In this study, we used an interpretative phenomenological research design to explore, from the perspective of healthcare providers, how effectively childbirth education classes impact mothers’ stress and anxiety levels, the rate of cesarean sections, the overall quality of care, and the provision of a positive childbirth experience. The findings included a core category of Road to a Pleasant and Safe Journey with Three themes: mother’s experience, roles, obstacles, and struggles of healthcare providers, and solutions & suggestions. The analysis yielded themes that provide insight into how healthcare providers’ perceptions of childbirth education classes relate to experiences of childbirth, and quality of care. The findings show that the participants were aware of the importance of the childbirth education in relation to quality of care and positive childbirth experience.
The first theme explores the impacts of healthcare professionals and childbirth education.
on mothers’ experiences. This theme is divided into three subthemes: Positive Experiences of Mothers, Negative Experiences of Mothers, and How Healthcare Providers Influence the Birthing Process. The first subtheme explores the positive impacts of childbirth education and emotional support on helping women during the childbirth to have enjoyable, and safe experience. The second explores the effectiveness of childbirth education among mothers who previously had difficult childbirth experiences. The third considers the significance of the role of healthcare providers in influencing how mothers experience childbirth. During the interviews, healthcare workers emphasized the substantial impacts of both childbirth education and healthcare professionals on how mothers experience the pregnancy and childbirth journey and on how a safe and fulfilling delivery is achieved.
According to the healthcare providers who participated in this study, childbirth education allows women to have a safe and happy experience during childbirth. Providing emotional support also contributes to positive outcomes. Healthcare professionals typically assert that childbirth should be a rewarding life event, suggesting that negative experiences of childbirth are caused by a lack of childbirth education. They also underlined the importance of their own role in supporting mothers during pregnancy and childbirth.
Similar to the experiences shared by the healthcare providers who participated in this study, Jan and Teijlingen [28] found that births that meet the International Confederation of Midwives’ definition of “normal occur when labor begins, progresses, and ends naturally; the baby is delivered at full term in the vertex position; and no medical, pharmacological, or surgical.
interventions are used.
Preset study’s findings align with those of Demirci et al. [29] and Yasin et al. [30] who found that all women struggled to have a normal birth and thus required prenatal education and emotional and psychological support from partners, family members, or healthcare professionals. Normal births and positive childbirth experiences also required good care during labor and a healthy environment.
Leinweber et al. [31] highlighted that a positive childbirth experience refers to a woman’s experience of interactions and events directly related to childbirth that make her feel supported, in control, safe, and respected; a positive childbirth can make women feel joy, confident, or accomplished and may have short- or long-term positive impacts on their psychosocial well-being [31]. AlKhunaizi et al., [32] Pointed out that some clear policies, childbirth education programs, and adequate space are essential for promoting labor companionship during childbirth to ensure a positive experience.
Mwakawanga et al. [33] asserted that prenatal health education and post-birth health messaging after hospital release might encourage favorable childbirth health outcomes for the mother and her child. High-quality intrapartum care should consider not only the mother’s physical and mental capabilities but also her sense of safety throughout the birthing [33]. Taheri et al. 2018 [34] found that providing emotional support and gentle intrapartum care, as well as encouraging mothers to be mentally and physically prepared for delivery, were the most effective ways to ensure a happy birth experience. Moreover, the researchers suggested that women should be engaged in childbirth education classes and provided with knowledge of the labor process to ensure a happy birth experience [34].
Healthcare providers reported inadequate administrative support from their colleagues and organizations, which impaired their ability to communicate and work together effectively. For example, midwives and labor and delivery nurses often felt helpless when advocating for women, and healthcare providers frequently felt guilt and self-blame after adverse events [35].
The second theme, roles, obstacles, and struggle of healthcare providers, highlights the attitudes of healthcare providers toward childbirth education classes’ promotion of natural childbirth and notes the negative attitude of certain obstetricians toward the classes, along with issues of access to these classes caused by obstetricians. Ten sub-themes are included under the main theme: Community Awareness, Mother’s Cultural Background, Staff Language Barriers, Staff Shortages, Access to Childbirth Education, Physical and Emotional Support, Attitudes, Responsibility, Teamwork, and Training. In addition, there is a need to raise community awareness of childbirth education and the importance of supporting mothers throughout pregnancy and childbirth while concurrently tackling staff shortages and language barriers. The healthcare providers also highlight the importance of considering mothers’ cultural backgrounds and the effects on the introduction and management of childbirth education programs.
The healthcare providers in this study indicated Community Awareness as a sub-theme. Similar to the experiences shared by the healthcare providers, Dantas et al. [36] suggested including communities in the process of childbirth education to help women overcome the barriers to safe delivery. Additionally, impediments may originate from within the community itself, such as a lack of awareness or encouragement for women to start preparing for motherhood [36]. In this study, the Mother’s Cultural Background sub-theme was raised by the healthcare providers.
Cultural background including practices, beliefs, and traditions also has a significant impact on the location of delivery, and the likelihood of home delivery increases as a result of cultural beliefs and practices of women influencing home births [15, 16]. The harmful cultural practices includes the food restriction and taboos, abdominal and uterine massage, home delivery were significantly linked to factors such as a woman lacking education, living in a rural area, not receiving antenatal care during her most recent pregnancy, and having an untrained attendant care for her during her pregnancy [14]. Chanimbaga et al. [37] conducted a study that highlighted the urgent need for community health education programs. These programs should focus on raising awareness about the impacts of traditional practices, such as restricting food intake during pregnancy and the insufficient use of skilled birth attendants. By addressing these issues, the aim is to improve maternal well-being within the study population.
Moreover, the researchers found that problems persist with regard to providing affordable, culturally sensitive birthing care. Removing such obstacles may improve labor and delivery outcomes for mothers and their newborns [38].
The healthcare providers who participated in this study highlighted the Staff Shortage subtheme as having a negative impact on childbirth education. Bogren et al. [39] found that professional barriers include heavy workloads and a shortage of staff, who are also not utilized to their full potential within the health system. Another Study found midwives reported barriers to women’s positive childbirth experience were identified on healthcare system factors included midwife shortage and hospital environment [39].
With regard to the Access to Childbirth Education sub-theme, most of the healthcare providers in this study observed a lack of access to childbirth education classes. Darling et al. [40] provided evidence that a lack of information about midwifery within social networks and a propensity to move passively through the healthcare system, which typically prioritizes physician treatment, may worsen inequitable access to midwifery care for persons of low socioeconomic status. Koh et al. [41] found that couple-centered prenatal education programs are helpful for couples adjusting to parenting, which is further supported by the results of previous studies Baraki et al. [42]; Doaltabadi et al., [43]; Munkhondya et al., [3]; Sanaati et al., [44].
The healthcare providers also raised the Physical and Emotional Support sub-theme. Koh et al. [41] found that it is critical to educate spouses about couple-relationship adaptation, including emotional connection, support, respect, empathy, and emotional interchange, following pregnancy and delivery. Moreover, prenatal education should emphasize male engagement and healthy lifestyles for pregnant women to lower the risk of pregnancy and delivery difficulties, as evidenced by Gultie et al. [45], Sufian et al. [46], Tunkara-Bah et al. [47], and Worku et al. [48]. Monguilhott et al. [49] found that the presence of supportive family members during labor and delivery was linked to positive outcomes with successful birth stories that end with healthy mothers and babies. The researchers found that male participation in normal prenatal and intranatal care improved labor and delivery outcomes. Male education on the value of participating reproductive and child health services is crucial in enhancing the birth experiences [50].
In this study, the Staff Attitude sub-theme was raised by the healthcare providers when they explained the obstacles of childbirth education classes. McCauley et al. [51] found that most healthcare practitioners assist women and improve the quality of pain treatment by using a culturally and religiously sensitive approach. The healthcare providers who participated in this study highlighted the sub- theme: Responsibility of healthcare provider, as the healthcare provider is responsible for improving mothers’ experiences during childbirth. According to González-Mesa et al. [52], educational measures should be implemented for obstetricians to improve their interactions with pregnant women. Moreover, medical staff should reconsider how they engage with expectant mothers to enhance the quality of care they provide and to make the birthing process more pleasant and humane for everyone involved [53]. Baranowska et al. [54] highlighted the necessity of verbal and nonverbal communication of healthcare providers with women during the delivery and early postpartum stages, as well as the distinct nature of the communication demands at these two stages. Additionally, prenatal education for women is necessary for them to have a normal delivery, and increasing the authority and duties of midwives is one way to promote normal birth. For the delivery to go according to plan, the mother and the midwife should both be more prepared [29].
With regard to the Teamwork sub-theme, most of the healthcare providers in this study observed a relationship between teamwork among the healthcare providers and the effectiveness of childbirth education classes. Researchers have shown the need for both formal and informal support for effective interprofessional cooperation and have highlighted the need to foster relationships based on trust and respectful communication in maintaining a safe workplace and delivering safe maternity care [55]. These results were corroborated by Kamkhen et al. [56], who demonstrated the pressing necessity of integrating team building into the routines of obstetric-gynecological healthcare providers. The competence and communication skills of nurses and midwives may be greatly improved, with a greater focus on enhancing prenatal appointment processes and providing continual professional training [57].
Improvements in pre- and post-training knowledge, confidence, and empowerment, as well as at the 12-week mark after the intervention, were made possible by the provision of training packages in these areas [58]. Moreover, to increase midwives’ familiarity with prenatal exercises and improve their interactions with pregnant women during prenatal consultations, Okafor and Goon [59] argue for the inclusion of exercise courses in antenatal healthcare and education for midwives about suitable exercises.
Third theme in the Suggestions and Solutions theme, healthcare providers proposed ideas for improving the quality of care and enabling a positive childbirth experience. This theme included five subthemes: Standardized Childbirth Education Program, Childbirth Education Publicity, Promoting Childbirth Education Classes, Developing the Quantity and Quality of Childbirth Education, and Improving Quality of Care. The providers suggested that significant changes should be made to existing childbirth education programs and recommended the introduction of a standardized childbirth education program, advising that this would benefit both mothers and healthcare providers. Healthcare providers also suggested that childbirth education programs should be widely publicized in the community, indicating that this would not only raise awareness among mothers and their families about the importance of these programs but also enhance mothers’ experiences and result in improved quality of care.
The healthcare providers in this study identified the Standardized Childbirth Education Program as a sub-theme. Ricchi et al. [60] found that women who had taken birthing classes were less likely to have epidural analgesia. The birthing class participants were also likelier to use breathing methods and to benefit from visualization exercises. Moreover, the women sought opportunities to connect with people in similar circumstances to share experiences, vent, and form lasting bonds; partner participation in the process of becoming parents was perceived as enhanced by these classes [61]. In this study, the Improving Quality of Care sub-theme was also raised. Khosravi et al. [62] recommend that health officials should prioritize the expansion of midwifery education and the hiring of qualified midwives to enhance the standard of care they provide to expectant mothers. Moreover, in line with previous studies, Kassaw et al. [63] found that it may be possible to improve treatment quality by promoting targeted prenatal care, expanding related infrastructure, supporting maternal education, and covering the medical expenditures of women from low-income families.
Strengths and limitations
This study has several strengths. It addresses the question of information needs regarding the perspective of healthcare providers, how effectively childbirth education classes impact mothers’ stress and anxiety levels, the rate of cesarean sections, the overall quality of care, and the provision of a positive childbirth experience in three governmental hospitals and the participants had exclusive experience of childbirth education. The qualitative approach allowed for a deeper and more understanding of the perceptions of healthcare providers as they provided during the interviews.
Some participants expressed concerns about being recorded when sharing their thoughts. To resolve this, we confirmed that their data would be kept confidential and reviewed only by the research team members. Additionally, we confirmed that all data would be deleted upon full completion of the study. Further, as qualitative research relies on participants’ experiences and opinions and researchers’ interpretations and subjective judgments, subjectivity and interpretation challenges may be introduced. An interpretative phenomenological approach aims to ascertain individual experiences’ rich details and meanings. In addition, the limited geographical scope is also a limitation and could have introduced bias into the results. However, the researcher minimized such biases as much as possible by recruiting employees from different institutions in the eastern province of Saudi Arabia to work in their current roles for different durations.
Implications and recommendations for practice
Childbirth education should be mandatory for all hospitals and primary healthcare institutions in the kingdom of Saudi Arabia and its curriculum should be standardizing by the ministry of health. Receiving childbirth education about natural and instinctive childbirth was necessary for low-risk mothers to experience a positive childbirth experience. The education also enabled mothers to feel in control during pregnancy, birth, and postpartum. Moreover, childbirth education clinics should be established at all hospitals, each with a certified educator who work in a relevant profession (e.g. health education, nurses, midwives, or physician).
Implications and recommendations for education
The research indicated that the main healthcare professionals involved with the mothers’ pregnancies (physicians, nurses, and midwives) should receive childbirth education as part of their training. This would decrease the likelihood of low-risk mothers choosing an unnecessary cesarean section and increase the likelihood of their having a natural birth.
Implications and recommendations for policy
It is vital that both government and private hospitals have clear and accessible policies about the provision and implementation of childbirth education programs. This will help to limit elective cesareans, increase vaginal deliveries, and enhance mothers’ childbirth experiences.
Implications and recommendations for future research
Very little quantitative evidence exists in Saudi Arabia on the efficacy of childbirth education programs in promoting quality care and positive childbirth experiences. If mothers’ childbirth experiences are to be improved, education programs need first to be properly evaluated under Randomized Control Trials. Only then can their effect on maternity care and birth outcomes be properly understood. Such research should include measures of couples’ preparedness for parenting. Moreover, it is important for future research to include participants with diverse language backgrounds in order to provide valuable insight applicable to different settings. To achieve a more comprehensive understanding future studies should also consider including healthcare providers from various public and private hospitals by conducting research across different healthcare settings would provide further support for the benefits of childbirth education for the women.
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