Document Type : Original Article
Authors
Abstract
BACKGROUND: Prenatal education provides opportunities for health promotion of healthy behaviors
and risk reduction. Quality and coherence with prenatal health promotion best practices depend on
an individual class instructor. The objective of our study was to document the experiences, practices,
and perceptions of our diverse Ottawa, Canada community of prenatal educators.
MATERIALS AND METHODS: In this quantitative, mixed methods e‑survey conducted in Ottawa,
Canada, prenatal educators were asked to describe their prenatal class settings, delivery formats,
content, perceptions of pregnant women, and recommendations. Data were analyzed by descriptive
statistics and thematic content analysis.
RESULTS: Respondents included public health nurses and a diverse group of “allied childbirth
educators” (ACE). Topics related to pregnancy, labor, and postpartum issues were well addressed;
however, established and emerging risks to pregnancy were omitted. Nurses were more likely to
discuss lifestyle risks to pregnancy and general prenatal health promotion, whereas ACE respondents
emphasized informed consent and individualized counseling. Women marginalized by social exclusion
including Indigenous women, immigrants, and women with disabilities were perceived as missing
from prenatal educational settings.
CONCLUSIONS: Heterogeneity of prenatal education provides opportunities for collaboration;
however, established and emerging risk factors to pregnancy are neglected topics. Addressing the
needs of diverse communities of pregnant women requires timely, evidence‑based, inclusive, and
culturally safe delivery of prenatal health promotion.
Keywords
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Education in Ontario: A Summary of Research Findings. Toronto,
Ontario, Canada. *In 2019, The Report was updated to Include
BORN 2017/2018 Data, Not Cited in This Article. Available from:
https://resources.beststart.org/product/e47e-delivery-prenataleducation-ontario-summary-report/. [Last accessed on 2020
Jan 23].
2. Public Health Agency of Canada. Care during pregnancy. In:
Public Health Agency of Canada. CH. 3. Ottawa, Canada: FamilyCentred Maternity and Newborn Care: National Guidelines; 2019.
Available from: https://www.canada.ca/en/public-health/
services/publications/healthy-living/maternity-newborn-careguidelines-chapter-3.html. [Last accessed on 2020 Jan 30].
3. Johnson K, Posner SF, Biermann J, Cordero JF, Atrash HK,
Parker CS, et al. Recommendations to improve preconception
health and health care - United States: A report of the CDC/
ATSDR Preconception Care Work Group and the Select Panel
on Preconception Care. MMWR Recomm Rep 2006;55:1-23.
4. Declercq ER, Sakala C, Corry MP, Applebaum S, Herrlich A.
Listening to mothersSM III: Pregnancy and birth. Report of
the Third National U.S. Survey of Women’s Childbearing
Experiences. Childbirth Connection; 2013. Available from:
https://www.nationalpartnership.org/our-work/health/
maternity/listening-to-mothers.html. [Last accessed on 2020 Jan
23].
5. Public Health Agency of Canada. What Mothers Say: The
Canadian Maternity Experiences Survey: Ottawa, Canada. Public
Health Agency of Canada; 2009. Available from: http://www.publichealth.gc.ca/mes. [Last accessed on 2020 Jan 23].
6. Kovala S, Cramp AG, Xia L. Prenatal education: Program content
and preferred delivery method from the perspective of the
expectant parents. J Perinat Educ 2016;25:232-41.
7. Chedid RA, Terrell RM, Phillips KP. Best practices for online
Canadian prenatal health promotion: A public health approach.
Women Birth 2018;31:e223-31.
8. Lagan BM, Sinclair M, Kernohan WG. Internet use in pregnancy
informs women’s decision making: A web-based survey. Birth
2010;37:106-15.
9. Crighton EJ, Brown C, Baxter J, Lemyre L, Masuda JR, Ursitti F.
Perceptions and experiences of environmental health risks among
new mothers: A qualitative study in Ontario, Canada. Health Risk
Soc 2013;15:295-312.
10. Halili L, Liu R, Hutchinson KA, Semeniuk K, Redman LM,
Adamo KB. Development and pilot evaluation of a
pregnancy-specific mobile health tool: A qualitative investigation
of SmartMoms Canada. BMC Med Inform Decis Mak 2018;18:95.
11. Vonderheid SC, Norr KF, Handler AS. Prenatal health promotion
content and health behaviors. West J Nurs Res 2007;29:258-76.
12. Statistics Canada. Ottawa, CDR [Census division], Ontario and
Ontario [Province] (table). Census Profile. 2016 Census. Statistics
Canada Catalogue no; 2017. Available from: https://www12.
statcan.gc.ca/census-recensement/2016/dp-pd/prof/index.
cfm?Lang=E. [Last accessed on 2020 Jan 16].
13. Edwards N. Factors influencing prenatal class attendance among
immigrants in Ottawa-Carleton. Can J Public Health 1994;85:254-8.
14. Moreau D, Polomeno V, de Pierrepont C, Tourigny J, Ranger MC.
Les rencontres prénatales: Sont-elles utiles? La perception des
couples parentaux franco-ontariens de la région d’Ottawa.[FrancoOntarian parenting couples living in the Ottawa region and their
perceptions regarding the usefulness of prenatal classes]. Rech
Soins Infirm 2015;123:36-48.
15. Lena SM, Marko E, Nimrod C, Merritt L, Poirier G, Shein E.
Birthing experience of adolescents at the Ottawa General Hospital
Perinatal Centre. CMAJ 1993;148:2149-54.
16. Institute of Medicine (IOM; US) and National Research
Council (US) Committee to Reexamine IOM Pregnancy Weight
Guidelines Weight Gain during Pregnancy: Reexamining the
Guidelines. Rasmussen KM, Yaktine AL, editors. Washington DC,
United States of America: National Academies Press; 2009.
17. Cohen TR, Koski KG. Limiting excess weight gain in healthy
pregnant women: Importance of energy intakes, physical activity,
and adherence to gestational weight gain guidelines. J Pregnancy
2013;2013:787032.
18. Darroch FE, Giles AR. Conception of a resource: Development
of a physical activity and healthy living resource with and for
pregnant urban First Nations and Métis women in Ottawa,
Canada. Qual Res Sport Exercise Health 2017;9:157-69.
19. Vaismoradi M, Turunen H, Bondas T. Content analysis and
thematic analysis: Implications for conducting a qualitative
descriptive study. Nurs Health Sci 2013;15:398-405.
20. Harris SJ, Janssen PA, Saxell L, Carty EA, MacRae GS, Petersen KL.
Effect of a collaborative interdisciplinary maternity care program
on perinatal outcomes. CMAJ 2012;184:1885-92.
21. World Health Organization. WHO Recommendations on
Antenatal Care for a Positive Pregnancy Experience. World Health
Organization; 2016. Available from: https://www.who.int/
reproductivehealth/publications/maternal_perinatal_health/
anc-positive-pregnancy-experience/en/. [Last accessed on 2020
Feb 12].
22. Brady V, Lalor J. Space for human connection in antenatal
education: Uncovering women’s hopes using Participatory Action
Research. Midwifery 2017;55:7-14.
23. Svensson J, Barclay L, Cooke, M. Effective antenatal education:
Strategies recommended by expectant and new parents.
J Perinatal Educ 2008;17:33-42.
24. Weatherspoon D, Weatherspoon C, Ristau C. Speaking their
language: Integrating social media into childbirth education
practice. Int J Childbirth Educ 2015;30:21-4.
25. Weeks A, Halili L, Liu RH, Deonandan R, Adamo KB. Gestational
weight gain counselling gaps as perceived by pregnant women
and new mothers: Findings from the electronic maternal health
survey. Women Birth 2020;33:e88-e94.
26. Phillips KP, O’Sullivan TL, Dow D, Amaratunga CA. Infectious
respiratory disease outbreaks and pregnancy: Occupational health
and safety concerns of Canadian nurses. Prehosp Disaster Med
2011;26:114-21.
27. Heaman MI, SwordW, Elliott L, Moffatt M, Helewa ME, Morris H,
et al. Barriers and facilitators related to use of prenatal care by
inner-city women: Perceptions of health care providers. BMC
Pregnancy Childbirth 2015;15:2.
28. Tarasoff LA. Experiences of women with physical disabilities
during the perinatal period: A review of the literature and
recommendations to improve care. Health Care Women Int
2015;36:88-107.
29. Mitra M, Long-Bellil LM, Smeltzer SC, Iezzoni LI. A perinatal
health framework for women with physical disabilities. Disabil
Health J 2015;8:499-506.
30. Di Lallo S. Prenatal care through the eyes of Canadian Aboriginal
women. Nurs Womens Health 2014;18:38-46.
31. Roth LM, Henley MM, Seacrist MJ, Morton CH. North American
Nurses’ and Doulas’ Views of Each Other. J Obstet Gynecol
Neonatal Nurs 2016;45:790-800.
32. Avery MD, Bell AD, Bingham D, Corry MP, Delbanco SF,
Gullo SL, et al. Blueprint for advancing high-value maternity care
through physiologic childbearing. Executive Summary. J Perinat
Educ 2018;27:130‑4.
Education in Ontario: A Summary of Research Findings. Toronto,
Ontario, Canada. *In 2019, The Report was updated to Include
BORN 2017/2018 Data, Not Cited in This Article. Available from:
https://resources.beststart.org/product/e47e-delivery-prenataleducation-ontario-summary-report/. [Last accessed on 2020
Jan 23].
2. Public Health Agency of Canada. Care during pregnancy. In:
Public Health Agency of Canada. CH. 3. Ottawa, Canada: FamilyCentred Maternity and Newborn Care: National Guidelines; 2019.
Available from: https://www.canada.ca/en/public-health/
services/publications/healthy-living/maternity-newborn-careguidelines-chapter-3.html. [Last accessed on 2020 Jan 30].
3. Johnson K, Posner SF, Biermann J, Cordero JF, Atrash HK,
Parker CS, et al. Recommendations to improve preconception
health and health care - United States: A report of the CDC/
ATSDR Preconception Care Work Group and the Select Panel
on Preconception Care. MMWR Recomm Rep 2006;55:1-23.
4. Declercq ER, Sakala C, Corry MP, Applebaum S, Herrlich A.
Listening to mothersSM III: Pregnancy and birth. Report of
the Third National U.S. Survey of Women’s Childbearing
Experiences. Childbirth Connection; 2013. Available from:
https://www.nationalpartnership.org/our-work/health/
maternity/listening-to-mothers.html. [Last accessed on 2020 Jan
23].
5. Public Health Agency of Canada. What Mothers Say: The
Canadian Maternity Experiences Survey: Ottawa, Canada. Public
Health Agency of Canada; 2009. Available from: http://www.publichealth.gc.ca/mes. [Last accessed on 2020 Jan 23].
6. Kovala S, Cramp AG, Xia L. Prenatal education: Program content
and preferred delivery method from the perspective of the
expectant parents. J Perinat Educ 2016;25:232-41.
7. Chedid RA, Terrell RM, Phillips KP. Best practices for online
Canadian prenatal health promotion: A public health approach.
Women Birth 2018;31:e223-31.
8. Lagan BM, Sinclair M, Kernohan WG. Internet use in pregnancy
informs women’s decision making: A web-based survey. Birth
2010;37:106-15.
9. Crighton EJ, Brown C, Baxter J, Lemyre L, Masuda JR, Ursitti F.
Perceptions and experiences of environmental health risks among
new mothers: A qualitative study in Ontario, Canada. Health Risk
Soc 2013;15:295-312.
10. Halili L, Liu R, Hutchinson KA, Semeniuk K, Redman LM,
Adamo KB. Development and pilot evaluation of a
pregnancy-specific mobile health tool: A qualitative investigation
of SmartMoms Canada. BMC Med Inform Decis Mak 2018;18:95.
11. Vonderheid SC, Norr KF, Handler AS. Prenatal health promotion
content and health behaviors. West J Nurs Res 2007;29:258-76.
12. Statistics Canada. Ottawa, CDR [Census division], Ontario and
Ontario [Province] (table). Census Profile. 2016 Census. Statistics
Canada Catalogue no; 2017. Available from: https://www12.
statcan.gc.ca/census-recensement/2016/dp-pd/prof/index.
cfm?Lang=E. [Last accessed on 2020 Jan 16].
13. Edwards N. Factors influencing prenatal class attendance among
immigrants in Ottawa-Carleton. Can J Public Health 1994;85:254-8.
14. Moreau D, Polomeno V, de Pierrepont C, Tourigny J, Ranger MC.
Les rencontres prénatales: Sont-elles utiles? La perception des
couples parentaux franco-ontariens de la région d’Ottawa.[FrancoOntarian parenting couples living in the Ottawa region and their
perceptions regarding the usefulness of prenatal classes]. Rech
Soins Infirm 2015;123:36-48.
15. Lena SM, Marko E, Nimrod C, Merritt L, Poirier G, Shein E.
Birthing experience of adolescents at the Ottawa General Hospital
Perinatal Centre. CMAJ 1993;148:2149-54.
16. Institute of Medicine (IOM; US) and National Research
Council (US) Committee to Reexamine IOM Pregnancy Weight
Guidelines Weight Gain during Pregnancy: Reexamining the
Guidelines. Rasmussen KM, Yaktine AL, editors. Washington DC,
United States of America: National Academies Press; 2009.
17. Cohen TR, Koski KG. Limiting excess weight gain in healthy
pregnant women: Importance of energy intakes, physical activity,
and adherence to gestational weight gain guidelines. J Pregnancy
2013;2013:787032.
18. Darroch FE, Giles AR. Conception of a resource: Development
of a physical activity and healthy living resource with and for
pregnant urban First Nations and Métis women in Ottawa,
Canada. Qual Res Sport Exercise Health 2017;9:157-69.
19. Vaismoradi M, Turunen H, Bondas T. Content analysis and
thematic analysis: Implications for conducting a qualitative
descriptive study. Nurs Health Sci 2013;15:398-405.
20. Harris SJ, Janssen PA, Saxell L, Carty EA, MacRae GS, Petersen KL.
Effect of a collaborative interdisciplinary maternity care program
on perinatal outcomes. CMAJ 2012;184:1885-92.
21. World Health Organization. WHO Recommendations on
Antenatal Care for a Positive Pregnancy Experience. World Health
Organization; 2016. Available from: https://www.who.int/
reproductivehealth/publications/maternal_perinatal_health/
anc-positive-pregnancy-experience/en/. [Last accessed on 2020
Feb 12].
22. Brady V, Lalor J. Space for human connection in antenatal
education: Uncovering women’s hopes using Participatory Action
Research. Midwifery 2017;55:7-14.
23. Svensson J, Barclay L, Cooke, M. Effective antenatal education:
Strategies recommended by expectant and new parents.
J Perinatal Educ 2008;17:33-42.
24. Weatherspoon D, Weatherspoon C, Ristau C. Speaking their
language: Integrating social media into childbirth education
practice. Int J Childbirth Educ 2015;30:21-4.
25. Weeks A, Halili L, Liu RH, Deonandan R, Adamo KB. Gestational
weight gain counselling gaps as perceived by pregnant women
and new mothers: Findings from the electronic maternal health
survey. Women Birth 2020;33:e88-e94.
26. Phillips KP, O’Sullivan TL, Dow D, Amaratunga CA. Infectious
respiratory disease outbreaks and pregnancy: Occupational health
and safety concerns of Canadian nurses. Prehosp Disaster Med
2011;26:114-21.
27. Heaman MI, SwordW, Elliott L, Moffatt M, Helewa ME, Morris H,
et al. Barriers and facilitators related to use of prenatal care by
inner-city women: Perceptions of health care providers. BMC
Pregnancy Childbirth 2015;15:2.
28. Tarasoff LA. Experiences of women with physical disabilities
during the perinatal period: A review of the literature and
recommendations to improve care. Health Care Women Int
2015;36:88-107.
29. Mitra M, Long-Bellil LM, Smeltzer SC, Iezzoni LI. A perinatal
health framework for women with physical disabilities. Disabil
Health J 2015;8:499-506.
30. Di Lallo S. Prenatal care through the eyes of Canadian Aboriginal
women. Nurs Womens Health 2014;18:38-46.
31. Roth LM, Henley MM, Seacrist MJ, Morton CH. North American
Nurses’ and Doulas’ Views of Each Other. J Obstet Gynecol
Neonatal Nurs 2016;45:790-800.
32. Avery MD, Bell AD, Bingham D, Corry MP, Delbanco SF,
Gullo SL, et al. Blueprint for advancing high-value maternity care
through physiologic childbearing. Executive Summary. J Perinat
Educ 2018;27:130‑4.
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