Four years after the province phased out its in-person prenatal classes in favour of an online parenting course, the Nova Scotia Health Authority has now scrapped that online program.

People seeking prenatal education from the province are now directed to a website with links to other websites.

In September 2014, the Health Department began replacing in-person classes with the Welcome to Parenting online course, which provided information about pregnancy, labour, birth, breastfeeding and newborn care. The course also offered a forum for parents to share their experiences.

But uptake and completion of the program did not meet expectations.

"The rate of new users has decreased and online class participation is low," said an emailed statement from a Nova Scotia Health Authority spokesperson.

"Since the launch of Welcome to Parenting, a number of new and updated pregnancy and parenting online resources are available. Based on these findings and the availability of credible online resources, a decision was made in 2018 to not renew the Welcome to Parenting contract."

Users were able to register for the course until the end of September, and those who were registered could access the site until Dec. 31.

Low enrolment

Nearly 8,500 babies are born each year in the province, but over the four years the course was offered, only 4,507 people registered for Welcome to Parenting.

More than half of those who registered never accessed any content on the site, and of those who did start the classes, few made it to the end. Only about a quarter of users participated in classes dealing with the third trimester of pregnancy, labour and delivery.

The program cost about $49,500 on average per year.

The Nova Scotia Health Authority refused to make anyone available for an interview about the program.

Laidlaw was in one of the last in-person prenatal classes offered by the province when she was pregnant with her son. (Dave Laughlin/CBC)

Tess Laidlaw, the mother of a four-year-old, was enrolled in one of the last in-person prenatal classes offered by the Nova Scotia Health Authority.

The classes were helpful because she could learn from and connect socially with other soon-to-be parents and was able to ask questions of the instructor, she said.

She said she felt online offerings just wouldn't be the same.

"I didn't think for me that would have been an ideal approach because you're sitting alone at a computer and you don't have that opportunity to meet up with people."

Laidlaw is also part of a working group of academics and health-care practitioners studying prenatal education and how it affects birth experience and outcomes. As part of the work, the group examined the Welcome to Parenting course.

Online prenatal courses may have visual messages that may not resonate with students, Laidlaw said.

Laidlaw is a member of a working group of academics and health-care practitioners studying the impact of prenatal classes. (Dave Laughlin/CBC)

"You see the image of the graceful expectant mom and it's like, 'I don't look like that,'" she said. "So our findings in terms of that study were basically those classes function to make you feel guilty because you can't possibly meet all of those requirements."

The Welcome to Parenting course gave students quizzes on material before it was even presented, Laidlaw said.

"They're basically designed so that you would get questions wrong. It kind of makes you feel guilty. It makes you feel, 'Why don't I know this stuff? Am I not a good parent?'"

Laidlaw said in general, prenatal education should receive more attention from both researchers and public health officials.

Cost of classes can be a barrier

There are still some in-person classes offered through family resource centres, private businesses and non-profits.

The Immigrant Settlement Association of Nova Scotia started its own in-person classes in spring 2018.

"Because of specific challenges faced by newcomers, like communication barriers, knowledge of the Canadian health-care system, health literacy and the need for culturally competent care, online prenatal classes were not an option for many newcomers," said the organization's immigrant health co-ordinator, Zrinka Seles-Vranjes, in a statement.

Beth Baker teaches prenatal classes at Memory Lane Family Place in Lower Sackville, N.S., that are funded through the Public Health Agency of Canada.

While those classes are free, some companies offering prenatal courses charge a couple hundred dollars for a few hours of class time — which can limit access for some people.

"It may be a drop in a bucket to some folks, but for other folks, that's a fairly substantial amount of money," Baker said.

She added that the move to online education may exclude people who don't have ready access to the internet.

"People need to be educated about the best possible ways to have healthy babies," Baker said. "I'm really surprised that public health … is not in a position to support that at this point."

The Nova Scotia Health Authority said in its statement that public health provides prenatal information through partnerships with family resource centres, primary health care, maternal and child services and through one-on-one support for vulnerable families.