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Pregnancy: an opportunity to look to the past and the future


Last week, I attended a conference organised by the Association for Infant Mental Health, UK.

I don’t think I have ever heard the message, ‘pregnancy is the time for early intervention’, sounded more clearly.

We heard that research has found an association between mothers’ experiencing depression in pregnancy and subsequently abusing their babies. We learned that antenatal depression may stem from mothers’ own adverse childhood experiences.

We heard that approximately 4% of women have PTSD in pregnancy and that this figure may be as high as 39% in women with a history of abuse. In addition, nearly 20% of women have a traumatic birth, of whom 3% then experience PTSD.

And we heard that women living with domestic abuse tend to have negative representations of their babies and themselves during pregnancy, and that these negative representations often persist into the postnatal period.

So where do we go from here? Well, the message, as I have said, was loud and clear that parenting begins in pregnancy, not when the baby is born, and that early intervention can support maternal wellbeing and thereby, the wellbeing of the baby. A raft of evidence-based parent education programmes and psychological therapies, can help women who have a childhood history of abuse to develop a positive, engaged relationship with their unborn baby.

The Healthy Child Programme, revised this year, now includes promotional interviewing during pregnancy. Health visitors can help the mother and father explore their ideas about their unborn baby, and develop their relationship with their child.

High-quality antenatal education can equip women with knowledge, strategies for coping with labour and confidence to communicate with health professionals that offer them a way to maintain control. Women who feel they have had agency during their labours have higher self-esteem and greater satisfaction with their births.

And as one inspirational delegate said to me during the lunch-break, the relationship that birth and parent educators develop with pregnant mothers and fathers can make all the difference in enabling women and their families to experience a positive pregnancy and emotional wellbeing that will in turn, impact their relationship with their unborn and newborn baby.

But where is the continuity of carer (NOT care) during pregnancy that ensures such supportive relationships are established, with all the benefits accruing to maternal and familial mental health? Where are the antenatal classes that prepare women and their birth companions to be active during labour and to make their own choices about how their babies will be born? And where are the targeted perinatal programmes that support traumatised and abused women to tell the story of their own childhood so that their children won’t have to tell the same story?

All of these things are available – but most certainly not to all women, or even to all those most in need. Pregnancy is the most important and the most effective opportunity for early intervention. We have to keep on shouting out loud to the policy-makers, the NHS chief executives, the commissioners, the local authorities, the media – to everyone who can play a part in realising the early intervention imperative.

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