Prepare for Pregnancy, Birth, and Parenting

It’s intuitive that preparation for anything is generally beneficial, and this is certainly true for parenting. Since all parents are learning on the job, multiple opportunities and stages arise to help parents prepare for smooth transitions into or through new or emerging situations.

As presented here, integrated prenatal care provided significant benefits for highly stressed mothers in particular. Childbirth education was shown to promote partner involvement, and high quality partner support is shown to be beneficial for mother and infant well-being. Parenting education demonstrated a wide benefit no matter which of the available formats was provided. Parents experiencing behavioral challenges with their children received a greater benefit from in-person classes over more passive learning experiences.

Does Antenatal Education Affect Labour and Birth? A Structured Review of the Literature

Ferguson, S., Davis, D., & Browne, J. (2012). Does antenatal education affect labour and birth? A structured review of the literature, Women and Birth, 26(1), e5–e8

Childbirth classes encouraged partner involvement, less anxiety, and less false labor but led to more labor interventions such as induction and epidural use.

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Sample

  • N: 10 articles (of 3286 identified) originating from Spain, Sweden, Canada, Australia, Iran, UK, Thailand and the United States
  • Search Method: Ovid Medline, CINAHL, Cochrane, and Web of Knowledge databases were used to identify appropriate research articles published in English from 2000 to 2012, using relevant terms in a variety of combinations
  • Inclusion Criteria: Relevancy for labor and birthing outcomes

Objective

  1. To determine the effect of antenatal education on labor and birth, particularly normal birth

Design—Systematic literature review

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Findings

  1. The labor and birthing effects on women attending antenatal education may include less false labor admissions, more partner involvement, and less anxiety but more labor interventions.
  2. Several studies found increased labor and birth interventions such as induction of labor and epidural use.
  3. There is contradictory evidence on the effect of antenatal education on mode of birth.

Effective Intervention Programming: Improving Maternal Adjustment Through Parent Education

Farris, J. R., Bert, S. S. C., Nicholson, J. S., Glass, K., & Borkowski, J. G. (2012). Effective Intervention Programming: Improving Maternal Adjustment Through Parent Education. Administration and Policy in Mental Health and Mental Health Services Research, 40(3), 1-13

Parent education delivered through in-person and web-based classes was helpful for mothers of toddlers, whether or not they reported behavior problems.

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Sample

  • N: 99
  • Subject Ages: 2 to 3 years
  • Location: United States, a suburban area in the Midwestern region
  • SES: Overall, these demographics indicated that the present sample represented a low-risk group of mothers and their toddlers
  • Eligibility: Mother had at least one child between the ages of 2 and 3 years
  • Additional: 
    • On average, participants were 30.74 years of age
    • 81.6% European-American, 10.7% African-American, 4.9% Asian-American, 4.1% Latina (numbers add to more than 100% because some participants were multiracial)
    • 71.4% married and 93.8% reported that their target child’s father was part of his/her life 

Hypotheses

  1. The intervention, consisting of 12 face-to-face parent education sessions in a university setting or online sessions combined with booklets, would improve maternal socioemotional well-being, but improvements would be most substantial when the booklet was supplemented with face-to-face or web-based components.
  2. Effects would be at least partially dependent on the mothers’ perceptions of their toddler’s behavior problems. 

Variables Measured, Instruments Used

  • Maternal socioemotional adjustment - The Symptoms Checklist-90-R (SCL-90-R)
  • Children’s behavior problems - the Brief Infant Toddler Social and Emotional Assessment (BITSEA; Briggs-Gowan, et al. 2004)

Design—RCT

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Findings

  1. All levels of intervention were associated with increases in maternal well-being for participants with typically developing children.
  2. Mothers of toddlers with behavior problems, however, did not benefit from receiving only the booklet but significantly benefitted from receiving either the face-to-face or web-based interventions. 

Limitations 

  • Maternal reports were used as the sole source of mothers’ and toddlers’ adjustment.
  • Did not include assessments of actual parenting behaviors or other potential mediational variables (e.g., parental involvement with pro-social others or supportive activities; Burstein, et al. 2006)
  • The limited sample size restricted statistical power, and therefore there was no control for the effects of all possible factors (e.g., race, gender of child, rather involvement) that may have been indirectly related to socioemotional adjustment and parenting.
  • Use of a single facilitator for in-person groups and no formal record of fidelity checks 

Effects of Group Prenatal Care on Psychosocial Risk in Pregnancy: Results from a Randomised Controlled Trial

Ickovics, J. R., Reed, E., Magriples, U., Westdahl, C., Rising, S. S., & Kershaw, T. S. (2011). Effects of group prenatal care on psychosocial risk in pregnancy: Results from a randomised controlled trial. Psychology and Health, 26(2), 235-250.

Group prenatal care was helpful in increasing self-esteem while decreasing social conflict and depression among at-risk women.

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Sample

  • N: 1,047
  • Subject Ages: Mothers 14–25 years
  • Location: United States, two public hospitals: one in New Haven, Connecticut, the other in Atlanta, Georgia
  • SES: Not available
  • Eligibility: Teen and young pregnant women
  • Additional:  
    • 80% African American, 13% Latina, 6% White, 1% mixed or other race/ethnicity
    • 38% had completed high school (or graduate equivalent degree), 36% were still in high school, 26% had dropped out
    • 32% were currently employed; the remainder received public assistance (22%) or economic support from the baby’s father (25%) or family members (16%)
    • All patients had public (e.g. Medicaid) or hospital assistance for complete prenatal care coverage
    • 48% were nulliparous

Hypotheses

  1. CenteringPregnancy Plus (CP+), a bundled intervention designed to reduce negative birth outcomes, decrease sexual risk, and improve psychosocial outcomes within a model of group prenatal care, will result in increased self-esteem and social support as well as decreased stress, social conflict, and depression.
  2. The intervention will have an even greater effect for those at highest risk of adverse outcomes: younger age, African Americans, and those highest in stress.

Variables Measured, Instruments Used

  • Stress - the Perceived Stress Scale (PSS)
  • Self esteem - the Rosenberg Self Esteem Scale
  • Social support - seven items of the social support subscale of the Social Relationship Scale
  • Social conflict - seven items of the social conflict subscale of the Social Relationship Scale
  • Depression - affect-only component of the Center for Epidemiological Studies Depression Scale
  • Demographic and behavioral characteristics

Design—RCT

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Findings

  1. No significant differences in psychosocial function using intention-to-treat models; yet, women in the top tertile of psychosocial stress at study entry did benefit from integrated group care.
  2. High-stress women randomly assigned to CenteringPregnancy Plus (CP+) reported significantly increased self-esteem, decreased stress, and decreased social conflict in the third trimester of pregnancy. Social conflict and depression were significantly lower one year postpartum. CP+ improved psychosocial outcomes for high-stress women.
  3. Most notably, the strongest finding for CP+ women was the reduction in social conflict. This effect is probably attributed to the heavy emphasis in CP+ on developing effective communication and negotiation skills.

Limitations  

  • Overall effects of the intervention were not found using intention-to-treat analysis, though important subgroup differences were identified. In terms of the potency of the intervention, it may be necessary to strengthen the psychosocial components of CP+ in order to improve psychosocial functioning for everyone and not just those with high initial levels of stress.
  • High-risk sample: Sample represents a relatively restricted group of young, ethnic minority women of low socioeconomic status who attend urban hospital clinics for prenatal care. This is a group at highest risk of adverse perinatal and psychosocial outcomes and therefore may be most in need of substantive clinical intervention to reduce risk.
  • Replication with diverse patient populations and within diverse clinical settings is essential to ensure reliability, generalizability, and clinical effectiveness.

Perceived Partner Support in Pregnancy Predicts Lower Maternal and Infant Distress

Stapleton, L. R. T., Schetter, C. D., Westling, E., Rini, C., Glynn, L. M., Hobel, C. J., & Sandman, C. A. (2012). Perceived partner support in pregnancy predicts lower maternal and infant distress. Journal of Family Psychology, 26(3), 453-463.

Women who received more support from their partners during pregnancy experienced less distress postpartum and reported that their infants were happier, too.

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Sample

  • N: 272
  • Subject Ages: Mean maternal age was 30 years
  • Location: United States, prenatal clinics affiliated with two large urban medical centers
  • SES: Diverse populations in terms of maternal education, income, and ethnicity/race
  • Eligibility: Women who reported being in an intimate relationship with a partner at T1, were pregnant, at least 18 years of age, at 18 weeks singleton gestation or less at enrollment, and able to be interviewed in English
  • Additional:
    • 79% of the current sample was married at T1, and all but three reported their partner was the baby’s father
    • 53% non-Hispanic White, 21% Latina, 1% African American, 10% Asian American
    • Distribution of annual household income was 16% under $30,000, 27% from $30,000-60,000, 24% from $60,000-90,000, and 33% over $90,000 (mean household size 2.9 persons)
    • 12% held a high school diploma or less education; 36% held a technical degree, certificate, associate’s degree, or attended some college; 52% held a bachelor’s degree or higher
    • 58% having a first birth 
    • Infants were born on average at 39.0 weeks gestation
    • 50% of the infants were male

Hypotheses

  1. Maternal interpersonal security and relationship satisfaction would covary inversely with prenatal maternal emotional distress and positively influence perceptions of partner support, consistent with prior research (Rini et al., 2006).
  2. Higher ratings of prenatal partner support would predict lower maternal postpartum emotional distress, as indicated by symptoms of depression and anxiety when controlling for prenatal symptoms.
  3. Partner support would mediate associations of relationship satisfaction and interpersonal security with postpartum outcomes.
  4. Prenatal and postpartum maternal emotional distress would be associated with more distressed infant temperament.
  5. Also tested was a set of hypotheses regarding indirect effects of support via reductions in maternal emotional distress based on past research (Davis et al., 2007) and direct, inverse effects of partner support on infant temperament.

Variables Measured, Instruments Used

  • Maternal interpersonal security (T1) -
    • a version of the Adult Attachment Scale (AAS; Collins & Read,1990) that contained three subscales (five items each): comfort with closeness, comfort depending on others, and anxiety about being rejected by others
    • the Network Orientation Scale
  • Relationship satisfaction (T1) - the Marital Adjustment Test (MAT; Locke & Wallace, 1959)
  • Partner support (T2) -
    • the Social Support Effectiveness (SSE) interview
    • the Pregnancy-Specific Support Needs questionnaire created by author based on prior research (Collins et al., 1993)
  • Maternal emotional distress (T1, P1) -
    • the State-Trait Anxiety Inventory (STAI; Spielberger, 1983)
    • the Center for Epidemiological Studies Depression Scale (CES-D; Santor & Coyne, 1997)
  • Infant distress to novelty (P1) - modified version of the Infant Behavior Questionnaire (IBQ)

Design—Longitudinal, prospective

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Findings

  1. Mothers who perceived stronger social support from their partners mid-pregnancy had lower emotional distress postpartum after controlling for their distress in early pregnancy, and their infants were reported to be less distressed in response to novelty.
  2. Partner support mediated the effects of mothers’ interpersonal security and relationship satisfaction on maternal and infant outcomes.
  3. A high-quality, supportive partner relationship during pregnancy may contribute to improved maternal and infant well-being postpartum, indicating a potential role for partner relationships in mental health interventions, with possible  benefits for infants as well.

Limitations

  • Self report: Future investigations may include data from both partners and additional temperament measures.
  • Depression and anxiety measures were not diagnostic tools.

 

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