ArticleBMC pregnancy and childbirth2026
Midwives' perspective on participation of pregnant individuals planning an elective caesarean section delivery in antenatal classes in Germany: a qualitative interview study.
Article in BMC pregnancy and childbirth, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
backgroundStudies indicate that pregnant individuals sometimes feel inadequately prepared for caesarean section (CS) in antenatal classes. This suggests that the antenatal classes may not sufficiently address the information needs of those planning an elective CS. As antenatal classes provide valuable information beyond preparation for vaginal birth, they may nevertheless be relevant for this group. This study aims to examine how antenatal classes in Germany address elective CS and what factors influence the participation of pregnant individuals planning to have an elective CS according to midwives.
methodsWe conducted a qualitative study using semi-structured interviews with midwives, who were sampled via a convenience sampling technique. The eligibility criteria required midwives currently offering antenatal classes who had conducted at least one antenatal class in Germany that included a pregnant individual planning an elective CS. Recruitment was carried out via telephone or email and through midwifery associations. The 15 interviews took place between October and December 2023. We performed data analysis using a content-structured approach (Mayring), employing MAXQDA 2022 (VERBI Software, Berlin, Germany).
resultsMidwives reported, as a barrier to participation, that pregnant individuals preparing for an elective CS often assume that antenatal classes are not relevant for them. This is partly due to a lack of information regarding the importance of their participation as well as insufficient awareness about the content of antenatal classes. Moreover, midwives noted that, as another barrier of participation, other participants and midwives in antenatal classes sometimes respond negatively to the decision of having a CS. All midwives generally take CS as a topic into account and most generally discuss the content of elective CS. The majority of midwives in the study considered addressing the informational needs of pregnant individuals preparing for an elective CS to be important. The idea of offering a separate course was subject to extensive discussion during the interviews. Some participants raised concerns regarding its practical feasibility.
conclusionsA more comprehensive education of all pregnant individuals regarding the content of antenatal classes is necessary. Tailored course formats could improve access to and relevance of antenatal classes for pregnant individuals planning an elective CS.
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