Supporting perinatal women in the context of the COVID-19 emergency: can web-based antenatal education classes make it possible?

Arising from the spread of severe acute respiratory syndrome coronavirus, the recent COVID-19 global public health emergency has changed people’s habits as well as the model of care dedicated to perinatal support. Moreover, the restrictions imposed by the forced social isolation and quarantine make it impossible to offer antenatal education in hospital or in the community. For perinatal women, gathering information via the Internet has probably become more pronounced.

Antenatal education has been available in most high-income countries for more than 50 years. The goal has been to equip expectant mothers with ways to deal with pregnancy, labour and childbirth and, to a lesser degree, with parenting. Despite the benefits, the best educational approaches remain unclear. Antenatal education programs often aim to increase learners’ knowledge of antenatal and postnatal depression, the birth process, pain relief and obstetric interventions. The classes also promote breast feeding and seek to bolster the participants’ confidence in their own ability to manoeuvre through childbirth and transition to parenthood. Communicating information to promote health and reduce risk is another key goal of antenatal education (Brixval et al., 2015). The structure of antenatal classes also enables participants to develop social networks and helps them connect with others in the same situation (Fabian et al., 2005).

Opinions and trends have influenced antenatal educators to implement changes over time. Class size has varied – in some eras, antenatal education was delivered to small classes with group discussion; in other periods, lectures were delivered to large numbers in auditoriums. Course content has also changed. Sometimes topics like breathing and/or relaxation techniques are included, and sometimes they are omitted from antenatal education programs (Brixval et al., 2015). Factors such as financial restrictions and structural reorganisations in health care delivery over time have also resulted in changes in the number of antenatal education sessions (Fabian et al., 2005).

There has been a growing interest in delivering antenatal care or education by e-health, however the effects of web-based antenatal care intervention on maternal wellbeing have not been widely investigated. In a study of a web-based antenatal care and education system consisting of 4 modules (web-based maternity health records, antenatal health education, self-management journals, and infant birth records), women reported significantly reduced pregnancy stress, improved self-efficacy, and increased satisfaction with antenatal care (Tsai et al., 2018). Web-based antenatal education classes are a fitting response to the need to offer support to pregnant women in a context that reduces the spread of COVID-19. Although there are few studies into the effectiveness, efficiency, equity and appropriateness of antenatal education delivered to small web classes with group discussions, many healthcare institutions offer these web services to perinatal women. When configuring these on-line services, it is important to consider what is reported in perinatal literature.

Setting their sights on a positive pregnancy experience, women seek to preserve physical and sociocultural normality. Likewise, they strive for a healthy pregnancy for both mother and baby, including prevention and treatment of risks, illness and death. Pregnant women also seek a positive transition to labour and birth. Finally, they are concerned with realising positive motherhood that includes their own self-esteem, their competence and their autonomy (Downe et al., 2018).A positive childbirth experience can be achieved when the woman is at the centre of care; when she is involved in decisions with respect to care; when she feels that she is in a safe, empathetic environment with competent healthcare professionals. The woman’s sense of control and her sense of personal achievement of the birth outcome are essential elements of care, particularly when intervention is considered necessary (Downe et al., 2016).

A woman’s empowerment during the childbearing period is expected to have a beneficial effect on her psychological well-being. There is a similar expectation of a favourable outcome regarding the woman’s readiness to face the challenges that arise after the birth when the new mother must adapt to her role and assume the responsibility of raising a child (Garcia & Yim, 2017). A positive birth experience also seems to have an empowering effect (Olza et al., 2018). Women’s empowerment is affected not only by collective, social, economic, legal and political conditions, but also by the individual psychological aspect. All of these elements are destabilised by the current serious health situation linked to the COVID-19 pandemic, forced social isolation and social distancing.

A literature review on how technology empowers patients concluded that health literacy of patients, remote access to health services, and self-care mechanisms are the most valued ways to accomplish patient empowerment (Calvillo et al., 2015).Future research is needed to investigate the perinatal skills and empowerment acquired by pregnant women who participate in web-based antenatal education classes.

The current COVID-19 emergency and quarantine, forced social isolation and social distancing have caught us unprepared in some sectors of public health, including web services for perinatal women. As we await further studies in this field, the basic knowledge present in the literature can be a good starting point to draft emergency protocols and offer sufficiently adequate services.

Note

In response to numerous requests for antenatal education classes during the social isolation period triggered by COVID-19, the considerations reported in this editorial have been adopted by some authors of this manuscript (P.G. and G.J.J.) in the local health service dedicated to perinatal health (Azienda ULSS 6 Euganea, Veneto Region, Italy). In this local experience, in just two weeks the health service received 500 registrations for online classes — a considerable increase when compared to the 2000 registrations for in-person class sessions received in a one-year period pre-COVID-19. During the Italian forced social isolation period (March-June 2020), the local demand was therefore 6.5 times higher than the expected enrolment.

Disclosure statement

All authors declare no conflicts of interest.

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This editorial was written without any financial grant or contribution from industrial sources or affiliations.