Twelve studies (1,219 participants) were included: 1 pre-test post-test study (35 participants), 3 qualitative studies (228 participants) and 8 descriptive studies (956 participants).
Health promotion behaviours (3 studies): all 3 studies suggested positive outcomes for education classes. However, research methods differed among the studies. One study (16 women at classes compared with 44 not at classes) found that women attending classes scored significantly higher on self-actualisation, health responsibility, exercise, nutrition and interpersonal support than women not attending classes. One descriptive study (291 women) found the greatest changes were for communication with partner, relaxation, and confidence for labour and birth. One qualitative study (214 participants) found significant changes in preparation for labour and birth, breast-feeding and after delivery, but not for nutrition.
Self-care (2 studies): none of the studies provided evidence that potential categories of self-care had been identified. One descriptive study (59 participants) found little effect of classes on decision-making about breast-feeding, but found that classes influenced decisions about analgesia. One qualitative study (7 participants) found no consistent results for enabling or non enabling for birth.
Perceptions related to birth (4 studies): the studies used a variety of outcomes and methods of analysis, and rarely used validated tools for measuring the degree to which the classes helped women deal with childbirth. One descriptive study (45 women) found no correlation between classes and perceived control, satisfaction with birth experience, perception of pain, or use of analgesia. One descriptive study (119 participants) found the only difference between women and their partners was that fathers had a more positive perception of the first stage of labour. One qualitative study (7 women) found participants in classes were more confident about the birth experience. One descriptive study (121 women) found that 66 to 81% of women felt fairly or very confident about facing childbirth after classes.
Class curriculum (2 studies): the studies rarely evaluated the content of the classes. One descriptive study (127 women) found that participants favoured classes but wanted more information on parenting. One descriptive study (134 participants) found that educators and parents differed in their priorities for class content.
Impact on coping (1 study): 1 pre-test post-test study (35 women) found a significant difference from pre- to post-test. The direction of the effect was not reported in the review.