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In maternity care, there is a strong and well-established commitment to providing information. Antenatal education, clinical conversations, written materials and, increasingly, digital platforms are all designed to support women and birthing people to make informed choices.
However, there is a more fundamental question that is less frequently explored: how much of that information is truly understood, retained and revisited when it matters most?
Providing information does not necessarily equate to supporting understanding. Across maternity services, variation in engagement and recall is widely recognised. Some women attend antenatal classes and actively seek out information, while others do not. Some leave appointments with clarity, while others feel uncertain or overwhelmed. For those facing language barriers, lower health literacy, or reduced confidence in navigating services, this gap can widen further. These challenges are rarely about motivation; more often, they reflect how information is designed and delivered.
Moving Beyond Learning Styles
For many years, education has been shaped by the concept of “learning styles”, suggesting that individuals learn best when information is tailored to a preferred mode such as visual, auditory or kinaesthetic. While widely adopted, robust research has not supported this approach. Reviews of the evidence have found little empirical support for the idea that matching information to a fixed learning style improves outcomes (Pashler et al., 2008).
This has led to a more meaningful shift in thinking. The focus is no longer on categorising individuals, but on designing information that is more likely to be understood by a wider range of people.
What the Evidence Tells Us About Learning
Evidence from cognitive science and patient education offers a more practical and applicable set of principles. People tend to understand and retain information more effectively when it is presented in more than one format, particularly when combining verbal and visual elements. The Cognitive Theory of Multimedia Learning suggests that individuals process visual and auditory information through separate channels, enabling deeper understanding when both are used together appropriately (Mayer, 2009).
This principle is reflected in healthcare research. A systematic review of randomised controlled trials examining audio-visual interventions for informed consent found that such approaches improved patient recall compared to standard information delivery alone, particularly when materials were designed with accessibility in mind (Schenker et al., 2011). Similarly, a Cochrane review of multimedia interventions for patient education reported improvements in knowledge and understanding across multiple studies, particularly when used alongside professional interaction (Ryan et al., 2014).
The concept of cognitive load is also central. When too much information is presented at once, or in a way that is difficult to process, understanding can be reduced (Sweller, 1988). More recent applications of Cognitive Load Theory within healthcare education emphasise the importance of structuring information into manageable segments and sequencing learning appropriately to support comprehension and retention (Young et al., 2014; van Merriënboer and Sweller, 2010; Baxter, 2025).
The ability to revisit information further strengthens understanding. Unlike a single clinical conversation, digital resources allow individuals to return to information as their needs evolve. This is particularly relevant in maternity care, where the timing and relevance of information changes throughout pregnancy.
Accessibility remains a critical factor. Language, literacy and cultural context all influence how information is received. Where information is only available in one format or one language, it risks excluding those who may benefit most (Kessels, 2003).
Why This Matters in Maternity Care
Maternity care presents a unique context for learning. Information is often delivered within time-limited appointments and at points of heightened emotion. Decisions can be complex, and recall may be affected by stress or fatigue. Partners and families, who play a key role in decision-making, may not always be present when information is first shared.
In this context, how information is delivered becomes as important as what is delivered. When information is accessible, clear and available to revisit, it can support greater confidence, improved understanding and more informed decision-making.
Applying Learning Science in Practice
Applying these principles requires a move away from static, single-format resources towards more flexible and accessible approaches. Digital platforms offer an opportunity to bring together multiple forms of information within a consistent and structured environment.
At The Real Birth Company, this evidence has informed the design of the RealBirth® programme. The platform integrates multiple complementary formats, including animated video, written content, subtitles, audio support and interactive elements.
Animation supports understanding of processes that are difficult to convey through text alone, while subtitles reinforce spoken information and improve accessibility. Audio playback enables content to be listened to, supporting those with different literacy levels or learning preferences at a given time. Interactive elements allow individuals to explore information at their own pace, reducing the risk of overload.
Content is also provided in multiple languages through human translation, supporting both accuracy and cultural relevance. The use of real human voices, rather than fully synthetic alternatives, helps preserve tone, nuance and clarity. While advances in artificial voice technology continue, evidence suggests that vocal authenticity and natural delivery can influence how information is perceived and understood (Nass and Brave, 2005).
Crucially, all content is available on demand, allowing women and families to revisit information as their needs change throughout pregnancy.
Supporting Understanding Through Clinical Training
Alongside the design of digital content, the way maternity professionals are supported to engage with and deliver education is equally important. Training approaches that reflect how people learn can strengthen both confidence and consistency in practice.
Training delivery incorporates a structured “reverse learning” approach, where sessions are segmented into smaller, progressive components. Each section establishes a baseline understanding before building into more complex concepts. This aligns with both foundational and contemporary applications of Cognitive Load Theory, which emphasise the importance of managing cognitive demand and sequencing information effectively (Sweller, 1988; Young et al., 2014; Si, 2024).
Sessions are designed to be participatory rather than didactic. Midwives are encouraged to explore content, engage with it directly and reflect on its application within their own practice. Structured questioning is embedded throughout, alongside opportunities for paired and group discussion.
Active learning approaches of this kind have been shown to improve engagement and knowledge retention compared to passive instruction (Freeman et al., 2014). Collaborative discussion also supports deeper understanding by enabling participants to process information in context and learn from shared perspectives.
Importantly, this approach mirrors the principles applied within digital education. By modelling exploration, reflection and accessibility within training, it supports a consistent approach to communication across maternity services.
A Shift in Perspective
The move away from “learning styles” does not remove the need for personalisation. Instead, it reframes it. The focus shifts from attempting to categorise individuals to designing information that is inherently flexible, accessible and supportive of understanding.
In maternity care, where information underpins choice, confidence and experience, this shift is particularly important. When information is clear, available in multiple complementary forms, and accessible at the point of need, it is more likely to be understood, retained and used.
This is not simply a matter of communication. It is a matter of enabling informed care.
References
Baxter, K.A. (2025) ‘The Application of Cognitive Load Theory to the Design of Health Programmes’, Health Promotion Practice.
Freeman, S., Eddy, S.L., McDonough, M., Smith, M.K., Okoroafor, N., Jordt, H. and Wenderoth, M.P. (2014) ‘Active learning increases student performance in science, engineering, and mathematics’, Proceedings of the National Academy of Sciences, 111(23), pp. 8410–8415.
Kessels, R.P.C. (2003) ‘Patients’ memory for medical information’, Journal of the Royal Society of Medicine, 96(5), pp. 219–222.
Mayer, R.E. (2009) Multimedia Learning. 2nd edn. Cambridge: Cambridge University Press.
Nass, C. and Brave, S. (2005) Wired for Speech: How Voice Activates and Advances the Human-Computer Relationship. Cambridge, MA: MIT Press.
Pashler, H., McDaniel, M., Rohrer, D. and Bjork, R. (2008) ‘Learning styles: Concepts and evidence’, Psychological Science in the Public Interest, 9(3), pp. 105–119.
Ryan, R., Santesso, N., Hill, S., Lowe, D., Kaufman, C. and Grimshaw, J. (2014) ‘Multimedia educational interventions for consumers about prescribed and over-the-counter medications’, Cochrane Database of Systematic Reviews, Issue 4.
Schenker, Y., Fernandez, A., Sudore, R. and Schillinger, D. (2011) ‘Interventions to improve patient comprehension in informed consent for medical and surgical procedures: a systematic review’, Medical Decision Making, 31(1), pp. 151–173.
Si, J. (2024) ‘Using cognitive load theory to tailor clinical reasoning training for preclinical students’, Medical Science Educator.
Sweller, J. (1988) ‘Cognitive load during problem solving: Effects on learning’, Cognitive Science, 12(2), pp. 257–285.
van Merriënboer, J.J.G. and Sweller, J. (2010) ‘Cognitive load theory in health professional education: design principles and strategies’, Medical Education, 44(1), pp. 85–93.
Young, J.Q., van Merriënboer, J., Durning, S. and ten Cate, O. (2014) ‘Cognitive Load Theory: Implications for medical education’, Medical Teacher, 36(5), pp. 371–384.
