Lay support for pregnant women with social risk: a randomised controlled trial

Abstract

Interventions: POWs were trained to provide individual support and case management for the women including home visiting from randomisation to 6 weeks after birth. Standard maternity care (control) included provision for referring women with social risk factors to specialist midwifery services, available to both arms. Main outcome measures: Primary outcomes wereantenatal visits attended and Edinburgh Postnatal Depression Scale (EPDS) 8-12 weeks postpartum. Prespecified, powered, subgroup comparison was among women with 2 or more social risks. Secondary outcomes included maternal and neonatal birth outcomes; maternal self-efficacy, and mother-to-infant bonding at 8-12 weeks; child development assessment at 6 weeks, breastfeeding at 6 weeks, and immunisation uptake at 4 months, all collected from routine child health systems.Results: Antenatal attendances were high in the standard care control and did not increase further with addition of the POW intervention (10.1 vs 10.1 (mean difference; MD) −0.00, 95% CI (95% CI −0.37 to 0.37)). In the powered subgroup of women with 2 or more social risk factors, mean EPDS (MD −0.79 (95% CI −1.56 to −0.02) was significantly better, although for all women recruited, no significant differences were seen (MD −0.59 (95% CI −1.24 to 0.06). Mother-toinfant bonding was significantly better in the intervention group for all women (MD −0.30 (95% CI −0.61 to −0.00) p=0.05), and there were no differences in other secondary outcomes.Conclusions: This trial demonstrates differences in depressive symptomatology with addition of the POW service in the powered subgroup of women with 2 or more social risk factors. Addition to existing evidence indicates benefit from lay interventions in preventing postnatal depression. This finding is important for women and their families given the known effect of maternal depression on longer term childhood outcomes. Trial registration number: ISRCTN35027323;Results.BACKGROUND Postnatal depression is a major public health issue, with lasting effects on the child, 1-3 and meta-analyses have reported prevalences of 13% and 19%. 4-6 Women with antenatal depression, or with a previous history, are at higher risk, 7 but most pregnant women who go on to have postnatal depression do not have these risk factors. It is known that postnatal depression is associated with social isolation and inadequate support. 8 Many of the factors considered to be indicators of increased risk of adverse perinatal morbidity and mortality are also surrogates for social isolation, including teenage pregnancy,

Building capacity and wellbeing in vulnerable/marginalised mothers: A qualitative study

“…(15) Other studies primarily focus on the role and impact of peer/volunteer support for socially marginalised women. (9,16,21,23) Whereas our study explores the support provided by both thirdsector volunteers and maternity professionals working collaboratively within hospital and community settings. This partnership approach offers a holistic approach to care which seeks to promote women's wellbeing in the widest sense.…”

“…(15) Our study also resonates with other research suggesting that offering multi-agency person centred care, in the form of targeted rather than generalised care is key to enabling marginalised women to access and benefit from interventions. (23) The need to identify the theoretical underpinnings of intervention designs is well highlighted in the literature. women's capabilities were increased via needs led information and practical support.…”

“…While, as reflected above, the majority of available evidence documents negative outcomes faced by vulnerable/marginalised women, there are some reports that highlight how targeted support can: increase uptake of services (9,16,21), reduce pre-term delivery, low birth weight and infant mortality (22) and facilitate a reduction in depressive symptoms (23). Issues such as social vulnerability, literacy, language fluency and complicated, often transient, lifestyles often provide challenges to researchers seeking to work with these women.…”

The moral economy of early intervention

“…Gibson and Hanson (2013) observe that UK mothers consider Facebook an important aspect of their motherhood because it allows them to be socially connected (see also Kaufmann, Buckner, and Ledbetter 2017). A randomised controlled trial suggested that support of lay workers improves maternal and child outcomes in disadvantaged families (Kenyon et al 2016). Hence, be it through family ties, ethnic associations, or support from lay workers, English mothers find support in paradigms of relatedness in response to perinatal social isolation.…”

Effects of lay support for pregnant women with social risk factors on infant development and maternal psychological health at 12 months postpartum

“…The POW’s role was also to provide support to mothers to improve their psychological health, including depression, self efficacy and bonding. Most contacts between POWs and the women in the trial took place antenatally (77%), with 27% being face to face contact and half of contacts lasting between 1–2 hours (see http://dx.doi.org/10.1136/bmjopen-2015-009203 [ 38 ] for full trial details). The trial found modest positive effects on maternal mental health at 8–12 weeks postpartum, particularly in those women with greater social risk [ 38 ] and a significant benefit for mother-to-infant bonding.…”