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Who Attends Prepared Childbirth Classes? A Demographic Study of CEA Classes in Rhode Island
research and studies
Who Attends Prepared
Childbirth Classes? A Demographic Study of CEA Classes in Rhode Island J O E L L E N WATSON, R N , B S N , M S , PhD
Using a registration questionnaire form for prepared childbirth classes, a study was undertaken to compile a socioeconomic profile of parents who attend such classes. The findings show that these couples are primarily well educated, 26 years old or older, are referred to classes by word of mouth or by their physicians, and are employed in professional, technical, or managerial occuputions. The implications of theke findings are discussed.
36
There has been a growth of interest in prepared childbirth in the United States over the past two decades following the introduction of the Lamaze method, and there has been a corresponding increase in the number of organizations offering prepared childbirth classes. An abundance of literature exists about prepared childbirth classes and methods of parent group education, but few longitudinal studies have been undertaken concerning the class participants themselves, i.e., who is served (social data about the participants) and what sources of information lead them to attend classes. Yankauer’s study’ indicated that those attending parents’ classes have a higher educational level and an occupation with more prestige (i.e., professional). The population in his study reflected an over-representation of higher executive and major professional occupations and an under-representation of skilled labor. Those attending classes in his study population also had a greater tendency to breastfeed. The study population chosen by Mann, Woodward, and Joseph’ also represented an overbalance of middle-class groups, judged in terms of occupation and social position. Most of the parents were highly educated, and many were in their late 20’s and early 30’s. Little other relevant material was discovered in professional literature for the past 20 years. It seemed useful, therefore, to investigate the data available o n parents a t t e n d i n g classes offered by the Childbirth Education Association of Rhode Island from its inception in 1968. This study proposed to investigate the characteristics of these parents. Data were collected through May 1973.
would still be represented in those attending class. As was found by Mann, Woodward, and Joseph,’ it was also suspected that most would be in their late 20’s and early 30’s. Rhode Island has eight voluntary, nonproprietary hospitals that provide maternity services, as well as two military hospitals and one hospital providing only maternity and gynecological services. It was suspected, however, that the majority of expectant parents attending classes would be served by the maternity hospital. Classes sponsored by CEA have centered in and around the greater Providence metropolitan area where that hospital is located. It was also suspected that most parents served would live in Providence or its adjacent metropolitan areas: Cranston, Warwick, and Pawtucket. From past experience, the investigator hypothesized that most referrals to classes would come from physicians or by word of mouth. From these observations, nine hypotheses evolved. They are summarized as follows: The majority of parents served by CEA classes 1 ) reside in Providence, Rhode Island, 2) have completed at least 1 year of college, 3 ) are in occupations classified as professional, technical, and managerial, 4 ) are 26 years old and up, 5 ) are referred to CEA by word of mouth, 6) are primigravidas who have not previously attended classes for childbirth preparation, 7) plan to deliver at Providence Lying-In Hospital. 8) N o significant difference exists in the number of couples served in any single calendar month. 9 ) The majority of women enrolled in CEA classes Dlan to breastfeed their babies.
Methods and Materials The CEA classes consisted of a series of five to six informal discussion classes and two to four forEvolution of the Hypotheses mal group lectures dealing with It appeared that the Childbirth pregnancy, fetal development, labor Education Association of Rhode IS- and delivery (based on a modified land, henceforth referred to as CEA, Lamaze technique), the postpartum had begun to serve a greater diver- period, and infant care. The registration questionnaire sity of parents since its inception, with regard to educational level, oc- form generally used for CEA classes cupation, and residence. It was an- was the tool used to obtain the reticipated, however, that an over- quired data (Figure 1). The data balance of middle income, highly were subjected to direct numerical educated, and professional parents computation and computation of March/April 1977 JOCN Nursing
parents would be 26 or older, was supported for the husbands but not for the wives. Two hundred and seventy-seven (45.3%)of the wives were 26 years of age or older at the time of registration for childbirth education classes. Of t h e husbands, 398 (65.1%)were 26 years of age or older at the time of registration. Of the 474 registration forms on which a question concerning mode of referral to CEA appeared, 165 (27%)responded “word of mouth.” An additional 163 listed their physicians as sources of information about CEA classes. Hypothesis 5, therefore, was not supported. (The question was inadvertently left off the other forms.) Of the 611 women, 426 (69.7%) were primigravidas and 185 (30.3%) multigravidas. Sixty-eight couples Results ( 11.1 % ) had attended previous childOf the 611 couples, 274 (44.8%) birth education classes. Hypothesis 6 resided in Providence, Rhode Island. was supported. Of the 611 couples in the study, The first hypothesis, therefore, was not supported. It is of interest to note 495 (81 % ) had chosen Providence that a substantial number of couples, Lying-In Hospital for delivery; 168, resided in areas of Rhode Island therefore, Hypothesis 7 was supported. outside the major metropolitan area. The number of deliveries expected Forty-two of the wives had completed one year of college, 47 had in any calendar month varies from a completed 2 years, 24 had completed low of 33 in September (5.4%)to a 3 years, and 205 were college gradu- high of 63 in May (10.3%).Lower ates. In addition, 97 had attended percentages at the end of the year graduate school. Thus, 415 wives (August through December) reflect, (68%)had completed at least 1 year in part, the termination of the study of college. In addition, 45 were regis- in May 1973, including only those tered nurses (7.4%), five had at- couples who completed their classes tended secretarial school (0.8%),27 within that month. All couples due had technical school education be- in the latter months of 1973 would, yond high school (4.4%),and nine therefore, be excluded from the were licensed practical nurses study. N o single calendar month is ( 1 . 5 % ) . Of t h e husbands, 504 over- or under-represented in the (82.5%)had completed at least 1 data. Hypothesis 8, therefore, was year of college. Of the remaining supported. Of the 611 women in the study, 107, 10 (1.6%)had attended technical school, 17 (2.8%)left the ques- 467 (76.4%)stated that they planned tion blank, and one had been edu- to breastfeed their infants; 100 cated in Europe and did not specify (16.4%)stated that they planned to beyond that. Therefore, Hypothesis bottlefeed their infants; and an additional 26 were undecided at the time 2 was supported. Three hundred and twenty of the of registration for classes (4.3%).Hywives (52.4%)were employed in jobs pothesis 9 was supported. categorized as professional, technical, or managerial. Of the husbands, Summary and Recommendations 329 (53.8%)were employed in proSummary fessional, technical, or managerial Education for childbearing has jobs. The third hypothesis, therefore, undergone a metamorphosis and trewas supported. Hypothesis 4, that the majority of mendous growth in the past decade.
percentages to test the hypotheses. The sample included the 611 parents registered for CEA classes between 1968 and May 1973, whose questionnaire registration forms were available. (Records are kept by individual teachers, and some teachers had moved out of state, taking the records with them.) There were some new programs in the area in which the usual form was not used. Parents in these programs were not included. A system of collating data was set up for each category of data and for each year. The occupational categories chosen for the data were taken from the Dictionary of Occupational Titles.3 Data were transferred to coded sheets and the computed data were then set u p in tables.
March/April 1977 JOCN Nursing
The concepts of active participation in the childbirth experience by both parents have brought about a need for education for this experience. In the void so often left by formal education in secondary schools and institutions of higher education, organizations of parents and professionals such as CEA have attempted to provide this education. It was suspected, however, that only a select segment of the population is being reached by classes and that this segment is highly motivated and education oriented. The purpose of this study was to determine the characteristics of the parents attending CEA classes with regard to residence, age, education, and occupation. The majority of parents who registered for CEA classes resided outside Providence, and a substantial portion (27.5%)resided in areas other than those towns which surround Providence. This is of interest in view of distances traveled for classes and the upper-middle-class communities represented. In spite of place of residence and availability of maternity services in nearby hospitals, most couples chose to deliver at Providence Lying-In. A small but significant percentage, however, chose to deliver in hospitals in locations other than place of residence which offer family-centered maternity services. It can be hypothesized that sharing the experience of childbirth and establishment of the family unit postpartum is sufficiently important to motivate couples to go considerable distances both for preparation for the experience and in seeking hospital services. In the years 1970-1973, a small but significant number of wives and husbands who had not completed high school began to be represented in the class population. The same may be said for representation of occupations other than those classified as professional, technical, and managerial and for younger parents. Most wives enrolled in classes were primigravidas and had not attended any other childbirth classes. Since CEA is a relatively young organization, it is expected and borne out in the data that the number of multigravidas is increasing as more
37
Name
Last
Address
Husband
Street
City
Date
Phone
Home
Due date
Wife State
Zip
Business Doctor
Hospital Wife’s age
0ccupation (past, present, future).
Husband’s age
Occupation
General education (years completed) High school
College
Degree
Other (describe)
Husband Number of pregnancies
History
Number of children
Names and ages
How fed and your reaction
Plans for feeding new baby Have you ever attended any other Childbirth Education Classes? If so, where?
Who referred you to CEA of RI? Com ments:
Figure 1. Registration questionnaire form for Childbirth Education Association of Rhode Island.
38
March/April 1977 JOCN Nursing
parents who attended previous classes are having other children. The majority of mothers had decided to breastfeed their infants, which suggests a correlation between desire for active participation in the birth experience and feeding. It is also perhaps a reflection of the growing acceptability of breastfeeding among the parents served by classes. Word-of-mouth and physician referral are the most common sources of information about CEA, with obvious implications for those individuals or groups offering childbirth classes and seeking means to reach expectant parents. From the growth in numbers of parents attending classes from the inception of the classes in 1968 to the present, it is obvious that, in a time of leveling off of the birth rate, the need and demand for childbirth classes is growing. Since formal classes are the means by which most couples are enabled to share the birth experience (class attendance is required for father participation in most hospitals in the study), it becomes obvious by inference that the number of couples seeking to share this experience is increasing.
Recommendations In view of the findings of this investigation, it is recommended that:
1. An effort be made to reach the majority of expectant parents who are not, at present, being served by childbirth classes in order to determine reasons for nonattendance and to establish education programs to meet their needs. 2. Publicity be directed to reach a maximum number of expectant parents early in their pregnancies. 3. A study be undertaken to investigate the long-term effects, if any, on the family who has experienced a prepared childbirth. 4. A follow-up study be undertaken to determine the utilization of teaching in the actual labor, delivery, and postpartum periods.
United States Department of Labor, Manpower Administration, Bureau of Employment Security, 1965
More detailed data than that presented in the published article is available from the author on request. Address reprint requests to Joellen Watson, RN, PhD, 98 Constitution Street, Bristol, R I 02809.
Joellen Watson is an Assistant Professor at Boston College, where she References took her M S and PhD degrees. Her 1. Yankauer, A. : Pregnancy, ChildB S N is from Northbirth, the Neonatal Period and western University, Expectant Parent Classes. Albany, New York, Bureau of Ma- and she has also attended Oberlin ternal and Child Health, New College and the Chicago Wesley York State Department of Health, Memorial Hospital School of Nursing (diploma). A member of ANA, 1958 2. Mann, D., L. F. Woodward, and APHA, and Sigma Theta Tau, Dr. N. Joseph: Educating Expectant Watson has published articles in Parents. New York, Visiting other professional periodicals and is currently collaborating on a textbook Nurse Service of New York, 1961 3. Dictionary of Occupational Ti- on child development and on two tles: ll, Occupational Classijica- non-sexist children’s books. The aution and Industry Index. Third thor is also a consultant for the edition, Washington, D.C., U.S. Childbirth Education Association of Government Printing Office, Rhode Island.
Childblrth Educaton The ICEA United States Midwest Regional Conference, sponsored by the Maternity Family League, Inc., of Indianapolis, will be held June 23-25 at the Indianapolis Convention Center. For registration materials or further information write Maternity Family League, PO Box 50274, Indianapolis, IN 46250.
March/April 1977 JOCN Nursing
39
Who Attends Prepared
Childbirth Classes? A Demographic Study of CEA Classes in Rhode Island J O E L L E N WATSON, R N , B S N , M S , PhD
Using a registration questionnaire form for prepared childbirth classes, a study was undertaken to compile a socioeconomic profile of parents who attend such classes. The findings show that these couples are primarily well educated, 26 years old or older, are referred to classes by word of mouth or by their physicians, and are employed in professional, technical, or managerial occuputions. The implications of theke findings are discussed.
36
There has been a growth of interest in prepared childbirth in the United States over the past two decades following the introduction of the Lamaze method, and there has been a corresponding increase in the number of organizations offering prepared childbirth classes. An abundance of literature exists about prepared childbirth classes and methods of parent group education, but few longitudinal studies have been undertaken concerning the class participants themselves, i.e., who is served (social data about the participants) and what sources of information lead them to attend classes. Yankauer’s study’ indicated that those attending parents’ classes have a higher educational level and an occupation with more prestige (i.e., professional). The population in his study reflected an over-representation of higher executive and major professional occupations and an under-representation of skilled labor. Those attending classes in his study population also had a greater tendency to breastfeed. The study population chosen by Mann, Woodward, and Joseph’ also represented an overbalance of middle-class groups, judged in terms of occupation and social position. Most of the parents were highly educated, and many were in their late 20’s and early 30’s. Little other relevant material was discovered in professional literature for the past 20 years. It seemed useful, therefore, to investigate the data available o n parents a t t e n d i n g classes offered by the Childbirth Education Association of Rhode Island from its inception in 1968. This study proposed to investigate the characteristics of these parents. Data were collected through May 1973.
would still be represented in those attending class. As was found by Mann, Woodward, and Joseph,’ it was also suspected that most would be in their late 20’s and early 30’s. Rhode Island has eight voluntary, nonproprietary hospitals that provide maternity services, as well as two military hospitals and one hospital providing only maternity and gynecological services. It was suspected, however, that the majority of expectant parents attending classes would be served by the maternity hospital. Classes sponsored by CEA have centered in and around the greater Providence metropolitan area where that hospital is located. It was also suspected that most parents served would live in Providence or its adjacent metropolitan areas: Cranston, Warwick, and Pawtucket. From past experience, the investigator hypothesized that most referrals to classes would come from physicians or by word of mouth. From these observations, nine hypotheses evolved. They are summarized as follows: The majority of parents served by CEA classes 1 ) reside in Providence, Rhode Island, 2) have completed at least 1 year of college, 3 ) are in occupations classified as professional, technical, and managerial, 4 ) are 26 years old and up, 5 ) are referred to CEA by word of mouth, 6) are primigravidas who have not previously attended classes for childbirth preparation, 7) plan to deliver at Providence Lying-In Hospital. 8) N o significant difference exists in the number of couples served in any single calendar month. 9 ) The majority of women enrolled in CEA classes Dlan to breastfeed their babies.
Methods and Materials The CEA classes consisted of a series of five to six informal discussion classes and two to four forEvolution of the Hypotheses mal group lectures dealing with It appeared that the Childbirth pregnancy, fetal development, labor Education Association of Rhode IS- and delivery (based on a modified land, henceforth referred to as CEA, Lamaze technique), the postpartum had begun to serve a greater diver- period, and infant care. The registration questionnaire sity of parents since its inception, with regard to educational level, oc- form generally used for CEA classes cupation, and residence. It was an- was the tool used to obtain the reticipated, however, that an over- quired data (Figure 1). The data balance of middle income, highly were subjected to direct numerical educated, and professional parents computation and computation of March/April 1977 JOCN Nursing
parents would be 26 or older, was supported for the husbands but not for the wives. Two hundred and seventy-seven (45.3%)of the wives were 26 years of age or older at the time of registration for childbirth education classes. Of t h e husbands, 398 (65.1%)were 26 years of age or older at the time of registration. Of the 474 registration forms on which a question concerning mode of referral to CEA appeared, 165 (27%)responded “word of mouth.” An additional 163 listed their physicians as sources of information about CEA classes. Hypothesis 5, therefore, was not supported. (The question was inadvertently left off the other forms.) Of the 611 women, 426 (69.7%) were primigravidas and 185 (30.3%) multigravidas. Sixty-eight couples Results ( 11.1 % ) had attended previous childOf the 611 couples, 274 (44.8%) birth education classes. Hypothesis 6 resided in Providence, Rhode Island. was supported. Of the 611 couples in the study, The first hypothesis, therefore, was not supported. It is of interest to note 495 (81 % ) had chosen Providence that a substantial number of couples, Lying-In Hospital for delivery; 168, resided in areas of Rhode Island therefore, Hypothesis 7 was supported. outside the major metropolitan area. The number of deliveries expected Forty-two of the wives had completed one year of college, 47 had in any calendar month varies from a completed 2 years, 24 had completed low of 33 in September (5.4%)to a 3 years, and 205 were college gradu- high of 63 in May (10.3%).Lower ates. In addition, 97 had attended percentages at the end of the year graduate school. Thus, 415 wives (August through December) reflect, (68%)had completed at least 1 year in part, the termination of the study of college. In addition, 45 were regis- in May 1973, including only those tered nurses (7.4%), five had at- couples who completed their classes tended secretarial school (0.8%),27 within that month. All couples due had technical school education be- in the latter months of 1973 would, yond high school (4.4%),and nine therefore, be excluded from the were licensed practical nurses study. N o single calendar month is ( 1 . 5 % ) . Of t h e husbands, 504 over- or under-represented in the (82.5%)had completed at least 1 data. Hypothesis 8, therefore, was year of college. Of the remaining supported. Of the 611 women in the study, 107, 10 (1.6%)had attended technical school, 17 (2.8%)left the ques- 467 (76.4%)stated that they planned tion blank, and one had been edu- to breastfeed their infants; 100 cated in Europe and did not specify (16.4%)stated that they planned to beyond that. Therefore, Hypothesis bottlefeed their infants; and an additional 26 were undecided at the time 2 was supported. Three hundred and twenty of the of registration for classes (4.3%).Hywives (52.4%)were employed in jobs pothesis 9 was supported. categorized as professional, technical, or managerial. Of the husbands, Summary and Recommendations 329 (53.8%)were employed in proSummary fessional, technical, or managerial Education for childbearing has jobs. The third hypothesis, therefore, undergone a metamorphosis and trewas supported. Hypothesis 4, that the majority of mendous growth in the past decade.
percentages to test the hypotheses. The sample included the 611 parents registered for CEA classes between 1968 and May 1973, whose questionnaire registration forms were available. (Records are kept by individual teachers, and some teachers had moved out of state, taking the records with them.) There were some new programs in the area in which the usual form was not used. Parents in these programs were not included. A system of collating data was set up for each category of data and for each year. The occupational categories chosen for the data were taken from the Dictionary of Occupational Titles.3 Data were transferred to coded sheets and the computed data were then set u p in tables.
March/April 1977 JOCN Nursing
The concepts of active participation in the childbirth experience by both parents have brought about a need for education for this experience. In the void so often left by formal education in secondary schools and institutions of higher education, organizations of parents and professionals such as CEA have attempted to provide this education. It was suspected, however, that only a select segment of the population is being reached by classes and that this segment is highly motivated and education oriented. The purpose of this study was to determine the characteristics of the parents attending CEA classes with regard to residence, age, education, and occupation. The majority of parents who registered for CEA classes resided outside Providence, and a substantial portion (27.5%)resided in areas other than those towns which surround Providence. This is of interest in view of distances traveled for classes and the upper-middle-class communities represented. In spite of place of residence and availability of maternity services in nearby hospitals, most couples chose to deliver at Providence Lying-In. A small but significant percentage, however, chose to deliver in hospitals in locations other than place of residence which offer family-centered maternity services. It can be hypothesized that sharing the experience of childbirth and establishment of the family unit postpartum is sufficiently important to motivate couples to go considerable distances both for preparation for the experience and in seeking hospital services. In the years 1970-1973, a small but significant number of wives and husbands who had not completed high school began to be represented in the class population. The same may be said for representation of occupations other than those classified as professional, technical, and managerial and for younger parents. Most wives enrolled in classes were primigravidas and had not attended any other childbirth classes. Since CEA is a relatively young organization, it is expected and borne out in the data that the number of multigravidas is increasing as more
37
Name
Last
Address
Husband
Street
City
Date
Phone
Home
Due date
Wife State
Zip
Business Doctor
Hospital Wife’s age
0ccupation (past, present, future).
Husband’s age
Occupation
General education (years completed) High school
College
Degree
Other (describe)
Husband Number of pregnancies
History
Number of children
Names and ages
How fed and your reaction
Plans for feeding new baby Have you ever attended any other Childbirth Education Classes? If so, where?
Who referred you to CEA of RI? Com ments:
Figure 1. Registration questionnaire form for Childbirth Education Association of Rhode Island.
38
March/April 1977 JOCN Nursing
parents who attended previous classes are having other children. The majority of mothers had decided to breastfeed their infants, which suggests a correlation between desire for active participation in the birth experience and feeding. It is also perhaps a reflection of the growing acceptability of breastfeeding among the parents served by classes. Word-of-mouth and physician referral are the most common sources of information about CEA, with obvious implications for those individuals or groups offering childbirth classes and seeking means to reach expectant parents. From the growth in numbers of parents attending classes from the inception of the classes in 1968 to the present, it is obvious that, in a time of leveling off of the birth rate, the need and demand for childbirth classes is growing. Since formal classes are the means by which most couples are enabled to share the birth experience (class attendance is required for father participation in most hospitals in the study), it becomes obvious by inference that the number of couples seeking to share this experience is increasing.
Recommendations In view of the findings of this investigation, it is recommended that:
1. An effort be made to reach the majority of expectant parents who are not, at present, being served by childbirth classes in order to determine reasons for nonattendance and to establish education programs to meet their needs. 2. Publicity be directed to reach a maximum number of expectant parents early in their pregnancies. 3. A study be undertaken to investigate the long-term effects, if any, on the family who has experienced a prepared childbirth. 4. A follow-up study be undertaken to determine the utilization of teaching in the actual labor, delivery, and postpartum periods.
United States Department of Labor, Manpower Administration, Bureau of Employment Security, 1965
More detailed data than that presented in the published article is available from the author on request. Address reprint requests to Joellen Watson, RN, PhD, 98 Constitution Street, Bristol, R I 02809.
Joellen Watson is an Assistant Professor at Boston College, where she References took her M S and PhD degrees. Her 1. Yankauer, A. : Pregnancy, ChildB S N is from Northbirth, the Neonatal Period and western University, Expectant Parent Classes. Albany, New York, Bureau of Ma- and she has also attended Oberlin ternal and Child Health, New College and the Chicago Wesley York State Department of Health, Memorial Hospital School of Nursing (diploma). A member of ANA, 1958 2. Mann, D., L. F. Woodward, and APHA, and Sigma Theta Tau, Dr. N. Joseph: Educating Expectant Watson has published articles in Parents. New York, Visiting other professional periodicals and is currently collaborating on a textbook Nurse Service of New York, 1961 3. Dictionary of Occupational Ti- on child development and on two tles: ll, Occupational Classijica- non-sexist children’s books. The aution and Industry Index. Third thor is also a consultant for the edition, Washington, D.C., U.S. Childbirth Education Association of Government Printing Office, Rhode Island.
Childblrth Educaton The ICEA United States Midwest Regional Conference, sponsored by the Maternity Family League, Inc., of Indianapolis, will be held June 23-25 at the Indianapolis Convention Center. For registration materials or further information write Maternity Family League, PO Box 50274, Indianapolis, IN 46250.
March/April 1977 JOCN Nursing
39