Over the last decades, many changes have occurred in perinatal care. The arrival of the epidural in obstetrics in 1972 and its increasing access in the 1980s also profoundly modified the preparation for birth, previously mainly focused on pain management (Standing, el-Sabagh, & Brooten, 1998). Antenatal classes have integrated a psychological preparation of the woman and her partner in addition to the physical preparation (Betolli, 2003), as psychological preparation may improve mental health during pregnancy (Moghaddam Hosseini, Nazarzadeh, & Jahanfar, 2018). Furthermore, couples are encouraged to participate actively in their birth project, starting during pregnancy (HAS, 2005).
The "classical" preparation for birth is a legacy of the psycho-prophylaxis training introduced in France by Lamaze in the early 1950s. From 1955, this model of antenatal classes, also named "painless childbirth", was adopted in French-speaking Switzerland (Vuille, 2009). Partly because of the feminist movements and the decreasing length of stay in maternity wards, the future co-parent became an active participant of antenatal classes: he/she took on the role of supporter and coach during childbirth, as well as support for the return home after birth. The role of those in charge of birth preparation, often midwives, has also changed. Often employed by hospitals, their new teaching model is still based on informing future parents about pregnancy, childbirth, breastfeeding, and childcare. However, they must also promote the medical environment in which the birth will take place (Standing, el-Sabagh, & Brooten, 1998).
In Switzerland, the “classical” birth preparation today is still based on the teaching of theoretical knowledge about pregnancy and childbirth, breathing techniques, and postural labor combined with relaxation (Centre Hospitalier Universitaire Vaudois, 2020; Département de gynécologie et d’obstétrique Hôpitaux Universitaires de Genève, 2015; Fédération Suisse des Sages-femmes section des sages-femmes Vaud-Neuchâtel-Jura, 2020; Maffi, 2014). However, these courses are now integrated in the birth plan that parents are invited to draw up, as recommended by the Haute Autorité de Santé (HAS) (2005), so that the couple's expectations can be taken into account. In addition, future parents are expected to develop specific skills, such as understanding and using information, and developing personal resources throughout the courses, thus marking the definitive shift from an objective of pain-free childbirth to one of psychological preparation for childbirth and parenthood. In the canton of Vaud, the usual costs of in-hospital sessions range from 160 to 344 $, while the Swiss compulsory health insurance reimburses 160$ for an individual or group course given by a midwife (Office fédéral de la santé publique (OFSP), 2021). These costs can represent a barrier to accessing antenatal classes.
Although many women and their partners have a positive childbirth experience, approximately one-third perceive their childbirth to be traumatic (Soet, Brack, & DiIorio, 2003). Between 3–6% of women in community samples (low risk) and between 6–18% of women in high-risk groups (e.g., preterm birth, emergency cesarean section) develop post-traumatic stress disorder following childbirth (PTSD-FC) (Grekin & O'Hara, 2014; Yildiz, Ayers, & Phillips, 2017). PTSD-FC consists of four symptom clusters: re-experiencing of the traumatic event (intrusions), cognitive and behavioral avoidance, negative alterations in mood and cognitions, and hyperarousal (APA,2013; Horesh, Garthus-Niegel, & Horsch, 2021). A recent study showed that intrusion is the most common symptom after a childbirth-related trauma (Harrison, Ayers, Quigley, Stein, & Alderdice, 2021). This may be due to the impact of pain, both in the bodily memory of the trauma but also as a reminder of the experience. The presence of the newborn near her mother can also be a constant reminder of the traumatic experience, thus triggering intrusions (Harrison, Ayers, Quigley, Stein, & Alderdice, 2021).
PTSD-FC can be influenced by a number of factors according to the diathesis–stress model of PTSD-FC (Ayers, Bond, Bertullies, & Wijma, 2016). Childbirth experience is one of these risk factors, as well as the mode of childbirth, the fear of childbirth, mental health status during pregnancy, and social support. The childbirth experience is a self-assessment of what a woman remembers about her birth (Taheri, Takian, Taghizadeh, Jafari, & Sarafraz, 2018), sometimes even many years later (Bernasconi et al., 2021;Simkin, 1991). More than just satisfaction with pain or care, the childbirth experience attempts to "measure feelings of control, expectancy satisfaction, confidence, and participation in decision making" (Taheri et al., 2018, p. 3). Questionnaires addressing the chilbirth experience assess both maternal satisfaction with the provided care and experience of birth (Nilvér, Begley, & Berg, 2017). The childbirth experience can therefore hardly be considered without the provided care. This is why some authors describe the childbirth experience as a subjective experience of birth, whereas the provision of care (mode of delivery, mode of anaesthesia/analgesia, duration of labor, state of the child at birth, etc.) is described as an objective experience (Garthus-Niegel, von Soest, Vollrath, & Eberhard-Gran, 2013).
Recent studies have shown that antenatal classes could prevent PTSD-FC. A prospective study showed that participation in antenatal classes was a predictor of PTSD-FC symptoms at four months post-partum ( t = -2.15, β =-0.15: p < 0.05) in a sample (n=275) of nulliparous and multiparous women, independent of the content of these antenatal classes (Denis, Parant, & Callahan, 2011). A randomised controlled trial highlighted that women who attended a specific program of antenatal classes had less PTSD-FC symptoms (Gökçe İsbir, İnci, Önal, & Yıldız, 2016). However, these results are difficult to generalise due to the large differences in content, teaching methods, and populations (Brixval et al., 2015; Gagnon & Sandall, 2007). In this context, the aim of this study was to compare women who had participated in antenatal classes with those who had not regarding their childbirth experience, PTSD-FC, as well as their obstetric and neonatal outcomes.