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AntenataleducationandthebirthingexperienceofBrazilianwomen:aqualitativestudyARTICLEinBMCPREGNANCYANDCHILDBIRTHSEPTEMBER2013ImpactFactor:2.15DOI:10.1186/1471-2393-13-171Source:PubMed

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RESEARCH ARTICLE

Antenatal education and taar

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opportunities to discuss the information transmitted and with what pregnant women need to maintain self-

Miquelutti et al. BMC Pregnancy and Childbirth 2013, 13:171http://www.biomedcentral.com/1471-2393/13/171ated with greater satisfaction. Participation in antenatalPostal 6181, 13084-971 Campinas, SP, BrazilFull list of author information is available at the end of the articleto practise pain relief techniques may hamper thebenefits of antenatal education [1,2]. There is evidenceof the need to reinforce the information during labor toensure a better effect, since the stress generated duringlabor and delivery may influence a womans memory,

control during labor [1,5].Womens ability to maintain self-control during labor

has been seen as fundamental for a good birthing experi-ence [6-8]. A systematic review [9] showed that womensexpectations related to self-control during delivery donot correspond to their factual experiences. Irrespectiveof the pain experienced, more realistic expectationsand self-control during labor, seem to be directly associ-

* Correspondence: mmakuch@cemicamp.org.br2Center for Research on Reproductive Health of Campinas (Cemicamp), Caixathe role of the pelvic floor muscles, the physiology of labor, and pain relief techniques. A single, semi-structuredinterview was conducted with each participant. All interviews were recorded, transcribed verbatim and thematicanalyses performed. The relevant themes were organized in the following categories of analysis: control of labor,positions adopted during labor, and satisfaction with labor.

Results: Women who participated in the systematic educational activities of the BPP reported they maintained self-control during labor and used breathing exercises, exercises on the ball, massage, baths and vertical positions tocontrol pain. Also they reported satisfaction with their birthing experience. Women who did not participate insystematic educational activities referred to difficulties in maintaining control during labor and almost half of themreported lack of control. Also they were more likely to report dissatisfaction with labor.

Conclusions: Women who participated in the BPP reported self-control during labor and used non-pharmacological techniques to control pain and facilitate labor and expressed satisfaction with the birthingexperience.

BackgroundEducational activities aimed at preparing women forlabor by providing information and practising physicalexercise, breathing and relaxation techniques promotewomens self-control and may contribute for a satisfac-tory birthing experience. However, it has been reportedthat a large amount of information given over a shortperiod of time may be ineffective; and that the lack of

compromising the information received during preg-nancy [3]. Also it has been argued that the inclusion of acompanion, either womens partner or somebody closeto her, in pre-natal education activities to becomeactively involved in the use of non pharmacological tech-niques for labor control is beneficial for women duringthe birthing process [4]. However, there are still gaps onwhether the information transmitted is in accordanceof Brazilian women: a quMaria Amelia Miquelutti1, Jos Guilherme Cecatti1 and M

Abstract

Background: Information is still scarce on the birthing exsystematic education programs. The objective of the studnulliparous women who participated and who did not in

Method: A qualitative study was conducted with elevenattending routine prenatal care selected through purposegroup meetings structured to provide physical exercise a 2013 Miquelutti et al.; licensee BioMed CenCreative Commons Attribution License (http:/distribution, and reproduction in any mediumOpen Access

he birthing experiencelitative studyia Yolanda Makuch2*

rience of women who participate in antenatalwas to report the experience of labor as described bysystematic Birth Preparation Program (BPP).

men who participated in a BPP and ten womenl sampling. The BPP consisted of systematized antenatalinformation on pain prevention during pregnancy,tral Ltd. This is an Open Access article distributed under the terms of the/creativecommons.org/licenses/by/2.0), which permits unrestricted use,, provided the original work is properly cited.

by women who participated and women who did not

Miquelutti et al. BMC Pregnancy and Childbirth 2013, 13:171 Page 2 of 8http://www.biomedcentral.com/1471-2393/13/171participate in an antenatal program of preparation.

MethodsA qualitative study was conducted to obtain in-depthunderstanding, beyond numbers, on womens experienceduring labor and delivery. Qualitative research in healthsettings considers the perspective of the people, focuseson emotions, beliefs and values, actions and behaviors tounderstand the participants responses to health relatedissues, the meanings the experience has for them, andtheir subsequent actions. Engaging a phenomenologicalapproach semi-structured interviews were used in thepresent study to understand how participants felt abouttheir birthing experience and gain a deeper understand-ing of the meaning of this experience for women, tounderstand womens experience of labor and deliveryfrom their perspective and as told by them. This ap-proach allowed the stories women told to be heard andto explore the meanings the experience had for them.This qualitative study was conducted simultaneously

with a Randomized Controlled Trial (RCT) conductedbetween June 2009 and September 2011 that evaluatedlumbopelvic pain, urinary incontinence, anxiety levels,physical exercises, obstetric and perinatal data accordingto the participation or not of a Birth Preparation Pro-gram (BPP) at a public maternity teaching hospital ineducation activities was also associated with women hav-ing more realistic expectations and, consequently, morepositive experiences of labor [10].A multicenter randomized study that evaluated an

antenatal educational program focusing on breathingtechniques, relaxation and massage found no differencesbetween intervention and control group with respect tothe experience of the women during delivery [11]. Onthe other hand, another study showed that women whoreceived guidance during pregnancy on the effects ofmassage or listening to music during labor reported feel-ing prepared for labor, having better self-control and amore positive experience of labor [12]. A Taiwan-basedstudy reported that women who received information onexercises with a birthing ball during pregnancy and whopractised these exercises during labor reported less painand greater self-control compared to a noninterventiongroup [13].There is still lack of information on the experience of

women who receive guidance on non-pharmacologicaltechniques and on the influence or benefits of systematicbirth preparation programs on their well-being duringlabor and delivery. The objective of this study was to de-scribe the experience of labor and delivery as reportedthe southeastern region of Brazil. The study was ap-proved by the Institutional Review Board, and informedconsent was obtained from all participants prior to theirinclusion in the study.

Study samplePrimiparous women enrolled in the RCT were invited totake part in the qualitative study in the maternity ward24 to 48 hours after delivery and before discharge.Women were approached and informed about the quali-tative component of the study, they were given time toask questions, to reflect and to decide if they wanted toparticipate. Those who agree were asked to sign a writ-ten consent form.Following the logic of purposeful sampling women,

from both the study and the control group of the RCT,were invited to participate in the qualitative study. Thestrategy used to select participants was criterion sam-pling [14,15]. Participants were selected according to thefollowing criteria: primiparous women with a single full-term fetus after a low risk pregnancy, between 16 and40 years old who had and had not participated of theBPP, who received antenatal care and delivered their ba-bies at a public maternity teaching hospital and who hadbeen in labor for more than 4 hours at the maternityward without receiving any spinal anesthetics. This lastcriterion was established to give women the opportun-ity to have similar minimum time in labor withoutanesthetics.Women in the intervention group of the RCT, in

addition to routine antenatal care, participated in theBPP - a systemized program planned and structuredspecifically for the study conducted by trained physicaltherapists that occurred on the same days of prenatalconsultation. Women participated in the BPP from18 weeks of pregnancy onwards, on a monthly basisup to 30 weeks of pregnancy, fortnightly from 31 to36 weeks and on a weekly basis from 37 weeks onwards.At each meeting physical exercises consisting of generalstretching and strengthening exercises, pelvic floormuscle training, breathing techniques and relaxationtraining were performed. Also as part of the programparticipants received information: at 24 gestationalweeks on lumbopelvic pain prevention during pregnancyand on the role of the pelvic floor muscles during preg-nancy, delivery and puerperium; between 34 to 36 weekson the physiology of labor, and non-pharmacologicaltechniques of pain control for labor were discussed andpractised; and from 37 weeks onwards doubts andnecessary reinforcements were discussed and non-pharmacological techniques for pain control duringlabor were practised. In this program partners did notparticipate in the meetings.Women of the control group (CG) of the RCT re-ceived the same routine prenatal care which includededucational activities provided by the nursing staff

(information on breastfeeding, the signs and symptomsof labor and visit to the maternity ward) on the samedays of the consultation. Not linked to consultation daysthey also were invited to participate in meetings whereinformation on physical exercise, coping techniquesduring labor; and information on puerperium andnewborn care were provided on a free participation andnon-systematic basis.

recordings. Data were analyzed for thematic manifestcontent [14,15]. An initial thematic frame was organizedbased on relevant topics identified in the interviews thatreferred to womens experience. During this initial phaseof analysis, in the process of reading through the inter-views and compiling the salient topics, the recurringideas, experiences and behavioral patterns, similar datawas organized in a meaningful way. The main themes

it

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in,

an

Miquelutti et al. BMC Pregnancy and Childbirth 2013, 13:171 Page 3 of 8http://www.biomedcentral.com/1471-2393/13/171At the hospital maternity ward non-systematizedguidance is given to all laboring women on non-pharmacological techniques of pain relief. A companionof womens preference is permitted by the institution tobe with the woman during labor and delivery.

Data collectionSemi-structured interviews were conducted at the ma-ternity unit using an interview guide (Table 1) withtopics related to the experience of labor and delivery,pain control, control of labor, positions adopted duringlabor, and satisfaction with labor and delivery. To elabor-ate the interview guide, initially informal conversions,based on the objectives of the study and the topicsabove mentioned, were conducted with women whodelivered at the same maternity ward where the studywas conducted. Subsequently open-ended questions andprompts to ensure feedback from the participants on therelevant aspects of the research were organized for theinterview guide.All interviews were recorded digitally, lasted approxi-

mately 3040 minutes and were conducted by a physicaltherapist (MAM) who was involved in the elaborationand supervision of the Birth Preparation Program butdid not participate in BPP activities. Therefore theinterviewer had domain of the theme under discussionand no previous contact with the women interviewed.The number of interviews performed was determinedby consensual agreement of the researchers that thedata was meaningful for the objectives proposed forthe study [14].

Data analysisAll the interviews were transcribed verbatim and thetranscripts were checked for accuracy against the

Table 1 Main topics of the interview guide

1 Tell me about your experience of labor and delivery. How was it? Was

2 During labor, before you received anesthesia, was there something thaanswer is yes: What helped you? Can you tell more about it. Can you g

3 In your opinion were you in control during labor or not? (Control of pa

4 What positions did you adopt during labor? Explain each one of themwith the adopted positions.5 What is your opinion on the attitudes of the staff of the maternity ward. W

6 Are you satisfied or not with your birthing experience? Why?identified and used for coding were: pain control, thepositions used during labor, wellbeing, and comfort ex-perienced in different positions, the possibility of controlduring labor using breathing techniques and the import-ance of the information received during pregnancy or inthe delivery ward.Subsequently, these themes considered relevant for the

understanding of the birthing experience were organizedin the following categories of analysis: control of labor,positions adopted during labor and satisfaction withlabor. Data were analyzed for thematic content by oneresearcher (MAM) and cross-checked by another re-searcher (MYM).

ResultsAll the women invited to take part in the study agreedto participate. Twenty-one primiparous women wereinterviewed after delivery and eleven of the intervieweeshad participated in a systematic preparation program.The women who participated in the systematic educa-tional activities of the BPP attended a mean of six meet-ings. General socio-demographic and obstetric data areshown in Table 2. No substantial differences were ob-served in the characteristics of the women who partici-pated in the BPP and those who did not. The followingcategories of analysis will be presented and discussedbelow: control of labor, positions adopted during laborand satisfaction with labor.

Control of laborIn this category of analysis all the information identifiedin the interviews related to what participants believedhad helped them during labor to be in control was con-sidered. All the interviewed women associated control oflabor with their ability to deal with pain and anxiety.

as you imagined? Was it different?

elped you when you had contractions?/When you felt pain? If thesome examples and explain them.

control of the contractions, of control of fear). Why?

d tell me why you adopted those positions and about your experienceere they helpful or not? Why?

ip

sys11

Miquelutti et al. BMC Pregnancy and Childbirth 2013, 13:171 Page 4 of 8http://www.biomedcentral.com/1471-2393/13/171The majority of the women who had participated in thesystematic educational activities of the BPP reported thatthe information received helped them reduce anxietyduring pregnancy and labor. Also they referred to havingfelt to a sense of safety, mainly during labor, becausethey had learned how to deal with pain and had re-sources to maintain self-control. The exception was awoman who participated in three BPP meetings whosaid that during labor she had been unable to rememberthe information received.

No, no control intense pain, emotionally exhausted;I was not in control at all. (33 years old CG)

Table 2 Socio-demographic and obstetric data of the partic

Socio-demographic andobstetric data

Women who participated in apreparationprogram (n =

Age (min max) 18 - 29

Gestational age at delivery(min max)

37 - 40

Education level

Primary 6

High school 2

University 1

Technical college 2

Steady partner 9

Planned pregnancy 7

Normal delivery 6

Delivery without spinal or epiduralanaesthesia

1It helped, because if it werent for the physiotherapistsguidance, I certainly would not have done it as I did,with breathingI managed to stay quite calm it reallyhelped. (20 years old BPP)

All the women who participated in the systematic educa-tional activities of the BPP said they had maintained controlfor most or all the time during labor. They reported usingbreathing techniques, exercises with a birthing ball, walk-ing, massage, baths and maintaining the upright position;taking the initiative to use these techniques and that theyhad felt at ease using them. Also they said that the informa-tion received during the preparation became meaningfulwhen they put the non-pharmacological techniques intopractice during labor and gained confidence in their ef-fectiveness as labor progressed.

The breathing exercises, the massages, the baths, andthen, I did everything, and the positions I adoptedBecause if I just stayed lying down, then the pain felteven worse; then when I sat up in that butterflyposition or with my two feet together, I could put moreeffort into it when it contracted, and with mybreathing, I could relax, and when I was able to relax,the pain was less. (24 years old BPP)

Depending on the intensity of the pain, I breathed moreshallowly or deeper; then I remembered what they said:smell the flower and blow out the candle; smell the flowerand blow out the candle (26 years old BPP)

The women who did not participate in systematic edu-cational activities of preparation referred to difficultiesin maintaining control during labor, and almost half ofthem reported lack of control. Two of the three women

ants

tematic)

Women who did not participate in a systematicpreparation program (n = 10)

19 - 32

37 - 40

3

5

2

0

7

6

8

2who had received some guidance during prenatal careon pain relief techniques said they had managed tohave some control during contractions. The womenwho received guidance on pain control techniques dur-ing labor said that they had used one or two of thesetechniques, and the most frequently mentioned tech-niques were baths and massages. They also reported theyhad felt that these techniques had been insufficient tocontrol pain.

I walked, I leaned on my husband, and he massagedmy back. That helped, it helped a little, but only forsome time, because afterwards I had no control Thepain was very intense, I could not control it, thebreathing everybody was telling me to do to alleviatepain, I could not do it, the pain was intense. (19 yearsold - CG)

Positions adopted during laborIn this category of analysis all the information on the po-sitions women adopted during labor discussed in the

Miquelutti et al. BMC Pregnancy and Childbirth 2013, 13:171 Page 5 of 8http://www.biomedcentral.com/1471-2393/13/171interviews was considered. All the women, independ-ently of having participated or not in the BPP, said thatthey had felt more comfortable during labor when theyadopted an upright position. The majority consideredsitting and standing up, walking around, exercising withthe ball on the floor or in the shower as the most com-fortable positions.Also they said that these positions permitted pelvic

mobility, were comfortable for massage, helped to relievepain and to relax the lumbopelvic region. On the otherhand these women considered horizontal positions lesscomfortable, since they hampered their mobility and in-creased the sensation of pain during contractions.

I think sitting was better for meI managed to movebetter; I was freer to move to get at least some relief; well,a little, from the pain in my back. (27 years CG)

The best position was under the shower, sitting underthe shower with the water falling on me to alleviatethe pain, but not on the bed (21 years old BPP).

All of the woman who participated in a systematicpreparation said that they had felt at ease to assume dif-ferent upright positions and had changed positionsbased on how they were feeling and on what they hadlearned during the preparation. They said they adoptedupright positions to facilitate cervical dilation and tohelp the progression of labor.

I was sitting down with the ball between my legswhile holding on to that rod in the bathroom for us tosupport ourselves I walked a lot along the corridor, Iwalked, I walked a lot. (29 years old BPP)

I think the exercises helped a lot because it helps withthe dilation too, right? (27 years old BPP)

The women who did not participate in a systematicpreparation reported that after receiving guidance fromthe staff in the labor room they began to use some up-right positions during labor. Some women said thatadopting vertical positions brought comfort and relievedpain, even though they were not at ease to adopt thesepositions or to change positions without seeking guid-ance from the staff.

They said that if I remained lying down it wouldnthelp much at delivery that it was better to walkaround a bit, sit down, walk, but not stay lying downfor too long. (20 years old CG)I went to the bathroom, there I was in the uprightposition, sitting on the ball and also squatting. Ithelped quite a lot with the pain. I felt as if it openedinside, then I separated my legs and it alleviated moreit seemed as if the baby was finding its way and I feltit was better much better. (23 years old CG)

In general, both women who participated and who didnot participate in a systematic preparation said that atthe maternity ward there were no restrictions with re-gard to changing position, that the staff did not interferewhen they assumed different positions and encouragedthem to walk, take baths and exercise with the birthingball.

Satisfaction with laborThe main themes identified in the interviews that re-ferred to satisfaction were organized in this category ofanalysis. The majority of the women interviewed, inde-pendently of having or not participated in the systematicpreparation, said that labor had been different from whatthey had expected or had imagined. Some said they hadimagined labor would be quicker and with less pain. Onthe other hand, some women said that labor was lesspainful than they had imagined.

Actually, for me, labor was something that I hadntexpected because I thought that it was going to besomething really, really slow, since I always heardstories of labor that lasted 10, 12 hours, but I was veryhappy, apart from the pain of course, because laborwas very fast. (26 years old BPP)

No, it wasnt as I had imagined it. It was tiring andpainful, very painful, and it took a long time before Igot anesthesia and under the circumstances, actuallythere was no way; they couldnt give me the anesthesiabefore, but because of that I was in a lot of pain and Ifound it very tiring (19 years old CG).

All the women who participated in the BPP reportedsatisfaction with labor. Those who said that labor hadnot been long and that they had not felt much pain saidthey were satisfied with labor per se and because theyhad managed to establish control.Those who reported intense pain were in labor for a

longer time and delivered with forceps, and associatedsatisfaction with the birthing experience with the factthat they and their babies were well.

I was certainly satisfied, because I managed tomaintain self-control, I felt more secure going throughthe delivery. (27 years old BPP)Some women who did not participate in a systematicprogram of preparation said they were not satisfied with

to maintain control, and used non-pharmacological

Miquelutti et al. BMC Pregnancy and Childbirth 2013, 13:171 Page 6 of 8http://www.biomedcentral.com/1471-2393/13/171techniques for pain relief. Women who did not partici-pate in the systemized educational activities of prepar-ation for childbirth and who reported dissatisfactionwith the experience were woman who said they had dif-ficulties maintaining control during of labor.The women in our study associated satisfaction with

their ability to use pain control techniques to reduce dis-comfort during labor. These results are in agreementwith previous reports [16,17] which showed that partici-pation in a prenatal education program was associatedwith satisfaction with the overall childbirth experience,better and more efficient utilization of pain control tech-niques and feelings of control during labor. On the otherhand excessive pain and lack of control were associatedwith a negative experience at delivery. Furthermore, re-sults of a qualitative study showed that having controlover their body during labor and the freedom to movearound and change positions affected positively womenssatisfaction with the birthing experience [18].Women in our study who participated in the system-

atic preparation reported that knowledge on what theyhad to do to control pain and how to use the nonpharmacological techniques for this purpose, irrespectivetheir birthing experience because pain had been exces-sive, their husband was not present, lack of attentionfrom the staff, insufficient physical space and the use offorceps for delivery. On the other hand, women whoreported having maintained self-control during labor saidthey were satisfied with their labor and delivery. The rea-sons given for their satisfaction were: labor had not beenlong and pain was not so intense, because they receivedanesthesia and the care of the maternity staff was good, andmainly because they and their babies were well.

Well, I wasnt very satisfied because of the pain.Because of the pain and, it was very quick and therewas a moment at which I thought they werent payingattention to my pain (27 years old CG).

I was very satisfied because, in the first place Ithought it would be more painful when the baby wasgoing to be born, but it did not hurt so much. Ithought it would be worse than the pain of thecontraction But after I saw the baby it was over(23 years old CG)

DiscussionIn the present study, women who participated in a sys-temized programme of preparation for labor and deliv-ery were satisfied with the birthing experience, managedof the pain experienced or the duration of labor, hadhelped them to be in control. Previous studies have alsosuggested that lack of information regarding the processof labor, pain and non-pharmacological techniques forpain control are factors directly related to lack of controlduring labor and dissatisfaction with the birthing experi-ence [3,10,19].Women who participated in the BPP reported having

received guidance and training on non pharmacologicalpain control techniques and having used these tech-niques during labor, a finding that is in agreement withprevious results [11]. The lack of opportunities for dis-cussion and practice of the non pharmacological paincontrol techniques during antenatal education makesthem less effective during labor [1,2]. Knowledge ac-quired during antenatal preparation for labor becomesmore effective when reinforced during labor [3], and thiswas also observed in the present study. For the BPPwomen the interventions reinforced and encouragedthem to maintain the breathing exercises and an uprightposition. For the CG women the guidance and encour-agement from the health professionals during laborhelped them to use pain control techniques; howeverthey reported having used fewer techniques and havingless control of labor.All the participants of this study were cared for at the

same maternity ward and it can be presumed that they re-ceived similar guidance and encouragement from thehealthcare staff during labor. The guidance was providedmainly by nurses, practical nurses and physiotherapistswho did not have special training on non-pharmacologicalpain control techniques used during labor. In the ma-jority of the Brazilian maternities there are no mid-wives to take on the support of laboring women sincethis profession does not exit in the country. Regardingthe companion, women usually receive guidance thatthey have the right to have a companion with themduring labor; however companions usually do not par-ticipate in pre-natal educational activities. It is worth-while to reinforce that BPP did not include activitiesfor companions.The encouragement to adopt different upright posi-

tions during labor helped women to find comfortableupright positions during labor. A RCT previouslyconducted by the authors in the same hospital settingshowed that the group of women who received instruc-tions and reinforcement during labor to adopt thevertical positions spent significantly more time in theupright positions and considered upright positionsmore comfortable than the horizontal positions [20].This finding was confirmed in the present study, inwhich the majority of the interviewed women reportedthey felt more comfortable in the upright rather thanhorizontal positions.

According to a recent review [21] although the major-

ity of the women reported their preference for a vaginal

Miquelutti et al. BMC Pregnancy and Childbirth 2013, 13:171 Page 7 of 8http://www.biomedcentral.com/1471-2393/13/171delivery, fear of pain lead many to opt for a Caesareansection. These data evidences the importance of system-atized programs to prepare women during prenatal careby providing information on labor and pain controltechniques. The present study discusses the experienceof labor as described by women. Women who partici-pated in BPP activities reported having felt at ease dur-ing labor using non-pharmacological techniques for painrelief. This may give further weight to the need insettings where antenatal systematic educational activitiesor programs are not part of routine pre-natal care toplan and implement interventions to prepare woman forlabor and delivery.A possible limitation of the present study was the fact

that spinal anesthesia is routinely used at the maternityward where the women delivered their babies. The deci-sion about when spinal anesthesia is performed in laboris made by the anesthetic and OBGYN staff and is not awomens choice. Consequently it was not possible toevaluate womens autonomy on pain relief only using thealternative of non-pharmacological coping strategies forpain control. Another possible limitation may be the factthat woman had the possibility of freely participating inroutine educational interventions offered at the institu-tion during prenatal care and for this reason most par-ticipants of the present study had taken part in someeducational activity. However, some routine activitiesoffered during pre-natal care were held outside themedical consultation days, with voluntary participation,were not attended regularly nor systematic educationalintervention were performed.A possible strength of the study lies in the fact that

only primiparous women were enrolled as intent to fa-cilitate identification of the effect of antenatal guidanceon labor and delivery. A possible strength of the studywas that the interviews were conducted before dischargefrom the maternity hospital; therefore the birthing ex-perience was very present for these women. As a way tominimize a possible courtesy bias, all the interviewswere conducted by a professional that did not have con-tact with the participants during BPP activities or otherproject activities.

ConclusionsWomen who received systematic guidance during preg-nancy on labor and pain control techniques maintainedself-control and used non-pharmacological techniquesto control pain and facilitate labor and expressed satis-faction with the birthing experience. Furthermore, theseresults may contribute to a better understanding of theneeds of women in labor and consequently help planand organize antenatal programs to promote womens

self-control during labor and may contribute to a moresatisfactory birthing experience.Competing interestThe authors declare that they have no competing interests.

Authors contributionsMAM participated in designing the research project, was involved in thedata collection, in the interpretation of the results and writing of themanuscript. MYM participated in designing the research project, interpretingthe results and preparing the manuscript. JGC contributed to the finalediting of the research project and manuscript and the interpretation of theresults. All authors read and approved the final manuscript.

AcknowledgementsThe authors are grateful to the physical therapists who collaborated in thisstudy, to the Department of Physical Therapy and to the nursing staff of theoutpatient prenatal clinic of the maternity hospital.

Details of ethics approvalThis study was approved by the Institutional Review Board of the School ofMedicine, State University of Campinas (UNICAMP) under registrationnumber 407/2008 on 24 June 2008. The study was also registered atclinicaltrials.gov (NCTO1155804).

FundingPartial financial support for the research was provided by Fundao deAmparo Pesquisa do Estado de So Paulo FAPESP grant #08/10392-5 andby Coordenadoria de Aperfeioamento do Pessoal de Ensino Superior(CAPES), Ministry of Education, Brazil.

Author details1Departament of Obstetrics and Gynaecology, School of Medical Sciences,University of Campinas (UNICAMP), Campinas, SP, Brazil. 2Center for Researchon Reproductive Health of Campinas (Cemicamp), Caixa Postal 6181,13084-971 Campinas, SP, Brazil.

Received: 7 March 2013 Accepted: 29 July 2013Published: 5 September 2013

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doi:10.1186/1471-2393-13-171Cite this article as: Miquelutti et al.: Antenatal education and thebirthing experience of Brazilian women: a qualitative study. BMCPregnancy and Childbirth 2013 13:171.

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AbstractBackgroundMethodResultsConclusions

BackgroundMethodsStudy sampleData collectionData analysis

ResultsControl of laborPositions adopted during laborSatisfaction with labor

DiscussionConclusionsCompeting interestAuthors contributionsFundingAuthor detailsReferences

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