• By Laura Whybra
  • Posted on Tuesday 11th November, 2014

Could parenting coaching for expectant couples deliver healthier babies?

strong>Stress and depression in pregnant women are linked to poor birth outcomes and a variety of long-term medical and developmental problems in children. Typical interventions focus on treating the mother’s stress, and leave the father out of the picture. But a program that takes a different approach – aiming to improve the parents’ relationship and co-parenting abilities – shows encouraging results. High stress levels during pregnancy pose a risk for babies because high levels of the stress hormone cortisol are linked to early labor. Early labor, in turn, can produce other difficulties, such as low birth weight and complications that require longer hospital stays. Could a program “designed to prepare couples to enter parenthood together in a supportive manner” help improve birth outcomes? A recent study of the Family Foundations program found that the program did not improve average outcomes among a group of relatively advantaged couples. But women who started the program with high levels of stress saw better outcomes for their children at birth than a comparison group – suggesting that couples’ coaching could be an effective route to healthier births for an important subgroup of women. The Family Foundations studySome other recent studies have found that therapies to improve pregnant women’s mental health result in better birth outcomes. Most of these focus exclusively on the women with programs like yoga, massage therapy, and cognitive behavioral therapy.But, as the program’s designer and co-authors point out, a major influence on mental health is the relationship with the partner. The team believed that a program designed to foster long-term positive parenting relationships between prospective mothers and fathers might also improve birth outcomes by lowering the mother’s stress levels. Family Foundations, created by Mark Feinberg from Penn State University, consists of nine classes teaching co-parenting approaches, starting before the child’s birth and finishing soon after. Topics included problem-solving, emotion and conflict management, communication, and joint parenting support strategies.This study involved 169 couples, aged over 18, living together and expecting their first child. Couples were randomly assigned to the intervention or to a control group. Participants in the control group received information on developmental stages and selecting quality childcare. Mothers were assessed at around 22 weeks pregnant. Cortisol saliva levels were taken and mothers were interviewed about how often they used drugs, tobacco and alcohol. After the intervention, parents sent back questionnaires and follow-up tests for mothers took place at six months, one year and three years from the child’s birth date. Promising resultsOverall, intervention group participants were found to have more positive birth outcomes on some measures, although the differences between groups were mostly not statistically significant. The most notable average difference between the groups was that women in the intervention group were, on average, less likely to need a C-section. The most intriguing results, however, come from comparing the effects of the program for women with different pre-natal cortisol levels. Among women with low pre-natal cortisol, there was little difference between control and intervention groups. But among women with high pre-natal cortisol, the difference was much more noticeable. Women with higher initial levels of cortisol who were in the program reported better birth weight, gestational age at birth, and length of newborn hospital stay than their counterparts in the control group.This suggests that programs that teach first-time expectant couples how to parent together may reduce poor birth outcomes by lowering stress levels in mothers-to-be – at least for mothers who start out with high levels of stress.For future researchBy focusing on couples rather than mothers alone, Family Foundations aims to promote the importance of the roles of both mothers and fathers in bringing up children. Good relationships between parents are linked to better child outcomes up to the age of at least six years. The authors also speculate that co-parenting strategies might help keep fathers engaged in their children’s life long-term in the event of the relationship with the mother breaking down. The authors acknowledge that their research has some limitations. Most importantly, data on the mothers’ psychological health changes were collected six months after delivery, and not during pregnancy. As such, it is unclear if reductions in mothers’ stress occurred during pregnancy as a result of the intervention. A second limitation is that this study is led by the program’s founder. In the long term, it will also be useful to see the results of independent program evaluations. *********Reference: Feinberg, M.E., Roettger, M.E., Jones, D.E., Paul, I.M., and Kan, M.L. (2014). Effects of a Psychosocial Couple-Based Prevention Program on Adverse Birth Outcomes. Maternal and Child Health Journal. DOI: 10.1007/s10995-014-1500-5Links:Family Foundations: http://www.famfound.net

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