Introduction
What happens if a pregnant woman comes to a hospital to give birth and doesn’t know anything about pregnancy and giving birth? What could possibly happen if the expectant mother doesn’t know what really is her condition prior to giving birth? What if she doesn’t have any knowledge on how to take care of herself during pregnancy? We can only think of the worst case scenarios. So what could possibly be the intervention on this? It is simply prenatal classes.
A prenatal class is an integral part of pregnancy for a woman to know what to do during and after pregnancy. This is the time a woman learns the best practices to take care of her health and her baby’s to prevent complications while pregnant or even during giving birth thus lowering the mortality and morbidity rate of mothers and babies. Once a woman finds out she’s pregnant, she should then see a professional health practitioner such as an OB-Gynecologist to have her pregnancy monitored for early detection of possible complications later on.
What could pregnant women possibly benefit from a prenatal class? According to Beier, childbirth may affect of how a woman may later view her birthing experience. Since a woman is more knowledgeable when it comes to birthing process and how to take care of herself during pregnancy and with constant monitoring to be sure of her and her baby’s condition, she would be more confident with her pregnancy and giving birth. Although a lot of women may not be able to attend prenatal classes due to a lot of factors such as schedule conflicts or financial constraints, there are a lot of ways for a pregnant woman to learn more about pregnancy and giving birth such as online classes or reading books, but if it is possible for them to attend prenatal classes they should do so for them to understand better and have the information from an expert.
What is Fetal Alcohol Syndrome and how important that a mother learns what this is all about? What is the necessary information that an expectant must know about what this syndrome is?
Fetal Alcohol Syndrome is a birth defect of a baby as a result of the mother’s drinking of alcohol during pregnancy (Doctors on Medicinenet.com). This defect was formally discovered on 1968 by Lemoine and his colleagues in France when they studied the 127 children born to alcoholic mothers, but this gained little attention. It was only in 1973 when it was rediscovered by Jones and colleagues from Seattle that it became popular. Since then a lot of reports were done about Fetal Alcohol Syndrome.
An expectant mother should learn about what this fetal alcohol syndrome is all about so to prevent them from drinking alcohol while pregnant. They may then wish to change their drinking habits while pregnant.
In a study done involving 400,000 women in the U.S. who all drank alcohol while pregnant gave a negative report on Fetal Alcohol Syndrome for so long as they didn’t exceed 8.5 or more drinks in a week. A review on studies about this disorder found out that it only prevalent among alcoholic mothers.
Thus expectant mothers need to know when to stop drinking and when they already had enough alcohol intakes so as not to endanger her baby.
Statement of the Problem
Is there any change in the drinking habits of pregnant women when fetal alcohol syndrome is included in the prenatal class?
Null Hypotheses
There is no change in the drinking habits of pregnant women when Fetal Alcohol Syndrome is discussed in prenatal classes in terms of age.
There is no change in the drinking habits of pregnant women when Fetal Alcohol Syndrome is discussed in prenatal classes in terms of annual income.
There is no change in the drinking habits of pregnant women when Fetal Alcohol Syndrome is discussed in prenatal classes in terms of educational attainment.
There is no change in the drinking habits of pregnant women when Fetal Alcohol Syndrome is discussed in prenatal classes in terms of civil status.
Research Design
The research design that would be used in the study is the causal research method wherein the cause and effect would be studied. This method would aim to investigate the effect of one variable to another variable. In this study the effect of the discussion of fetal alcohol syndrome during prenatal classes to the drinking habits of the pregnant women.
List of Variables
Independent Variables
Prenatal Classes discussing Fetal Alcohol Syndrome – is the term used for the prenatal class attended by the respondents discussing fetal alcohol syndrome.
Drinking habits – is the term used that refers to the number of alcohol intake of the respondents every week
Age – refers to how old the respondent is
Educational attainment – refers to the degree of education finished by the respondent
Annual Income – refers to the total household income each year
Civil Status – refers to the status of the respondent whether she is single, married, widow, separated or divorcee.
Measurements of the Variables
Drinking Habits
Women: 0-6 *drinks per week = light drinking, 7-20 drinks per week = moderate drinking, 21 and above per week = heavy drinking (for female under age 65)
Men: 0-14 drinks per week = light drinking, 14-34 drinks per week = moderate drinking, 35 drinks and above = heavy drinking
*One drink = one 12-oz bottle of beer (4.5 percent alcohol) or one 5-oz glass of wine (12.9 percent alcohol) or 1.5 oz of 80-proof distilled spirits.(family doctor.org editorial staff)
Age Bracket
Bracket 1 = 18-22, Bracket 2 = 22-27, Bracket 3 = 28-32, Bracket 4 = 33-38, Bracket 5 = 38-menopausal stage
Educational Attainment
Elementary Level, Elementary Graduate, High School Level, High School Graduate, College Level, College Graduate
Annual Income Bracket
Less than $10,000 per year, $10,000-$50,000 per year, $50,000- $100,000 per year and above $100,000 per year
Civil Status
Single, married, widow, separated or divorcee
Description of Sampling Procedure
The sampling procedure that would be used is the non-probability purposive-sampling. This type of sampling method is appropriate for this study since it would only include pregnant women who attend prenatal classes and these respondents are chosen purposely for the study. There would be a certain target group that is chosen purposely to participate in the study with the qualification that they are pregnant women undergoing prenatal classes.
Data Collection Methods
The data collection method that would be used in this paper is through a questionnaire wherein this tool would be provided to the respondents. They would be choosing from the selections that would best apply to them. The questionnaire would be made by the researcher and have it validated by the professor. This would be appropriate for the study so it would not be very time consuming for a one on one interview with the respondents that may affect their number.
How the Data Will be Coded and Analyzed
The answers of the respondents of the study would be tabulated. The tabulation would be according to the variables presented above. The data in the questionnaire would then have a number that would represent each item. A computer application such as the MS Excel may be used to help the researcher sort out the data The computer application may perform the statistical analysis or a statistician may help determine what appropriate statistical technique would be applied.
How Ethical Issues will be addressed?
The ethical issue as to the use of human beings as sample would not be a problem. The respondents would not be forced to become respondents of the said study. Their consent would be sought prior to giving them questionnaires to answer. They would be informed as to what the study is all about and how this study would be of help in the future. Their answers would be strictly kept confidential. The respondents would not be subjected to or predisposed to any physical harm. They would not be undergoing any invasive procedures that may be affecting their health or their baby’s.
Conclusion
This study would explore on the pregnant women’s response in terms of their alcohol drinking habits prior to and after pregnancy. After the respondents would be subjected to the prenatal class wherein a discussion on fetal alcohol syndrome would be included, the study would find out how this would change the number of their alcohol intake every week. This study would then prove if there would be any positive change in the alcohol drinking habits of these pregnant women then it would be an integral part to include the discussion of Fetal Alcohol Syndrome during prenatal classes. This would then help lower the cases of children born with defects caused by excessive alcohol drinking of mothers during pregnancy. This would also help many women have a safe pregnancy and avoid possible complications in the duration of their pregnancy.
Literature Review
A lot of studies have already been conducted about Fetal alcohol Syndrome and the importance of prenatal classes during pregnancy. The following works are cited would be presented to show the importance of knowledge about Fetal Alcohol Syndrome prior to getting pregnant and during the pregnancy stages.
In a study done by Nichols (1995), regarding the comparison in the adjustment to new parenthood between first time parents and what was the effect of attending prenatal classes on them. The study included parents who attended prenatal classes and those who did not. The study showed a difference in maternal age and maternal and paternal educational levels but didn’t show difference in terms of prenatal attachment, prenatal childbirth involvement, the satisfaction during childbirth and the sense of competence in parenting, and the transition to being first time parents. It suggested further studies then on how prenatal classes can help on becoming first time parents.
This study then can help us show how important prenatal classes are to new parents. This would show how important the information that they got from attending such classes would help them later on to adjust to a new chapter in their life.
Another study from Koehn ML (1993) entitled “The psychoeducational model of prepared childbirth education.” states that childbirth classes influences pregnant women on effective coping to the experience of childbirth. They would have confidence in actively participating in the birthing process and pain management without artificial pain management interventions.
In an article from familydoctor.org (2003) states that attending a childbirth class are one great way in preparing for labor and birth and a lot of topics related to pregnancy and giving birth are discussed. These articles also suggest selecting a childbirth class that would perfectly fit ones needs. The classes may range from discussing basic knowledge to the in depth discussion on the complication of pregnancy.
This would be a great help to pregnant women to learn things about pregnancy that they would not learn when they opt not to attend prenatal class. This may then increase the level of confidence of an expectant mother to have her baby.
In a study done by Lumley J; Brown S (1993) entitled “Attenders and nonattenders at childbirth education classes in Australia: how do they and their births differ?” the results stated that there were minor difference when it comes to measures of pain and to the use of procedures, interventions, and pain relief, that there was no difference in terms of satisfaction with the provision of information through pregnancy, birth, and the postnatal period. The results also showed that women who attended prenatal classes were not more confident and they are less likely to develop depression 8 months after giving birth. The greatest difference that was showed was with the health practices by women during pregnancy in terms of cigarette smoking, missed antenatal appointments, breastfeeding, and alcohol consumption during pregnancy.
Thus this study suggests the importance of including appropriate health practices during pregnancy. The inclusion of this discussion would greatly help first time parents to have healthy babies. It would also give them knowledge on how to have healthy practices to prevent complications of pregnancy and lessen the chances of child birth defects.
Another study from Bradley LP (1995) entitled “Changing American birth through childbirth education”, it stated that educators on childbirth classes could bring changes to the prenatal care of an expectant mother.
This study would then suggest that attending prenatal classes may be essential to the decision making an expectant mother would make as to the kind of prenatal that she should be receiving.
In another study by Handfield B (1995) entitled “Do childbirth classes influence decision making about labor and postpartum issues?”, suggests that childbirth education classes had minimal effect on their decision for breastfeeding and staying for 24 hours where they gave birth. This also suggested a further study.
This study aimed to show if there would be an effect as to women’s decisions on matters regarding prenatal and post natal care. However the researcher was not able to establish a significant relationship thus needs further study.
Another paper entitled “The Impact of Birth Complications on Parental Decision Making: Could Prenatal Classes Help?” by Phillips and SJ, Tooley, GA discusses the importance of preparations before birthing. This article proposed that an option of attending prenatal classes should be considered to have knowledge about birth complications thus lowering their chances to experience it.
This study then suggests that enough knowledge about the possible complications is important and these are discussed in prenatal classes. This then implies the importance of prenatal classes so the expectant mother would know what to avoid during pregnancy. She would also know what factors that may predispose her and her baby to the dangers of complications.
Another article from Multiple Moms (2007) sited the importance of taking prenatal classes especially for women who are carrying twins. It stated that this kind of pregnancy is unique as there is a different set of physical and emotional challenges. The article says that there are a lot of concerns regarding multiple pregnancies. Topics on multiple pregnancies would include Nutrition, weight gain, appropriate exercise, rest, and stress-management are even more important when you’re caring two or more. How much to eat? How much to drink? What can you can and can’t do?
The article then suggests that the expectant mothers especially when carrying twins should be very careful in handling her pregnancy. An expectant mother must learn more about the possible complications, the possible method of delivery since it would be twins and what to expect with her pregnancy. This may then give the expectant mother more confidence during her pregnancy and thus may lower anxiety rates that may affect the process of her delivery.
An article entitled Annie’s Song states that since proper prenatal care is an important for an expectant mother, a key step could be attending prenatal classes to learn more about her pregnancy and the stages she’s into and what to expect on these stages. Annie’s Song is an education program offered to the ‘lost’ population of young and unmarried women who weren’t attending these critical classes.
Through this service the young people who are afraid to attend prenatal classes may be educated. They are the ones who need the education the most since they are the ones who tend to abuse themselves to release the pressure of their condition. Most of the young pregnant moms are the ones who have unwanted pregnancies. They are the ones who might have the complication of postpartum depression. They need to be educated on the processes of pregnancy and birthing for them to have a background of what parenting really is.
Studies had also been made about Fetal Alcohol Syndrome that are important facts that parents must learn prior to pregnancy and during pregnancy. The following reviews had been found.
Fetal alcohol syndrome (FAS) is a leading but preventable cause of mental retardation during pregnancy wherein alcohol consumption is quite high. Though there have been public education this disease still increases its cases as much as 12,000 approximation each year (American Academy of Pediatrics, 2000). Despite of information dissemination on how to prevent FAS women still pursue drinking alcoholic beverages during pregnancy which in turn exposes the fetus in their womb to the adverse effects of alcohol ( Sokol, Delaney – Black, and Nordstrom, 2005). The alcohol that a pregnant woman drinks travels through her bloodstream and across the placenta to her fetus, or developing baby. A fetus’s small body breaks down alcohol much more slowly than an adult’s body does. So the alcohol level in the fetus’s blood is higher than in the mother’s blood, and the alcohol remains in the fetus’s blood longer. This exposure of the fetus to alcohol causes FAS. Studies have shown that there is no proven particular amount of alcohol that causes FAS still moderate and light drinking of alcohol still shows an effect on the babies. An average of only one drink per day increases a baby’s risk of FAS (WebMD.com,LLC. 2005-2008). Alcohol rapidly reaches the fetus in which it crosses the placenta. Extensive studies have demonstrated equivalent fetal and maternal alcohol concentrations, suggesting an unimpeded bidirectional movement of alcohol between the 2 compartments. The fetus appears to depend on maternal hepatic detoxification because the activity of alcohol dehydrogenase (ADH) in the fetal liver is <10% of that observed in the adult liver. Furthermore, the amniotic fluid acts as a reservoir for alcohol, prolonging fetal exposure.
The diagnosis of fetal alcohol syndrome (FAS) is based on findings in the following 3 areas: (1) characteristic facial anomalies, (2) growth retardation (intrauterine growth restriction and failure to have catch-up growth), and (3) CNS involvement (cognitive impairment, learning disabilities, or behavioral abnormalities) (www.emedicine.com/ped/topic767.htm).
Studies have also found that alcohol damages the fetal brain by interfering with the growth factors and neurotransmitters that regulate cell proliferation and brain development (7). Normal neuron development requires neurons to develop and migrate to the outer layers of the cerebral cortex. Alcohol exposure at critical times can alter normal migration, and neural cells end up in abnormal positions, thus altering the connections among neurons. The growth and differentiation of serotonin-releasing neurons (i.e., serotonergic system – 5HT) has been studied with interest, since this system plays an important role in human mood disorders. Research seems to indicate that environmental influences in early development may alter neuron determination in the serotonergic system. Alteration in the function of the serotonergic system is associated with increased individual susceptibility to mental health disorders and can affect how well the individual respond to pharmaceutical agents.
There have been many disorders associated to Fetal Alcohol syndrome.
A study of Dr. Ann P. Streissguth,. Et al. have shown that Attention Deficit & Distractibility Increase when Mothers Consumed Alcohol during Pregnancy. Attention, distraction, and impulsive behavior problems more likely to occur to children whose mothers have taken alcohol moderately during pregnancy. A test called continuous performance test was conducted in order to determine endurance, persistence, organization, distractibility and impulsivity in this large group of 7 year old children. One test given, considered to be effective at assessing Attention Deficit Disorders, and is called the AX-task. In this test the child sits at a computer screen that is flashing single letters at one second intervals. The child is asked to push a button when the letter “X” appears, but only when it was immediately preceded by the letter “A”. The numbers of errors were then calculated for three different mother alcohol consumption levels (0-3 drinks daily, 3-4 drinks daily, & more than 4 drinks daily) to determine if there was any correlation between the amount of alcohol consumed and the number of errors the child made on the test. The results showed that greater alcohol exposure resulted in far more errors on the AX task. The authors stated that the direction of the effect is as predicted, with poorer performance associated with higher (alcohol) exposure.” Tests of distraction were also conducted while the child was taking the CPT tests. There was an 8% distraction rate for the 0-3 drink exposure children, a 14% distraction rate for the 3-4 drink exposure children and a 46% distraction rate for the children whose mothers drank more than 4 drinks per day. Average reaction times were about twice as slow for the more than 3 drink exposure children. In conclusion the researchers stated that this study is vital in showing the continuity of the impact pre natal alcohol exposure on the child’s attention and reaction time even after adjusting for different predictors.
Sally E. Shaywitz, M.D., et al, stated that milder degrees of the dysfunction of the central nervous system are frequently encountered in the child of alcoholic women, and suggested the broader study of FAS to include the behavioral and learning deficits as manifested in the central nervous system. An indication of mild dimorphic features of fetal alcohol syndrome there have been a manifestation of hyperactivity and learning difficulties in children with normal intelligence born to heavy drinking mothers. Alcohol exposure in utero (during pregnancy) may be an important, preventable determinant of attention deficit syndromes in childhood.”
Reading Test Scores Lower in Children Whose Mothers Drank Alcohol During Last Trimester of Pregnancy presented by Dr. Claire D. Coles she stated that during the third trimester of pregnancy alcohol exposure may affect the developing hippocampus or allied structures, leading to deficits in the ability to encode visual or auditory information of the child. They (the child) found to be low in academic levels and it is possible that some of these children will develop particular learning disabilities.
A study presented by Dr. Joanne L. Gusella that among the 84 children who have been tested at 13 months were found to have lower verbal comprehension and spoken language scores whose mothers have drank at about .24 ounces of alcohol per day. The Bayley Scales of infant Development was used to test language and comprehension which included da-da or equivalent, Jabbers expressively, Imitates words, Says 2 words, Names 1 object, Vocalizes 4 different syllables, Listens selectively to familiar words, Responds to verbal request, Inhibits on command, Shows shoes or other clothing or own toy. The test was conducted by professionals who are not aware that the mothers of these kids were drinking alcohol during pregnancy. It showed a positive result showing the significance at the 0.05 level.
FASD and FAS are not genetically inherited conditions. A child must be exposed to prenatal alcohol in order to be affected. However, there are believed to be variations in the susceptibility and severity of the conditions based on environment-gene interactions. The environmental impact of alcohol on the fetus may vary due to the timing and dosage of alcohol; the genetic make-up of the mother who consumes and metabolizes the alcohol; and the fetus, which responds to the toxic effects of alcohol and eventually metabolizes it in later development. Research has demonstrated that dosage and timing of exposure may impact the severity of the disorders. It is assumed that drinking alcohol during the first trimester of pregnancy results in the most severe physical anomalies. However the inner structure of the brain changes and the cognitive injury as the result can occur with alcohol exposure during pregnancy.
Despite these findings not all incidences of prenatal exposure to alcohol will result in FAS. The possibility that genetic risk factors play a role in the susceptibility to adverse effects was first considered when animal researchers noted that different strains of mice and chick research models were affected differently by alcohol exposure during gestation. Certain strains consistently experienced more severe alcohol-related disorders than others, even when the amount of alcohol ingested was kept constant. This suggests that genetic differences in metabolism and molecular mechanisms of alcohol toxicity control teratogenic effects. At the same time, genetic risks that predispose the woman to alcohol addiction and conditioning may indirectly affect her drinking pattern. While intake is generally considered an environmental issue alone, there is now evidence that genetic variations may affect the amount of alcohol desired and the risk of dependency and addiction. The mechanisms responsible are not totally clear and more study is warranted. How the environmental issues, such as pattern of alcohol consumption, impacts the protective benefits is also unknown and more difficult to study. Other genetic factors, such as the role of placental enzymes and maternal-fetal interactions, also need consideration. Such factors may be the key to predicting which newborns will be at risk for the most adverse outcomes. Although promising, more population-based research is needed before polymorphisms can be used as a biomarker to identify women or newborns at higher risk of FAS. Genetic makeup alone does not account for enough of the variance in outcome.
Another study was done by May, P et. al. entitled Maternal Risk Factors for Fetal Alcohol Syndrome in the Western Cape Province of South Africa: A Population-Based Study states that there is a difference between case and control mothers when it comes to socioeconomic status, religiosity, education, gravidity, parity, and marital status. The result also showed that children with Fetal Alcohol Syndrome were mostly born to mothers with alcohol abusing families where in mothers are heavy drinkers.
This result alone would prove that there is really an effect when pregnant women drink too much alcohol during pregnancy and this would also account for the occurrence of Fetal Alcohol Syndrome. Thus, it is very necessary for expectant mothers to know the level of alcohol allowed when they are pregnant. They must know safe practices when it comes to health to prevent complications such as Fetal Alcohol Syndrome.
These are some important facts that we need to know that would guide us with this study. This would greatly help us in understanding why this study needs to be conducted.
Sources:
Beier, Catherine. (2007, November 09). Online Childbirth Education – A New Way to Prepare for Your Baby’s Birth. EzineArticles. Retrieved March 20, 2008, from http://ezinearticles.com/?Online-Childbirth-Education—A-New-Way-to-Prepare-for-Your-Babys-Birth&id=822907http://www.medicinenet.com/fetal_alcohol_syndrome/article.htm Last Editorial Review: 4/1/2002 Fetal Alcohol Syndrome
This site is maintained by Prof. David J. Hanson, Ph.D. Fetal Alcohol Syndrome. Alcohol: Problems and Solutions http://www2.potsdam.edu/hansondj/FetalAlcoholSyndrome.html#3
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Could Prenatal Classes Help? (http://209.85.173.104/search?q=cache:5kQE8wrwsJoJ:www.aare.edu.au/04pap/phi04946.pdf+Importance+of+prenatal+classes&hl=tl&ct=clnk&cd=40&gl=ph&client=firefox-a)
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Annie’s Song (http://www.qualityoflife.org/ich/anniessong/anniessong.cfm)