Why do people decide to take a prenatal class?
It's perhaps an obvious, self-evident question that might even seem trivial.
One prepares to experience the new birth, the arrival of the one so desired, and whom one cannot wait to meet, in the best possible way.
However, the wait is not short, and it is filled with all kinds of emotions; one goes from maximum euphoria to extreme apprehension in the blink of an eye, just like being on the most challenging and adventurous roller coasters there are.
Let's be clear, only a woman can describe, or at least try to, what feelings pregnancy brings, what emotions arise from it, and what thoughts or conjectures can consequently be born.
We men, on the other hand, are companions, caring and attentive, of course, but always just companions; we walk alongside our partners, experiencing equally strong emotions and moods, but it is undeniable that biologically, due to the copious hormones in constant turmoil, what a woman perceives is totally subjective and extremely intimate, so personal that a mind-reading machine, if it ever existed, would be needed to transcribe it all.
As proof of this, an article published on the Polyclinic's website clearly explains how "during gestation [...] The main hormones involved are estrogens, which contribute to the growth of breast tissue, uterine growth, and the formation of adequate blood circulation for the fetus; progesterone, which promotes the relaxation of uterine muscles, preventing premature contractions and playing a fundamental role in maintaining pregnancy [...] prolactin, which promotes the preparation of the mammary glands for breast milk production, and human chorionic gonadotropin (hCG), responsible for the production of estrogens and progesterone in the early stages of pregnancy." (https://tinyurl.com/54hwbwbk)
So far so good, right? All quite simple and straightforward. Of course, but only if it is usually explicitly stated and correctly explained.
Often, these topics are not covered during prenatal classes. Strange to say, but it's true. To verify this, I decided to personally ascertain how satisfied mothers were with the prenatal class they attended, in order to understand strengths and possible shortcomings, particularly regarding the topics covered during the meetings. In the research conducted, 42 women residing mainly in Milan City, the province of Milan, and the province of Monza were interviewed using the following questionnaire (https://forms.gle/rjFNkxbUVZk2eHq8A), and they were asked some questions concerning: topics covered, topics not covered, emotions experienced, possible improvements to be made, and so on (you can consult the questions at the link provided).
Remember a little while ago when we mentioned the role of hormones? Well, they were asked if hormonal regulation was a topic covered or not during the meetings, and the answer was emblematic:
Only 6 out of 42 women, or 14.3%, received in-depth information regarding hormonal regulation in pregnancy, which is not only insufficient for the prenatal phase but especially in relation to everything that happens in the postpartum phase, a definitely delicate period from this point of view.
From this graph, we can note that the most frequently addressed topics were labor and childbirth (92%), breastfeeding (83.3%), and the pelvic floor (a very positive aspect – 78.6%); these are cardinal and essential elements of a prenatal class, we agree.
However, other areas that I believe are very important were touched upon too little, or even not at all: postural changes (14.3%), hormonal regulation (as mentioned, 14.3%), proper nutrition (14.3%), the importance of physical activity (11.9%), and postpartum consequences (33.3%).
Why such a clear difference? Why is so little said, for example, about the importance of physical activity during pregnancy? Why is generally little space given to demonstrating how a woman's body changes posturally and hormonally during pregnancy? Why are the possible psycho-physical consequences typical of postpartum only briefly mentioned?
The reasons can be manifold, and a specific study would be needed for concrete data, but I believe the following graphs can provide us with some plausible explanations.
The first important data point is the start date of the course. Only 7.1% of the interviewed mothers participated in the first meeting before the 24th week of gestation, demonstrating how the first trimester, in terms of information, is completely skipped, despite being perhaps the most critical period, especially in relation to hormonal regulation, emotional stress, and the concern of maintaining a proper diet.
59.5% started their course between the 25th and 30th week, while as many as 33.3% only started in the period from the 31st to the 35th week.
Upon reading the obtained data, I asked myself some questions, which I would like to share with you.
How can a woman, who may not be particularly accustomed to sports, understand the real reason for the importance of proper physical activity during pregnancy? How can she physically have the time to take care of her body's well-being before childbirth, receiving such advice so late? How could she follow a proper and varied diet without having to rightly worry about whether a food is harmful or not to the health of the fetus?
I know what you might be thinking now, that many years ago women gave birth without ever having done sports, that when they said they had to "eat for two" everything was still fine, that if a pregnant woman had back pain it was all normal; so why bother?
But the truth is that nowadays, in 2025, we are so interconnected that I, a hypothetical 32-year-old Italian woman from Milan, 28 weeks pregnant, can come across, with a simple click on Google or through an Instagram reel, what diet a peer of mine in Alabama, in the same situation, is following; and rest assured that the first thing I will do is ask myself if I should also follow the same diet, regardless of whether it is correct for me or not. Because nowadays, perhaps more than in the past, we need certainty and security, and one way or another we will find it somewhere, at the risk of learning incorrect notions.
Why then not make a prenatal class even more complete, both in terms of information and instructors?
Of the 42 interviewed mothers, 88.1% indicated the midwife as the sole professional speaker for the prenatal course they attended, with some sporadic exceptions involving psychologists, gynecologists, and other professionals.
When it comes to childbirth, breastfeeding, and the pelvic floor, who better than a midwife can be of great help to the expectant mother in learning more about her own body? No one, I assure you. But if we all agree on the importance of adding other valuable topics to our cauldron, then other professionals (psychologist, nutritionist, osteopath, personal trainer, etc.) should also be added to the team of people capable of supporting the woman, in order to combine more skills for a single purpose, which is the health of the expectant mother. This is precisely one of those cases where unity can truly make a difference, and alleviate many anxieties and fears.
Speaking of anxieties and fears... from the research conducted, another significant piece of data emerged, perhaps the most important as a useful indication received. I am talking about the effectiveness of the prenatal course in significantly reducing stress and anxiety, increasing the woman's serenity throughout pregnancy.
As you can see from the graph, it didn't quite turn out that way for many of them. In this specific question, mothers were asked to state whether participation in the prenatal course had a positive impact on their serenity. To do this, they had to assign a score on the indicated scale, ranging from 1 ("not at all") to 5 ("absolutely yes"). We can consider scores from 1 to 3 as negative or partially negative, while scores from 4 to 5 are acceptable and largely positive.
Adding up the scores of 1, 2, and 3, it emerges that 54.7% of mothers perceived almost no, or only a partial, improvement in their serenity, while the remaining 45.3% (sum of scores 4 and 5) described themselves as reassured by attending the prenatal course.
It is true that 42 interviewed women may not represent a statistically significant sample, but they give us a very important idea of how the information received may not have been sufficiently clarifying or totally exhaustive to significantly increase the serenity of mothers, which, in my humble opinion, should be one of the primary objectives of the course.
In addition to this aspect, it should not be overlooked that information, if communicated in a too technical or excessively "frontal lecture" manner, can even produce the opposite effect.
This other graph illustrates the trend of another important question, through which each mother was asked to express any increase in anxiety or feelings of inadequacy during the prenatal course attended. The criteria were the same as the previous question, i.e., always assigning a score from 1 ("not at all") to 5 ("absolutely yes"); in this case, we can consider scores from 1 to 2 as positive and acceptable, while scores from 3 to 5 are fair or negative. Always summing the data obtained in scores 1 and 2, it emerged that 73.8% of participants perceived no or minimal increase in anxiety, while 26.2% (scores 3, 4 and 5) noted a fair or significant increase in emotional stress.
This last percentage is one that absolutely needs to be reduced; doing so would mean that one in four women who spontaneously decide to take a prenatal course experiences a fair or clear increase in worry, stress, or feelings of inadequacy, thus worsening their initial situation.
Why should they decide to attend it then? It wouldn't make much sense, would it? In fact, it might even prove counterproductive.
Attention, I don't want you to think that everything is wrong or to be discarded, quite the opposite! There is much that is positive in the prenatal courses described, for example, the empathy of the professional or professionals involved, who almost always proved capable of fostering pleasant listening, an aspect certainly not to be underestimated.
This data perhaps helps us understand that the intent of every professional is never to further complicate the emotions of expectant mothers; this is certainly not the goal. But sometimes, as we have seen together, it can happen.
Why do you think this is?
While collecting the data, I kept asking myself this question, trying to construct a plausible answer, thanks to the information provided by the mothers themselves.
What emerged most prominently concerns the lack of "practicality" in the meetings, i.e., the tendency to conduct predominantly theoretical lessons, leaving little room for a practical application of what was being explained.
As can be seen from the graph, only 14.3% of women had an experience rich in practical sessions, 61.9% experienced few, and 23.8% never had the opportunity.
While some theory is inevitably necessary to face and digest, let's not forget that putting into practice what is heard makes learning not only more effective but also more enjoyable and, by involving the partner, can prepare both members of the couple to experience pregnancy in the best possible way.
Obviously, it's a completely debatable concept, but in my opinion, it could be a reason for reflection, don't you think?
In conclusion of this in-depth analysis, you are probably wondering: "how could prenatal courses be improved or implemented to make them increasingly a positive experience for the woman and for the couple in general?"
Not considering myself an absolute bearer of truth or solutions, I decided to rely once again on our dear participants, who were asked the final question:
"If you could go back, what changes would you like to see applied to the Prenatal course you attended?"
Below are some of their most significant responses; who knows, perhaps these are the same suggestions you thought of, and if so, we would have a possible common path to pursue to make the prenatal course experience even better.
"I would choose not in a hospital, with someone willing to listen to my needs and not just give me a theoretical lesson on how to breastfeed and give birth (things that, by the way, didn't happen at all!)" Giulia
"I would like artificial feeding to be explained as an option where breastfeeding is not possible." Chiara
"Much more information regarding the importance of posture, physical activity, and postpartum." Helen
"I would recommend a combined psychological and postural approach." Enza
"I would try to instill more positivity, especially about postpartum and family management." Bianca
"I would have preferred the course to delve into postpartum consequences and more practical aspects concerning breastfeeding." Stefania
"Provision for meetings aimed at also addressing topics such as nutrition, physical activity, and hormonal and physical changes." Francesca
"Give more space to the physical and psychological impact on women in the first few months after birth." Pamela
"I would like more awareness about the hormonal impact, particularly the risks and effects of postpartum depression." Irene
As I bid you farewell, I once again sincerely thank all the women who enthusiastically and willingly participated in this valuable interview: you have been and will be of great help to future mothers!
Dr. Andrea Pagani
Your Family Osteopath