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Strengthening the evidence base for maternal and child health programs

New: MCH Best strategies database for sample ESMs

Evidence Tools
MCH Best. NPM 2: Low-Risk Cesarean Deliveries

MCH Best Logo pregnant woman reviewing a chart with a doctor

Strategy. Childbirth Education Classes

Approach. Support the development of a community-based childbirth education class series.

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Overview. Attending prenatal education classes has been associated with higher rates of vaginal deliveries among women in the study sample.1

Evidence. Emerging. Interventions implemented at the patient level appear effective in decreasing the percentage of cesarean deliveries among low-risk first-time mothers. This strategy has been tested more than once and results trend positive overall. Access the peer-reviewed evidence through the MCH Digital Library. (Read more about understanding evidence ratings).

Target Audience. Patients.

Outcome. Reduction of primary cesarean delivery rates among nulliparous women. For detailed outcomes related to each study supporting this strategy, click on the peer-reviewed evidence link above and read the "Intervention Results" for each study.

Examples from the Field. There are currently XXX ESMs across all states/jurisdictions that use this strategy directly or intervention components that align with this strategy. Access descriptions of these ESMs through the MCH Digital Library. You can use these ESMs to see how other Title V agencies are addressing the NPM.

Sample ESMs. Using the approach “Support the development of a community-based childbirth education class series,” here are sample ESMs you can use as a model for your own measures using the Results-Based Accountability framework (for suggestions on how to develop programs to support this strategy, see The Role of Title V in Adapting Strategies):

Quadrant 1:
Measuring Quantity of Effort
("What/how much did we do?")

  • Number of counties in state offering community-based childbirth education class series at least twice per month.

Quadrant 2:
Measuring Quality of Effort
("How well did we do it?")

  • Percentage of counties within the state offering a community-based childbirth education class series at least twice per month.

Quadrant 3:
Measuring Quantity of Effect
("Is anyone better off?")

  • Number of women who attended community-based childbirth class series and report an increase in knowledge of the labor and delivery process with post-class survey.
  • Number of low-risk women who attended community-based childbirth class series and report not having cesarean delivery.

Quadrant 4:
Measuring Quality of Effect
("How are they better off?")

  • Percentage of women who attended community-based childbirth class series and report an increase in knowledge of the labor and delivery process with post-class survey.
  • Percentage of low-risk women who attended community-based childbirth class series and report not having cesarean delivery.

Note. ESMs become stronger as they move from measuring quantity to measuring quality (moving from Quadrants 1 and 3, respectively, to Quadrants 2 and 4) and from measuring effort to measuring effect (moving from Quadrants 1 and 2, respectively, to Quadrants 3 and 4):

Learn More. Read how to create stronger ESMs and how to measure ESM impact more meaningfully through Results-Based Accountability.


Reference:

1 Stoll KH, Hall W. Childbirth education and obstetric interventions among low-risk Canadian women: is there a connection? J Perinat Educ. 2012;21(4):229-237. doi:'10.1891/1058-1243.21.4.229

This project is supported by the Health Resources and Services Administration (HRSA) of the U.S. Department of Health and Human Services (HHS) under grant number U02MC31613, MCH Advanced Education Policy, $3.5 M. This information or content and conclusions are those of the author and should not be construed as the official position or policy of, nor should any endorsements be inferred by HRSA, HHS or the U.S. Government.