A Grounded Theory Study of the Impact of Yoga for Pregnancy Classes on Women's Self-Efficacy for Labour and Birth

In addition to lower healthcare costs, straightforward birth has physiological and psychological benefits for women and families (Smith et al., 2016; Kassebaum et al., 2014; O’Mahony et al., 2010). Most women would prefer to birth their babies without medical intervention (Wharton et al. 2017; Care Quality Commission, 2015) and the reduction of birth interventions has been identified as an urgent healthcare priority (Amis, 2016). As pharmacological pain relief in labour results in more instrumental deliveries (Anim-Somuah et al., 2011), enabling women to use self-management strategies to cope with the sensations of labour should result in more women birthing their babies physiologically.

Antenatal education has the potential to teach women pain coping strategies which can help them in labour, but unanswered questions remain around which approaches are most effective (McMillan et al, 2009; Gagnon & Sandall, 2007). Yoga for pregnancy (YfP) has been suggested as an antenatal education intervention which may have an effect on women’s perception of pain during labour (Jones et al., 2012) and may therefore enable them to birth their babies without pharmacological pain relief.

Self-efficacy beliefs affect women’s ability to succeed in the tasks they set themselves and may be able to influence both labour pain perception and perinatal outcomes (Tilden et al., 2016). This thesis reports on a grounded theory study which explored which aspects of YfP delivered by a group of teachers trained by a national charity

(NCT) might be effective in enhancing women’s self-efficacy, and therefore ability to manage labour. This two-part study compared the aims and content of YfP classes with the experience of women who attended them. Part 1 analysed YfP class observations and individual face-to-face interviews with a convenience sample of three YfP teachers. Part 2 was a longitudinal study of women attending YfP classes. Twenty-two women, recruited via the YfP teachers, volunteered to participate in semi-structured interviews at three time points. Two of the interviews were in the antenatal period, and one was held postnatally.

Four themes emerged from the part 1 analysis of class observations and teacher interviews: ’Creating a sisterhood’, ‘Enabling an easier or more positive labour’, ‘Building confidence’ and ‘Enhancing learning’. In the first interviews with the pregnant women in part 2, different themes emerged but with similar threads to the teacher interviews. An overarching theme of ‘Looking after myself and the baby’ emerged with four subthemes: ‘Hoping for a natural or easier labour’, ‘Preparing for something I can’t prepare for’, ‘Being calm and in control’, and ‘Making friends’. These themes developed and changed focus at the second interviews once the women had attended YfP classes and were close to their birth. An overarching theme of ‘Gaining confidence in managing labour’ emerged. The subthemes ‘Preparing for something I can’t prepare for’ and ‘Being in control’ remained, and two new subthemes emerged: ‘Practising techniques for labour’, and ‘Learning from each other’. Postnatally, the women attributed their positive birth experiences to having learned and practiced a variety of pain management strategies and hearing positive birth stories within the YfP classes. The resulting feelings of calm and confidence enhanced their ability to manage labour.

The overarching theme which emerged postnatally was ‘Having a positive experience’ with subthemes ‘Using techniques to manage labour’, ‘Being calm, confident and in control’, and ‘Enhancing the learning’.

A self-efficacy framework was used to analyse the findings and showed that all four of Bandura’s (1977) efficacy-enhancing techniques were present in the YfP class curriculum and matched the elements which the women said increased their self- efficacy for labour. This study demonstrates the value of integrating psychological theory within education interventions and adds to the overall body of knowledge in three areas: yoga during pregnancy, antenatal education and self-efficacy.