Background
Methods
Setting
Description of the potential content on pregnancy, labor, birth, postpartum and childrearing
Prioritisation of topics using the Delphi method
Seeking consensus among experts: the nominal group technique
- Eight healthcare professionals (2/3 of participants), who had at least 10 years of clinical experience and carried out their work in Basque Country, except in the case of home births:
- Three primary care midwives, directly involved in the care of women during pregnancy, the postpartum period and childrearing, and in maternal education;
- Two specialized-care midwives working in a hospital setting, involved with care of women in the delivery suite and after the birth until hospital discharge;
- One midwife with experience in home births;
- One hospital-based postpartum nurse, an expert in breastfeeding; and.
- One primary care pediatrician;
- Four experienced non-health professionals (1/3 of participants), who offered a point of view that is closer to that of a recipient of maternal education, with an additional broader focus from their professional perspective and their own experience as mothers:
- One journalist specializing in maternity issues who writes for a national publication;
- Two individuals specializing in Information Technology (IT) applied to the promotion of maternal breastfeeding who had developed an online tool (www.lactapp.es);
- One representative of a nationwide association, called “El parto es nuestro” (meaning “Birth is ours” in Spanish), which seeks to improve the conditions of care for women and children during pregnancy, labor, birth and the postpartum period in Spain (www.elpartoesnuestro.es).
Results
Description of the potential content on pregnancy, labor, birth, postpartum and childrearing
Prioritisation of topics using the Delphi method
Experts | No. of questionnaires sent, 1st round | No. of questionnaires received, 1st round (= sent, 2nd round) | No. of questionnaires received, 2nd round | Final response rate % | |
---|---|---|---|---|---|
Health professionals | Midwives | 70 | 38 | 23 | 32.9 |
Obstetrician/gynecologists | 13 | 10 | 9 | 69.2 | |
Pediatricians | 16 | 6 | 6 | 37.5 | |
Pediatric nurses | 18 | 4 | 4 | 22.2 | |
Non-health professionals | Women’s association representatives | 42 | 15 | 10 | 23.8 |
State school staff | 0 | 0 | 0.0 | ||
Private sector school staff | 107 | 5 | 2 | 1.9 | |
Nursery staff | 46 | 1 | 0 | 0.0 | |
TOTAL | 356 | 79 | 54 | 15.2 |
Topic | Number of participants who Scored 0–6 | % of Participants |
---|---|---|
74.- Infants with behavioral problems. | 11 | 20.3 |
76.- Twins. | 11 | 20.3 |
75.- Food allergies. | 12 | 22.2 |
20.- Adolescent mothers. | 13 | 24.0 |
25.- Difficulties conceiving. | 13 | 24.0 |
36.- Fetal defects and abnormalities. | 13 | 24.0 |
35.- Miscarriage. | 14 | 25.9 |
17.- Sexually transmitted infections. | 14 | 26.4 |
13.- The family. | 15 | 27.7 |
14.- Social and community support. | 15 | 27.7 |
18.- Motherhood as a single parent. | 15 | 27.7 |
19.- Families with same-sex parents. | 15 | 27.7 |
11.- Body changes related to reproduction. | 16 | 29.6 |
39.- Intrauterine growth restriction. | 16 | 29.6 |
26.- Sterility/infertility treatment. | 17 | 31.4 |
34.- Ectopic pregnancy. | 21 | 38.8 |
24.- Pregnancy testing: when and how. | 23 | 42.5 |
Topic | Participants who Scored ≥7 | % | Participants who Scored ≥8 | % |
---|---|---|---|---|
1.- Healthy diet. | 54 | 100.0 | 41 | 75.9 |
4.- Strengthening the pelvic floor. | 52 | 96.30 | 44 | 81.4 |
5.- Smoking. | 51 | 94.44 | 44 | 81.4 |
6.- Drinking alcohol. | 50 | 92.59 | 44 | 81.4 |
27.- Normal signs and symptoms of pregnancy. | 52 | 96.30 | 39 | 72.2 |
30.- Medical check-ups and tests. | 52 | 96.30 | 39 | 72.2 |
31.- Fears and concerns during pregnancy. | 53 | 98.15 | 38 | 70.3 |
43.- Recognizing the onset of labor. | 53 | 98.15 | 47 | 87.0 |
44.- Care during labor and birth. | 54 | 100.0 | 50 | 92.5 |
47.- Childbirth in a hospital/clinic. | 51 | 94.44 | 44 | 81.4 |
48.- Options for pain management during labor and birth. | 54 | 100.0 | 50 | 92.5 |
49.- Fears and concerns about the birth. | 53 | 98.15 | 47 | 87.0 |
55.- Stimulating labor. Induction of labor. a(Total n = 53) | 51 | 96.23 | 33 | 62.3 |
57.- Normal signs and symptoms after the birth. | 54 | 100.0 | 51 | 94.4 |
58.- Care and check-ups after the birth. | 54 | 100.0 | 48 | 88.8 |
59.- Fears and concerns postpartum/postnatal problems. | 52 | 96.30 | 45 | 83.3 |
60.- Complications that may develop after the birth. | 53 | 98.15 | 45 | 83.3 |
61.- Initiating, establishing and maintaining breastfeeding. | 54 | 100.0 | 52 | 96.3 |
62.- Potential problems with breastfeeding and solutions. | 54 | 100.0 | 52 | 96.3 |
65.- Characteristics of a normal newborn baby. | 53 | 98.15 | 45 | 83.3 |
66.- Healthcare for newborns in the first hours. | 53 | 98.15 | 44 | 81.4 |
67.- Looking after a newborn baby. | 51 | 94.44 | 45 | 83.3 |
68.- Fears and concerns about looking after a newborn baby. | 52 | 96.30 | 44 | 81.4 |
70.- Prevention of accidents and first aid. | 52 | 96.30 | 41 | 75.9 |
Seeking consensus among experts: the nominal group technique
Session 1: topics related to maternity, pregnancy and childbirth
“For me, topics 48, 49 and 46 should be considered together, and as a midwife, I’m unable to talk about them separately: it’s all to do with supporting normal physiological childbirth” (G)
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Nutrition was mentioned but always together with lifestyle, which was mentioned eight times:
“It doesn’t seem possible to me to talk about nutrition without mentioning alcohol, or exercise without mentioning smoking” (G)
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Similarly, the normal signs of pregnancy were grouped with resources for change management, and the building of skills at this stage, mentioned by seven participants.
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Signs of the onset of labor were mentioned by two participants.
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Participants considered a topic covering the development of a birth plan and related decision-making to be a very important topic, which involved knowing the options available and taking responsibility, this being mentioned by eight people:
“… choice of the type of birth, development of a birth plan (a template being given to women between weeks 28 and 32 of pregnancy); people’s rights and duties, informed consent. It is important that best practice indicators are clear” (E).
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The topic of pain management during labor and birth, existing options and empowerment at this stage was mentioned by eight people:
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Resources available in the community was mentioned twice.
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Care for immigrants and fear of giving birth were mentioned by one participant each.
Session 2: topics related to the postpartum period, breastfeeding and newborn care
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On six occasions, the normal symptoms of the postpartum were mentioned, frequently in conjunction with care and rehabilitation of the pelvic floor, which was mentioned by five participants. The ‘baby blues’ were also mentioned:
“We talk more about the physical aspects, but we women don’t talk about what we feel after giving birth and you feel like you’re going crazy… it turns out that we are all in the same boat and that it doesn’t usually last long, but it seems like it’s more stigmatized if you look for help …” (E)
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All the participants considered the initiation of breastfeeding to be very important, in many cases without being able to separate it from the establishment of breastfeeding. They talked particularly about the fact that the information should be given at the right time, observing the lack of effectiveness of this information if the woman is not actually breastfeeding.
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Solving of the most common problems during breastfeeding was mentioned by seven participants:
“They feel accompanied by midwives during pregnancy but afterwards they feel abandoned, because pediatricians also care for the baby, and of course… that’s all very well… but all their needs… We joke that breasts are left in no-man’s land”.
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While three participants mentioned the topic of describing what a normal newborn baby is like, nine participants referred to the topic of “looking after a newborn baby”, stating that the information on care involved already having information about what could be considered normal, thereby linking the two topics.
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Two participants mentioned supplementary feeding of newborn babies, and the following topics were mentioned once: perinatal grief and mourning, nonviolent communication, the role of the father, searching for support, problems with the extended family, bottle feeding, community resources and care for mild infant illnesses.
Session 3: Selection of the 5 highest priority topics for maternal education
Topic | Score | % of total score awarded |
---|---|---|
Initiating, establishing and maintaining breastfeeding. Common problems and potential solutions. | 50 | 27.7 |
Choice of the type of birth, making decisions: The birth plan | 44 | 24.4 |
Normal signs and symptoms after the birth/care and check-ups/pelvic floor rehabilitation | 31 | 17.2 |
Diet (always mentioned together with a healthy lifestyle) | 24 | 13.3 |
Options for pain management during labor and birth | 14 | 7.7 |
Characteristics of a normal newborn/looking after a newborn baby | 12 | 6.6 |
Normal signs and symptoms of pregnancy | 3 | 0.0 |
Social and community support | 2 | 0.0 |