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Before we begin. The importance of antenatal

education
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12 Antenatal education

April 2012 THE PRACTISING MIDWIFE

Before we begin. The importance

of antenatal education
Mary Nolan introduces a series of
articles on preparation for birth
and beyond about a new
antenatal education programme

SUMMARY A review of the impact of universal antenatal education

found that group based programmes which promote the transition to
parenthood by focusing on relationships (between the couple and with
the baby), and which are participative and build social support, are most
likely to be effective (McMillan et al 2009). An Expert Reference Group
convened by the Department of Health has designed a Preparation for
Birth and Beyond programme to incorporate the evidence about what
works and which draws on neurology, sociology and psychology
including theories about fetal programming, social capital, self-efficacy,
adult learning and health promotion. Learning from the Family Nurse
Partnership, the PBB programme builds on parents strengths and their
intrinsic motivation to be the best parents they can for their children.
Keywords Antenatal education, groups, Birth and Beyond, themes
Author Mary Nolan, Professor of perinatal education at the University of
Worcester

n recent years, antenatal

education has become the poor
relation of pregnancy care.
Women in some parts of the
country have found that there is no
antenatal education provision at all,
and in other areas, that classes are
limited to one or two in very late
pregnancy and not available at all to
second timers, even if its the first baby
for their partner (Nolan 2008).

We need antenatal education

Yet supporting mothers and fathers
across the transition to parenthood
through information sharing and
network building has been on the
government agenda for several years
now. In 2008, the Child health
promotion programme (Department of
Health (DH) 2008) emphasised the need
for support for mothers and fathers,

Adverse experiences
can have a profound
effect on how children
are emotionally wired
and so influence their
future ability to
empathise with other
people

especially those entering parenthood

for the first time, and to promote stable
positive relationships within new
families. A year later, the Government
promised to develop a new preparation

for parenthood programme which

would improve access to high quality
antenatal education from early
pregnancy onwards (DH 2009).
Recognition that childrens life
chances are strongly related to the kind
of parenting they receive informed
Labour MP, Frank Fields Independent
review on poverty and life chances (DH
2010), which claimed that good
parenting could compensate for lack of
material advantage. The need to
support mothers and fathers in their
vital task of bringing up the next
generation of citizens was echoed in
Early intervention, the next steps (DH
2011). This Report by Graham Allan, MP
for Nottingham North, drew on the
latest thinking in neuroscience and
developmental psychology and
suggested that, in the period between
birth and three years, neglect, the

Antenatal education 13

wrong type of parenting and other

adverse experiences can have a
profound effect on how children are
emotionally wired.

The impact of life before birth

Exciting and challenging scientific
research underpins this renewed
interest in supporting mothers and
fathers to provide the best possible
physical and emotional environment for
their unborn and newborn babies.
Research carried out over the last 20
years suggests that the fetuss brain is
sculpted not only by its genes, the
oxygen it receives in the womb and the
nutrients which cross the placenta, but
also by the mothers state of mind.
Researchers have found possible effects
of the mothers mood on placental
function (Sarkar et al 2008).

The impact of early experiences

The new babys and young childs brain
development is influenced by the social
network of which they are a part (a
network created primarily by the
parents) as well as by their genetic
heritage, toxins in their environment
(such as smoke) and the food they are
given. A body of evidence supports the
theory that cortisol is toxic to growing
brain cells, so that if a mother is very
stressed while pregnant, and
unsupported, in conflict or depressed
after her baby is born, her baby is more
likely to have emotional and cognitive
problems (Harold et al 2007, Talge et al
2007). The experiences that babies have
in the first two or three years of life
interact with their genes to determine
the architecture of their developing
brain (Shonkoff and Phillips 2000).

The impact of parental

relationships
If relationships build the brain and the
key relationships in a babys life are
those with parents, the importance of
looking after the mother and fathers
relationship with each other and with
their baby is self evident. The

Preparation for birth and beyond (PBB)

programme was therefore designed to
help pregnant mothers and fathers
anticipate the changes in their lives and
relationships that a new baby will
bring, and develop strategies for coping
with the inevitable stresses and strains
of becoming a parent.

Getting the right support

There has been some disquiet
expressed that the findings of
neuroscience will be used to blame
parents for any and every intellectual
and social problem that their children
may experience. However, the PBB
programme is based on the principle
that the overwhelming majority of
parents want to do their best for their
children, that they are the people who
know what is good for their families,
and that the onus is not on them to
perform better but on communities
and services to support them more
effectively in the critical job they are
undertaking.

Themes
The PBB programme is set out in six
themes. Under each theme is a menu of
topics, and topics are selected at any
particular PBB session in response to
the needs and interests of the mothers
and fathers present. The relationship of
each topic to the six themes is made
clear in the way the facilitator leads the
session. The themes are:
to know my/our unborn baby
Getting
Changes
for me and us
Giving birth
our baby
My/our healthandandmeeting
well
being
Caring for my/our baby
Who is there for us? People and
services
One of the topics for a PBB session
might be How smoking affects my
unborn baby. This can be related to the
theme of Changes for me and us (what
changes am I prepared to make in my
life to become the parent I want to be?);

The new babys and

young childs brain
development is
influenced by the social
network of which they
are a part

to the theme of Giving birth (does

smoking in pregnancy really make birth
easier?); to the theme of Caring for
my/our baby (what does my/our baby
need to be healthy and happy?); to the
theme of My/our heath and well being
(healthy lifestyles) and to the theme of
Who is there for me/us (where can I get
help to cut down or quit smoking?).

PBB Theme 1
GETTING TO KNOW MY/OUR
UNBORN BABY
This is all about building the
relationship between the mother and
father and their baby in the womb,
exploring how the babys world is
created by the mother and how her joys
and fears are shared by the baby in a
very real way through the hormones
she releases. Its important to stress
that this theme is not about making
mothers feel bad about their lifestyles
or worried about being worried! Its
much more a question of giving
mothers permission to take care of
themselves, to relax and to take time to
think about their baby. The same is true
for fathers PBB puts fathers centre
stage with mothers, acknowledging
that for the majority of women, their
main source of support and of
wellbeing is their partner. Fathers are
invited to explore their relationship
with their unborn baby, to learn about
how the baby is developing in the
womb and how the baby will recognise
him when she or he is born.

THE PRACTISING MIDWIFE April 2012

14 Antenatal education

Next time
The next article in this series will
explore the second PBB theme, Changes
for me and us. In the meantime, you
can visit the DH website and explore
the PBB resource pack at www.dh.gov.
uk/en/Publicationsandstatistics/Publica
tions/PublicationsPolicyAndGuidance/
DH_130565 which is aimed at anyone
involved in planning or running groups
for expectant or new parents, such as
midwives, health visitors, childrens
centre staff and voluntary
organisations. TPM

April 2012 THE PRACTISING MIDWIFE

analysis. Journal of Child Psychology and

The onus is not on them

to perform better but
on communities and
services to support
them more effectively
in the critical job they
are undertaking

Psychiatry, 48(12): 223-231.

Nolan M (2008). Antenatal survey (1): what do
women want? The Practising Midwife, 11(1):
26-28.
McMillan AS, Barlow J and Redshaw M (2009).
Birth and beyond: a review of the evidence
about antenatal education, Warwick:
University of Warwick.
Sarkar P, Bergman K, OConnor TG et al (2008).
Maternal antenatal anxiety and amniotic
fluid cortisol and testosterone: possible
implications for foetal programming. Journal
of Neuroendocrinology, 20: 489-496.
Shonkoff J and Phillips D (2000). From neurons

Mary Nolan is Professor of perinatal

health, London, DH.

education at the University of Worcester

DH (2010). Independent review on poverty and

References

DH (2011). Early intervention, the next steps

life chances (Field report), London: DH.

DH (2008). Child health promotion programme,
London: DH.

(Allan Report), London: DH.

Harold GT, Aitken J and Shelton KH (2007).

to neighbourhoods: the science of early

childhood, New York: National Academies
Press.
Talge NM, Neal C and Glover V (2007). Antenatal
maternal stress and long-term effects on
child neurodevelopment: how and why?

DH (2009). Healthy lives, brighter futures: the

Inter-parental conflict and childrens

Journal of Child Psychology and Psychiatry,

strategy for children and young peoples

academic attainment: a longitudinal

48(12): 245-261.