Jane Fisher¹, Heather Rowe¹ and Lauren Matheson¹
¹Key Centre for Women’s Health in Society, School of Population Health
Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne
beyondblue Victorian Centre of Excellence
Project completion year
Depression and anxiety in mothers of newborns are recognised as a significant public health problem in Australia. In the research into women admitted to residential early- parenting programs, two previously unaddressed risk factors for postpartum depression which occur after childbirth were identified.
First, that worse mood in mothers of newborns is associated with the intimate partner having limited involvement in infant care or household work, and being insensitive and critical.
Second, that infant behaviour is influential and that women are more likely to become depressed if the baby cries inconsolably, resists soothing, wakes frequently overnight or has feeding difficulties.
This project aimed to address these two important factors and prevent the development of depression by means of a brief universal psycho-educational intervention for first-time parents and their six week old babies.
In 2003, an intervention entitled Psycho Educational Program for Parents (PEPP) was developed through existing evidence, careful consultation with mothers of a first newborn and a range of health professionals providing care to families at this life stage.
It addressed two aspects of parenting.
First, strategies to assist mothers and fathers to renegotiate the paid and unpaid workload fairly and to increase understanding of the disproportionate losses and gains associated with the birth of a baby.
Second, strategies to manage infant crying and distress through improved understanding of their developmental needs for sleep, soothing and stimulation and practice in establishing sustainable routines of daily care.
An intervention for small groups of parents and their four-to-six-week old babies using adult learning principles to give them language, concepts and skills to assist adjustment to a new life phase was developed. It included a professionally-designed book what were we thinking? covering this material in accessible language for ongoing reference which was evaluated.
Process evaluations from 50 mothers of young infants and health professionals were that the strategies and the book were regarded as original, effective and highly relevant to current needs:
“I love the worksheet for parents. It makes me realise how hard I work each day and that without sleep, of course I am a zombie. My partner thinks that I should do what his mother did – all the housework, all the cooking, all the washing and keep the baby happy, but he also wants me to earn a living, which his Mum never did. This book would help us talk about these things without fighting.”
Zara, mother of Amy, aged 8 months
Implications for Policy and Practice
Women who are anxious about infant health, unsettled behaviour and well-being commonly present first to maternal and child health nurses and to general medical practitioners.
This brief targeted intervention is designed be applied in these primary care settings and enhance current care.
If found to be effective, evidence from this trial will be used to develop a Train the Trainer program for primary health care professionals, contributing to primary health care capacity in the fields of maternal, infant and family health.
The next step has been to test whether this one-day, psycho-educational intervention for parents and their first four-to-six week-old baby(ies) could reduce prevalence of depression and anxiety in the first six months following childbirth.
In 2004, a grant of $481,000 was awarded to the investigators in a competitive round by the Australian Government Department of Family and Community Services for a controlled trial to examine the effectiveness of this intervention in 2005 - 2008.
Mothers, Fathers and Newborns; Promoting Confidence and Preventing Distress is comparing the well-being of parents and infant behaviour at age six months between those who have received the intervention and those who have had current standard care. Participants are being recruited from five local government areas at the first maternal and child health nurse home visit and outcomes are being assessed by structured telephone interviews.
In order to investigate whether this material can also be of value to parents in an online form, a website is being designed to present the content and activities in a form that is accessible to both general and professional audiences.
Process evaluations are being conducted to ensure comprehensibility to both groups prior to its launch.
About the Principal Researcher
Jane Fisher is Associate Professor at the Key Centre for Women’s Health in Society in the School of Population Health at the University of Melbourne. She leads a program of research investigating the links between reproductive health and mental health in women. This includes investigations of the psychological consequences of infertility and assisted conception; caesarean birth and the social and obstetric determinants of psychological adjustment in mothers of newborns. She is conducting controlled trials to test the effectiveness of psycho-educational interventions in reducing distress and promoting confidence in early parenthood. She has been Consultant Clinical Psychologist to Masada Private Hospital’s Mother Baby Unit since 1996.
Austin, M.-P. and J. Lumley (2003). "Antenatal screening for postnatal depression: a systematic review." Acta Psychiatrica Scandinavica 107: 10 - 17.
Fisher, J., C. J. Feekery, et al. (2002). "Health and social circumstances of women admitted to a private mother baby unit." Australian Family Physician 31(10): 966-973.
Fisher, J., H. Rowe, et al. (2004). "Temperament and behaviour of infants aged four to twelve months on admission to a private mother-baby unit and at one and six months follow up." Clinical Psychologist 8(1): 15 - 21.
Fisher, J. R. W., C. J. Feekery, et al. (2002). "Nature, severity and correlates of psychological distress in women admitted to a private hospital mother baby unit." Journal of Paediatrics and Child Health 38: 140-145.
Lumley, J. and M.-P. Austin (2001). "What Interventions may reduce postpartum depression." Obstetrics and Gynecology 13: 605-611.