An Intervention to Prevent and Reduce Maternal Distress in the Netherlands - Its Development from Start to Finish

Abstract

IntroductionPregnancy is not solely a physical process. The many emotional and social changes and the challenges and demands that accompany pregnancy mark it as a psychosocial process as well. These changes, challenges and demands can affect a woman's emotional wellbeing during pregnancy and for some women this effect is more profound than it is for others [1,2]. Affected emotional wellbeing accompanied by psychological signs and symptoms during pregnancy is defined as maternal distress. Depression, anxiety and pregnancy-related anxiety are the most frequent occurring psychological signs and symptoms that construct maternal distress, varying in severity [1]. Prevalence rates of maternal distress among Dutch healthy pregnant women vary from 2 % to 30 % [3][4][5][6][7][8][9][10][11][12][13][14] measured with psychometric measures of depression and/ or (pregnancy-related) anxiety with scores above set cut-off points. Maternal distress can be caused by either pregnancy itself or non-pregnancy related factors [1][2][3]. Maternal distress can be regarded as a spectrum. This is consistent with a broad approach to antenatal maternal emotional health and wellbeing, as opposed to a one-dimensional view that emphasizes distinct psychological constructs such as depression and anxiety. A broad approach can be interpreted as viewing all aspects of health and wellbeing without emphasizing a specific construct [15,16]. There does not seem to be a need to prioritize or select between the above-mentioned mood disorders, as there is a recognized interrelation between them [17]. Maternal distress can be a predictor for negative birth outcomes and short or long-term post partum health problems for both mother as well as child [18][19][20][21].In the Netherlands, midwives are the main providers of antenatal care [22], making them the default healthcare practitioners for the identification of women who are at-risk to develop maternal distress or who experience maternal distress [23]. A timely antenatal intervention in midwife-led care may prevent or reduce maternal distress. To prevent or reduce maternal distress an intervention must be based on an understanding of the factors that can promote positive change, factors that consider not only the situation of pregnant women, but also the abilities of the midwives who will provide the intervention [24]. "Promoting Healthy Pregnancy" And the Development of the InterventionThe "Promoting Healthy Pregnancy" project (2011Pregnancy" project ( -2015 was funded and launched as a response to the Department of Health concerns about maternal distress and to midwives' uncertainty about their specific role and responsibilities in providing care for women with maternal distress [25]. The aim of the "Promoting Healthy Pregnancy" project was to gather evidence that could be used to create an antenatal intervention for the prevention or reduction of maternal distress during pregnancy for women receiving midwife-led care, i.e. women with healthy pregnancies.The Intervention Mapping protocol [24] was use...