support for our results comes from a Cochrane review,19 although this did not have the primary goal of assessing the role and effectiveness of midwives versus other health professionals in maternal education. Several differences in the practices of midwives and other health professionals were noted in that review, ie, more frequent initiation of breastfeeding, fewer episiotomies, and fewer surgical deliveries. That review documents that the practice of midwives is directed more towards achieving specific goals, such as initiating breastfeeding and reducing instrumental deliveries, which may be due to their training and engagement with the actual experience of pregnancy, delivery, and the postpartum period. These practices are in agreement with the recommendations of the World Health Organization20 and different health agencies.11
Regarding the limitations of the present study, selection bias does not affect the results because the participation rate was very high. Confounding bias cannot be completely ruled out, and is a limitation inherent in most observational studies. We have collected and taken into account the most relevant variables influencing the outcome of delivery in multivariate analyses. Misclassification bias is unlikely, because most of the variables are objective and do not allow for interpretation by the participants. In addition, the outcomes were verified using the clinical charts. Therefore, our study suggests that midwives achieve better results than other health professionals when they are in charge of maternal education programs.
The authors extend their gratitude to the women who participated as volunteers in this study and to the interviewers who assisted with data collection. This research was subsidized by the Health Research Fund of the Carlos III Health Institute (PI11/01388).
The authors report no conflicts of interest in this work.
Gagnon AJ, Sandall J. Individual or group antenatal education for childbirth or parenthood, or both. Cochrane Database Syst Rev. 2007;3:CD002869.
Junta de Andalucia. [Consejeria of Health. Integrated Asistencial Process Pregnancy, Childbirth and Puerperium]. 2nd ed. Seville, Spain: Consejeria de Salud; 2005. Spanish.
Artieta-Pinedo I, Paz-Pascual C, Grandes G, et al. The benefits of antenatal education for the childbirth process in Spain. Nurs Res. 2010;59:194–202.
Fabian HM, Rådestad IJ, Waldenström U, et al. Childbirth and parenthood education classes in Sweden. 2005. Women’s opinion and possible outcomes. Acta Obstet Gynecol Scand. 2005;84:436–443.
Araneda H, Cabrera C, Cabrera J, et al. [Prenatal education and its relation to the mode of delivery: a route to natural childbirth]. Rev Chil Obstet Ginecol. 2006;71:98–103. Spanish.
Consonni EB, Calderon IM, Consonni M, De Conti MH, Prevedel TTs, Rudge MV. A multidisciplinary program of preparation for childbirth and motherhood: maternal anxiety and perinatal outcomes. Reprod Health. 2010;29:28.
Márquez García A, Pozo Muñoz F, Sierra Ruiz M, et al. [Profile of pregnant women who do not go to a maternal education program]. Medicina de Familia (And). 2001;3:239–243. Available from: http://www.samfyc.es/Revista/PDF/v2n3/original5.pdf. Accessed May 23, 2012. Spanish.
Goberna i Tricas J, García i Riesco P, Galvez i Lladó M. [Evaluation of the quality of prenatal care]. Aten Primaria. 1996;18:75–78. Spanish.
Tajada N, Bernués, A, López F, et al. [Prenatal health education: characteristics of participation in a health area]. Enferm Científ. 1991;116:4–6. Spanish.
Pina F, Martínez ME, Rojas P, Campos M, Rodríguez MS. [The planning and maternal education favor the development of labor]. Enferm Clín. 1994;4:209–215. Spanish.
Ministry of Health and Social Policy. Clinical Practice Guidelines on Normal Childbirth Care. 1st ed. Vitoria, Brazil: Servicio Central de Publicaciones del Gobierno Vasco; 2010. Spanish.
Delgado Beltrán P, Melchor Marcos JC, Rodríguez-Alarcón Gómez J, et al. [Fetal development curves of newborns at the Hospital de Cruces (Vizcaya)]. II. Length, perimeter and ponderal index. An Es Pediatr. 1996;44:55–59. Spanish.
Delgado Beltrán P, Melchor Marcos JC, Rodríguez-Alarcón Gómez J, et al. [Fetal development curves of newborns at the Hospital de Cruces (Vizcaya)]. I. Weight. An Es Pediatr. 1996;44:50–54. Spanish.
Spanish Society of Gynecology and Obstetricia. [Perinatologic Definitions]. Madrid, Spain: SEGO; 2004. Spanish.
Vázquez Valverde C, Jiménez Franco F. Depression and mania. In: Bulbuena Vilarrasa A, Berrios GE, Fernández de Larrinoa Palacios P, editors. [Clinical Measurement in Psychiatry and Psychology]. 1st ed. Barcelona, Spain: Masson; 2003. Spanish.
García Mozo R, Alonso Sagredo L. [Valuation maternal prenatal measures to promote breastfeeding]. Aten Primaria. 2002;29:79–83. Spanish.
Torres Díaz A, Sánchez Fernández F, Martínez Martínez L, Fernández Cano E. [Opinion postpartum mothers about the program]. Matronas Prof. 2001;2:38–42. Spanish.
Hildingsson I, Waldenström U, Rådestad I. Women’s expectations on antenatal care as assessed in early pregnancy: number of visits, continuity of caregiver and general content. Acta Obstet Gynecol Scand. 2002;81:118–125.
Hatem M, Sandall J, Devane D, Soltani H, Gates S. Midwife-led versus other models of care for childbearing women. Cochrane Database Syst Rev. 2008;4:CD004667.
World Health Organization. Care in normal birth: a practical guide. Technical Working Group, World Health Organization. Birth. 1997;24:121–123.
- Observe return demonstrations to see whether the patient has learned the necessary psychomotor skills for a task.
- Ask the patient to restate instructions in his or her own words.
- Ask the patient questions to see whether there are areas of instruction that need reinforcing or re-teaching,
Group discussion is considered a very effective method of health teaching. It is a tow-way teaching method. People learn by exchanging their views and experiences.How can healthcare professionals improve patient education? ›
There are communication methodologies and behaviors that physicians can implement to ameliorate the potential risks associated with limited patient health literacy, including avoiding medical jargon, engaging in patient questions, explaining unfamiliar forms, and using “teach back” as a method to ensure understanding ( ...What is the importance of effective patient education in nursing? ›
Why Is Patient Education Important? Patient education is a significant part of a nurse's job. Education empowers patients to improve their health status. When patients are involved in their care, they are more likely to engage in interventions that may increase their chances for positive outcomes.How do you evaluate the effectiveness of a health program? ›
- Engage Stakeholders: No evaluation can be effective unless all those involved in the program participate. ...
- Describe the Program: Everyone has to agree on what the program is designed to do. ...
- Focus the Evaluation: Decide what you're specifically evaluating.
- Teaching functional health information (essential knowledge).
- Shaping personal values and beliefs that support healthy behaviors.
- Shaping group norms that value a healthy lifestyle.
A demonstration is the best method of teaching. Demonstration: A method of teaching that is experience-based and designed to illustrate a procedure, process, or phenomenon in a step-by-step manner is called a demonstration.What is the most important benefit of patient education? ›
Patient education can help providers inform and remind patients of the proper ways to self-manage care and avoid nonessential readmissions. Better education can also help patients understand the care setting most appropriate for their condition and avoid unnecessary trips to the hospital.What is the importance of health education for patients? ›
Patient education promotes patient-centered care and increases adherence to medication and treatments. An increase in compliance leads to a more efficient and cost-effective healthcare delivery system. Educating patients ensures continuity of care and reduces complications related to the illness.What is the most important goal in patient education? ›
The most important purpose of patient education is to aid patients in achieving the best state of health possible through their actions and determination. By providing patients with a complete understanding of their diagnoses and treatment options, nurses can help promote patient-centered care and autonomy.
What is the importance of professional commitment in developing patient education as a clinical skill? ›
Professional commitment is important while developing patient education to enable development of a patient centered content to address the individual healthcare needs of patients. Patient education should be specific to the client needs and be respectful to the literacy levels.What is patient education examples? ›
Patient education can include many types of instruction, such as: Maintaining treatment outside of a medical facility, such as dressing a wound. Administering injections for medication like insulin. Practicing preventative care, such as diet modifications for sustained health.What is patient education for the patient? ›
According to the American Academy of Family Physicians (AAFP), patient education is “the process of influencing patient behavior and producing the changes in knowledge, attitudes and skills necessary to maintain or improve health.”What does effectiveness mean in healthcare? ›
Effectiveness is the ability of an intervention to have a meaningful effect on patients in normal clinical conditions. Efficiency is doing things in the most economical way.What does effectiveness in healthcare services mean? ›
Efficacy is the extent to which an intervention does more good than harm under ideal circumstances. Effectiveness assesses whether an intervention does more good than harm when provided under usual circumstances of healthcare practice.1)How would you evaluate outcome effectiveness? ›
Outcome/effectiveness evaluation measures program effects in the target population by assessing the progress in the outcomes or outcome objectives that the program is to achieve. Impact evaluation assesses program effectiveness in achieving its ultimate goals.How do you measure the effectiveness of an intervention? ›
A common way of evaluating an intervention study is to divide it time-wise into three main phases: the first before the intervention begins, the second its actual implementation, and the third on a number of occasions after its completion .Why is it important for health educators to be good managers? ›
Administer and Manage Health Education/Promotion
If you've developed a health education or promotion program, it's likely you will be running that program. That's why health educators must be good managers, capable of performing administrative tasks, supervising staff, and working with community stakeholders.
- Take Proper Sleep: ...
- Eat a Balanced Diet: ...
- Expose Your Body to Sunlight: ...
- Deal with Stress: ...
- Exercise Daily: ...
- Stay Away from Smoking and Alcohol: ...
- Be Social, as Much as You Can: ...
- Find and Practice New Hobbies:
- Helping People Who Smoke Quit.
- Increasing Access to Healthy Foods and Physical Activity.
- Preventing Excessive Alcohol Use.
- Promoting Lifestyle Change and Disease Management.
- Promoting Women's Reproductive Health.
- Promoting Clinical Preventive Services.
- Promoting Community Water Fluoridation.
What strategies can you use to create opportunities to promote health education that positively contributes to a good quality of life for students? ›
Establish healthy eating and physical activity supportive environments. Provide a quality school meal program. Implement comprehensive physical education and health education programs.What are the components of efficiency in healthcare? ›
The measures most commonly used to rate the efficiency of physicians' performance are the relative value units for services provided per physician per month, the number of patient visits per physician per month, and the cost per episode of care.What is effective teaching and learning? ›
effectively allocates time for students to engage in hands-on experiences, discuss and process content and make meaningful connections. H. designs lessons that allow students to participate in empowering activities in which they understand that learning is a process and mistakes are a natural part of learning.Which way of learning is most effective? ›
One of the most impactful learning strategies is “distributed practice”—spacing out your studying over several short periods of time over several days and weeks (Newport, 2007). The most effective practice is to work a short time on each class every day.What is the most effective form of learning? ›
Practice (by) doing
Practice by doing, a form of "Discover Learning", is one of the most effective methods of learning and study. This method of study encourages students to take what they learn and put it into practice – whereby promoting deeper understanding and moving information from short-term to long-term memory.
Patient education improves outcomes and reduces readmissions. Finally, many healthcare organizations have specific goals around improving outcomes and reducing readmissions. Ensuring your patients have education that prepares them to take care of themselves helps the patients AND your bottom line.What is the importance of providing patient care? ›
The importance of a patient-centered care model
Care is collaborative and coordinated and goes beyond physical well-being to also include emotional, social, and financial aspects of a patient's situation. Patients should always be in complete control when it comes to making decisions about their own care and treatment.
Patients who participate in their decisions report higher levels of satisfaction with their care; have increased knowledge about conditions, tests, and treatment; have more realistic expectations about benefits and harms; are more likely to adhere to screening, diagnostic, or treatment plans; have reduced decisional ...How patient education can reduce health care costs? ›
Cost containment studies show that educating patients results in significant savings. Educated patients maintain better health and have fewer complications; as a result, they require fewer hospitalizations, emergency department visits, and clinic and physician visits.How can a patient knowledge of their health risks affect their health? ›
Knowing the risks you and your family may face can help you find ways to avoid health problems. It can also keep you from fretting over unlikely threats. Knowing the risks and benefits of a medical treatment can help you and your doctor make informed decisions.
- Say hello. Acknowledge the patient by name.
- Introduce yourself and your role.
- Apologize for their wait if necessary.
- Start the conversation with something non-medical.
- Acknowledge their concerns.
The purpose of health education is to positively influence the health behavior of individuals and communities as well as the living and working conditions that influence their health.Which characteristics make a patient goal useful and effective? ›
Specific: Your goals for the patient must be well-defined and unambiguous. Measurable: You need to set certain metrics to measure the patient's progress toward these goals. Achievable: Their goal should be possible to achieve. Realistic: Their goals must be within reach and relevant to the overall care plan.What are four benefits of continuing education for healthcare professionals? ›
- You can provide better care to your patients. Continuing education has been shown to improve patient outcomes (source). ...
- You experience professional growth. ...
- You experience personal growth. ...
- You stay up to date. ...
- You can keep your certification active.
Professional development contributes to this goal by enhancing the knowledge, skills, and attitudes of health and education professionals so that they can more effectively implement strategies that positively impact young people.What is the value of continuing education for healthcare professionals? ›
It helps them stay abreast on the latest treatments and procedures, maintain their licensure, and improve the quality of care they provide to their patients. There are many ways to continue your education, so find one that works best for you and make time for it in your busy schedule.What are the three components of patient education? ›
- Targeting your patient demographic. ...
- Your use of technology, or lack thereof. ...
- The “share-ability” of your materials.
The guidelines are based on the four components of the patient education process: assessment, planning, implementation and evaluation (APIE) (Bastable, 2017). Each component is essential for effective patient education.What are some examples of patient education? ›
- Maintaining treatment outside of a medical facility, such as dressing a wound.
- Administering injections for medication like insulin.
- Practicing preventative care, such as diet modifications for sustained health.
- Assessing learning needs.
- Developing learning objectives.
- Planning and implementing patient teaching.
- Evaluating patient learning.
- Documenting patient teaching and learning.
The teach-back method is a way of checking understanding by asking patients to state in their own words what they need to know or do about their health. It is a way to confirm that you have explained things in a manner your patients understand.How do we assess a patient's educational need? ›
You can also consider using checklists and questionnaires to obtain information about learning needs, learning style, and learning readiness. Written materials also help you determine the patient's literacy level and ability to understand written information. Confer with other health care team members.How to evaluate the effectiveness of a nursing care plan? ›
- Did anything unanticipated occur?
- Has the patient's condition changed?
- Were the expected outcomes and their time frames realistic?
- Are the nursing diagnoses accurate for this patient at this time?
Nursing evaluation includes (1) collecting data, (2) comparing collected data with desired outcomes, (3) analyzing client's response relating to nursing activities, (4) identifying factors that contributed to the success or failure of the care plan, (5) continuing, modifying, or terminating the nursing care plan, and ( ...What are some strategies you can use to confirm the patient understands how to take their new medication? ›
- Understand each patient's medication-taking behaviors. ...
- Talk about side effects. ...
- Write it down. ...
- Collaborate with patients. ...
- Consider the financial burden to the patient. ...
- Assess health literacy. ...
- Reduce complexity. ...
- Follow up with patients.
There are several different methods to assess pre-existing knowledge and skills in students. Some are direct measures, such as tests, concept maps, portfolios, auditions, etc, and others are more indirect, such as self-reports, inventory of prior courses and experiences, etc.What is the importance of assessment in health education? ›
In all areas of nursing education and practice, assessment is important to obtain information about student learning, evaluate competencies and clinical performance, and arrive at other decisions about students and nurses. Assessment is integral to monitoring the quality of educational and healthcare programs.What is the importance of providing education to patients? ›
Patient education can help providers inform and remind patients of the proper ways to self-manage care and avoid nonessential readmissions. Better education can also help patients understand the care setting most appropriate for their condition and avoid unnecessary trips to the hospital.Why is it important to assess patient learning needs and readiness before teaching? ›
Patients who do not exhibit the readiness to learn will find it hard to be receptive to any teaching. When the willingness to learn is present, the nurse can expect teaching efforts to be received well.How do you provide effective nursing care? ›
- Deliver Individualized Patient Care. If you walk down the hall of any nursing unit, you will likely hear nurses refer to the “CHF patient in Room 12” rather than simply calling the patient by their name. ...
- Empower Towards Self-Care. ...
- Show Compassion. ...
- Advance Your Education. ...
- Offer Empathy.
- Show respect. ...
- Express gratitude. ...
- Enable access to care. ...
- Involve patients' family members and friends. ...
- Coordinate patient care with other providers. ...
- Provide emotional support. ...
- Engage patients in their care plan. ...
- Address your patients' physical needs.
Respect: To truly provide a high quality of care, nurses should never become desensitized to their patients' humanity and must always exercise a high degree of respect. Successful nurses maintain a professional demeanor, take confidentiality seriously, and keep patients' wishes at the forefront of treatment.How do you evaluate the effectiveness of an intervention? ›
How to evaluate your intervention. Once you have implemented a planned intervention, you can look at ways to evaluate its success. Evaluation relies on knowing the outcomes and goals of a project and testing them against results. Effective evaluation comes from measurable data and clear objectives.Why is it important to evaluate the effectiveness of intervention? ›
By examining the three elements of an intervention – process, impact, and outcomes – your evaluation can tell you whether you did what you had planned; whether what you did had the influence you expected on the behaviors and factors you intended to influence; and whether the changes in those factors led to the intended ...Which step of the nursing process considers the effectiveness of nursing care? ›
The final phase of the nursing process is the evaluation phase. It takes place following the interventions to see if the goals have been met. During the evaluation phase, the nurse will determine how to measure the success of the goals and interventions.