Original Title: Rediseño de la educación maternal: propuesta de un marco para la elaboración de un programa de educación para la salud y preparación al nacimiento efectivo y centrado en las necesidades de las mujeres

Authors' objectives: Seek the agreement of experts as to the contents of a new kind of maternal education based on the health needs of women, and analyse the different theoretical and strategic models of maternal education that might respond to such needs.

Authors' results and conclusions: Women report anxiety or fear for different reasons during their pregnancy (adequate foetal development), and during birth (pain), about the care of their child (to do “the right thing”) or breast feeding. They demand that the father be included in the entire process and that care be provided on a continuous basis, beyond the birth. They request rigorous, useful information and greater flexibility in ME methodology (timetables, formats of sessions, etc.). According to Education for Health models, the timeliness of the intervention, the involvement/negotiation of/with the individual and social support are essential variables to achieve healthier conducts. These theoretical models of maternal education state that the perception of self-efficacy and availability of tools to manage pain bring about considerable improvements in the mother’s level of satisfaction. Ten areas of improvement have been identified with regard to (1) the individualised aim of ME, (2) assessment of the needs of women/families, (3) maternity as a physiological process, (4) participation of fathers, (5) support networks, (6) continuity of postpartum care, (7) accessibility of midwives, (8) training of midwives, (9) format and content of ME and (10) coordination between professionals at different levels of health care. The aim proposed for the new ME is to instruct women from different backgrounds on how to take the appropriate decisions for their needs and circumstances, allowing them (1) to improve their own health and that of their family, (2) choose, decide and confront the maternity-paternity model in a responsible manner (3) use health and community resources adequately, create and maintain support networks. CONCLUSIONS AND RECOMMENDATIONS The maternal education proposed in this document sets out to increase the capabilities of women and their partners to manage their own health and that of their family, and especially of their child. This must be seen against the background of a general vision of health promotion, integrated with other health or community services with a similar objective: acquisition of healthy habits, promote the greater autonomy of women and their partners in taking decisions, improve their skills in the care of children and elimination of bad habits. It begins with the assessment of the needs of each woman and generates an educational programme focused on her own needs, beginning with the preconception consultation and lasting throughout the postpartum period. It helps couples to choose their own birth and upbringing model and to accept their responsibilities in the face of a range of different decisions that involve directly in their roles as mothers and fathers. It favours the use of resources and the setting up of support networks. In order to achieve these objectives, maternal education must have a reference professional (midwife) and use formats and resources adapted to the way of life of modern women and, lastly, to evaluate their results on a permanent basis. To achieve this, the modelling proposed for the intervention is a bottom-up process. The main actors in this process must identify the specific needs of their centres, assess the priority, feasibility and applicability of innovating strategies and of their effectiveness in the specific context, with the aim of adapting these to the real circumstances of their centres. The process of implementation should follow an action strategy organised at several levels, from the individual to the organisation and the community. With regard to the assessment, this should pay attention both to the effectiveness for women and on the feasibility of introducing this in populations and its maintenance over time. The application of an education model for health and preparation for birth such as the one proposed here, needs to be adapted to the context and requires the cooperation of researchers, health professionals and those responsible for services, as well as a coordination between the health system and the community

Authors' methods: Based on the model proposed by the Medical Research Council for the pre-clinical stage of the design and assessment of complex interventions: 1) a review was made of the current understanding of the needs of women with regard to maternity. 2) the study was carried out on four focus groups, taken from different socio-economic levels, of expectant mothers and postpartum women following the birth of their first child. An analysis was made of their perceptions with regard to the maternity process, the health system, etc. 3) 7 structured sessions were organised with a group of experienced professionals at different stages in this process to analyse the theoretical and strategic models of maternal education that might respond to the needs detected in the study. Finally, a new proposal for maternal education was agreed.

Project Status: Completed

Year Published: 2013

URL for published report: https://www.euskadi.eus/contenidos/informacion/2013_osteba_publicacion/es_def/adjuntos/Informe%20D-13-07.pdf

English language abstract: An English language summary is available

Publication Type: Other

Country: Spain

Organisation Name: Basque Office for Health Technology Assessment

Contact Address: C/ Donostia – San Sebastián, 1 (Edificio Lakua II, 4ª planta) 01010 Vitoria - Gasteiz

Contact Name: Lorea Galnares-Cordero

Contact Email: lgalnares@bioef.eus

Copyright: Osteba (Basque Office for Health Technology Assessment) Health Department of the Basque Government