title: The benefits of antenatal education for the childbirth process in Spain.
abstract: BACKGROUND
  Childbirth has changed dramatically over the past 40 years, although antenatal education (AE) has not. This education has been shown to be beneficial in some countries but not in others.
  
  
  OBJECTIVE
  The objective of this study was to assess the benefits of AE during the childbirth process, controlling for the possible confounding effects of other variables and involving a comprehensive assessment of the birth process.
  
  
  METHODS
  A prospective observational study was conducted in Bizkaia, Spain, to follow 616 low-risk pregnant nulliparous women aged 18-42 years until childbirth. Women who had attended different numbers of AE sessions were compared in terms of the following: whether they arrived at hospital in established labor, whether they received epidural anesthesia before the active phase of the birth, length of the first and second stages (i.e., dilation and delivery), anxiety (Hospital Anxiety and Depression Scale), type of birth, perineal injury, satisfaction with the experience, and the 5-minute Apgar score. Results were adjusted by age, nationality, educational level, social class, personality, and the hospital where the birth occurred.
  
  
  RESULTS
  Spanish women who had attended AE classes experienced less anxiety during birth than those who had not (Hospital Anxiety and Depression Scale score adjusted difference = -1.5, 95% confidence interval = -0.1 to -3.0), whereas the opposite was found for immigrant women (adjusted difference = 2.4; 95% confidence interval = -0.6 to 5.4; AE x Nationality interaction, p = .02). No dose-response relationship was found between AE and anxiety, and no benefits were seen for the other variables.
  
  
  CONCLUSIONS
  Antenatal education is not found to be associated with benefits during childbirth. Subsequent research should be focused on redesigning and assessing AE in light of the current needs of women.
authors.affiliation: Zuazo Health Centre, Primary Care Research Unit of Bizkaia, Osakidetza Basque Health Service, Bilbao, Spain.
authors.forename: Isabel
authors.initials: I
authors.lastname: Artieta-Pinedo
authors.forename: Carmen
authors.initials: C
authors.lastname: Paz-Pascual
authors.forename: Gonzalo
authors.initials: G
authors.lastname: Grandes
authors.forename: Gurutze
authors.initials: G
authors.lastname: Remiro-Fernandezdegamboa
authors.forename: Itziar
authors.initials: I
authors.lastname: Odriozola-Hermosilla
authors.forename: Amaia
authors.initials: A
authors.lastname: Bacigalupe
authors.forename: Janire
authors.initials: J
authors.lastname: Payo
mesh_terms: D000328:Adult; D000704:Analysis of Variance; D001007:Anxiety / Q000453:epidemiology / Q000517:prevention & control; D016009:Chi-Square Distribution; D003479:Curriculum; D036861:Delivery, Obstetric / Q000451:nursing / Q000706:statistics & numerical data; D003863:Depression / Q000453:epidemiology / Q000517:prevention & control; D054242:Emigrants and Immigrants / Q000193:education / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D016014:Linear Models; D016015:Logistic Models; D009035:Mothers / Q000193:education* / Q000523:psychology / Q000706:statistics & numerical data; D009721:Nurse Midwives / Q000458:organization & administration; D015403:Nursing Evaluation Research; D007744:Obstetric Labor Complications / Q000453:epidemiology / Q000517:prevention & control; D010353:Patient Education as Topic / Q000458:organization & administration*; D011247:Pregnancy; D011256:Pregnancy Outcome / Q000453:epidemiology; D011295:Prenatal Care / Q000458:organization & administration*; D015397:Program Evaluation; D011446:Prospective Studies; D013030:Spain / Q000453:epidemiology