Parenting from the start: Evaluating a preventative intervention to improve outcomes for mothers and babies

Brief name: Antenatal parenting intervention During pregnancy, intervention group participants will receive an antenatal parenting intervention involving an evidence-based parenting workshop plus a gifted sling. The 8-hour Parenting From the Start Pregnancy Workshop examines the basic needs of infants (stable, loving, responsive care by sensitive, reflective caregivers) and may be offered in a single day or split over two sessions. The non-judgemental, participatory format will provide parents with ideas about how they can be responsive, and get them thinking about how best to meet their baby’s needs within the constraints of modern life. The goal is to provide expectant mothers and their whanau with evidence-based information to facilitate informed decision making. The workshop does not involve giving advice or telling people how to parent. The workshop includes a number of videos, discussions, and hands-on activities within the Keynote presentation format. The parenting topics discussed include early brain development, pregnancy, birth, infant feeding, skin-to-skin time following vaginal or surgical birth, infant sleep, infant toileting options, alloparenting (shared care by multiple adults), and early care. Content is informed by research evidence, and situated within the context of the evolved developmental niche (Narvaez, Fuentes, McKenna, & Valentino, 2014; Narvaez, Panksepp, Schore, & Gleason, 2012; Narvaez, Gleason, et al., 2013; Narvaez, Wang, et al., 2013). Participants will be encouraged to reflect on our origins as mammals, Homo sapiens and hunter-gatherers, and how parenting has changed over the 10-15,000 years since humans developed permanent settlements and agriculture, and diversified into modern cultural groups. Many strands of research suggest the ongoing importance of stable, loving, sensitive, and responsive care if babies are to grow up happy and healthy, and it has been suggested that this is the early environment human infants have evolved to expect. The present intervention also replicates and extends a previous experiment which found that gifting mothers of newborns a soft baby carrier (‘sling’) significantly reduced infant crying, increased maternal sensitivity as rated by blind observers, and doubled the rates of secure attachment 13 months later (Anisfeld, Casper, Nozyce, & Cunningham, 1990). Thus, our intervention participants will be gifted a sling during pregnancy (at the end of the workshop) and shown how to use it safely. The slings to be gifted are 100% cotton, NZ-designed Moby Wraps, which come in a range of colours and fit men and women of all shapes and sizes, and infants up to 16.5kgs (most children weigh less than this at age 2). Workshops will be designed and presented by the lead researcher, Leith Anna Pugmire, a registered clinical psychologist who has completed specialist training relating to attachment. Leith is also a mother-of-three with personal experience of pregnancy, labour, birth, and breastfeeding. She speaks conversational Maori (and has a Diploma in Te Ara Reo Maori from Te Wananga o Aotearoa) as well as being fluent in English. The culturally-appropriate nature of the workshop will be extended by the use of appropriate Maori (indigenous NZ) practices such as beginning with a mihi (greeting) and a short, non-religious karakia. Whakatauki (Maori proverbs) and kupu (words) will also be used. Participants in each workshop will be provided with and hot lunch and snacks, which will be preceded by a karakia kai (Maori blessing performed prior to eating), and the gathering will begin with time set aside for whakawhanaungatanga (relationship building). In keeping with our acknowledgement of Maori as tangata whenua (the indigenous people) of Aotearoa New Zealand, the workshop draws on traditional Maori parenting for examples of sensitive and responsive caregiving. The negative impacts of Pakeha (European) colonisation are explicitly acknowledged. The mode of delivery is face-to-face, and the workshops will take place at a variety of community venues around the Manawatu region such as health hubs and wananga (Maori tertiary education institutions). Each workshop is intended to include approximately 10 pregnant women, plus their partners, support people, and/or family/whanau members, although the number of participants may need to be adjusted to fit the demand at each locality. The presenter is expected to be sensitive to the needs of the people in each group and flexible in her presentation style – providing extra explanation or hands-on demonstration as appropriate. Each woman / couple / family will ‘adopt’ a lifesize, weighted baby doll for the day, to enable them to physically ‘try out’ various parenting practices in a safe and supportive atmosphere. Participants will be encouraged to seek further evidence-based information, such as by reading the book The Science of Parenting: How today’s brain research can help you raise happy, emotionally balanced children (2016) by Margot Sunderland. Intervention adherence / fidelity will be assessed. At the conclusion of each workshop, a checklist will be completed by the presenter to indicate whether key topics were covered, and key process issues adhered to. Participants will complete a Workshop Feedback Form at the end of the workshop, providing the presenter with information about what is working and/or not working so that the workshop can be adjusted as appropriate.