Prenatal education : its impact on second stage breathing

An observational study of the impact of prenatal education on the conduct of second stage labour was conducted in the Grace Hospital Low-Risk Labour and Delivery Module. The study participants, 35 prenatal class attenders and 15 non-attenders, were recruited following admission to the hospital during the first stage of labour. Data were collected utilizing three data collection tools: a Childbirth Observation Instrument; a Medical Record Data Form; and, a Postpartum Interview. Findings indicated that the majority of women in the prenatal attender group (74.3%) were English speaking and Caucasian, while the majority of women in the non-attender group (73.3%) were of Asian descent and did not have English as their main language. Fifteen (42.9%) in the prenatal group, and 3 (20%) in the non-attender group received epidural anesthesia during the first stage of labour. Eighteen (51.4%) of the attenders and 4 (26.6%) of the non-attenders required intervention (delivery by forceps or caesarean section); The majority (12 attenders and 2 non-attenders) received epidural anesthesia during the first stage of labour. The majority (62.9% and 66.7%) of attenders and non-attenders used Valsalva pushing throughout the second stage; with 37.1% and 33.3% respectively using spontaneous pushing. Overall 72% of the women were always instructed to use the Valsalva Maneuver and 28% received conflicting guidance (spontaneous and Valsalva), when verbal instructions were given. Two prenatal attenders attributed the breathing techniques used to information received during prenatal classes. Four of the 5 non-attenders who used spontaneous pushing did so because they chose to ignore directions to use Valsalva pushing and used a spontaneous pushing approach. The findings failed to detect a significant difference in the study population due to the limited sample size. The overall second stage duration was 70.4 minutes for attenders and 71.6 minutes for non-attenders. For those women who used spontaneous pushing for the majority of their contractions the second stage was 75.6 minutes and 81.3 minutes respectively; and, 68.3 minutes and 68.0 minutes for those using Valsalva pushing. Apgar scores were the same for both groups —20% scored less than seven and 80% with a score of seven or more at one minute after delivery. Since the study results failed to show that prenatal classes have a significant impact on the conduct of second stage, there is a need for more discussion of the effects of the Valsalva maneuver during prenatal classes and a need for greater emphasis and practice of 'tools' which can be used in coping with second stage contractions.Medicine, Faculty ofPopulation and Public Health (SPPH), School ofGraduat