None listed
Conditions
Brief summary
Postnatal depression (PND) is common and can have a devastating impacts on the parent, the child, the couple and the wider family. There is particularly compelling evidence that mothers with PND are at risk of attachment and interactional difficulties with their infant and adverse consequences for their child’s development. It is important to identify families at risk of postnatal depression and to elucidate preventive interventions that are feasible, acceptable and that promote successful adaptation to parenthood. There is a unique opportunity in the perinatal period to provide effective interventions and potentially make a difference to the developmental trajectory of new families, as it is a time of great motivation and help-seeking, even by individuals and couples who may be otherwise hard to reach. Attachment based, relationship-focussed interventions have been shown to help vulnerable new parents successfully adapt to the role of parenthood and even brief perinatal interventions can be helpful. The Newborn Behavioural Observations (NBO) is a relatively new, brief attachment based intervention that aims to promote adaptation to parenthood by helping new parents get to know, and adapt to caring for, their newborn baby, and by reducing parents’ distress in the transition to parenthood. This reproducible, affordable intervention holds appeal and has generated widespread interest internationally. Pilot studies and clinician reports suggest the NBO is effective in various family contexts and settings and there is preliminary evidence the NBO is associated with reduced post-natal depressive symptoms among new mothers. However, it has not yet been shown that the NBO is an effective intervention in the context of maternal depression. This study therefore aims to determine whether, in an Australian population of new families with antenatal risk factors of PND, the NBO supports the adaptation to parenthood, by reducing symptoms and diagnosis of PND, reducing parenting stress and enhancing the quality of relationship they are able to form with their baby.
Interventions
In this study, the intervention group (G2), will be offered three NBO sessions coinciding with episodes of routine post-natal care in the first month of parenthood (in addition to being offered treatment as usual (TAU) in the hospital or in the community for their mental health as required). Standard care may involve regular therapy sessions with a mental health professional and/or medication, depending on the needs of the individual.
The intervention will be delivered by a midwife who is an ac
In this study, the intervention group (G2), will be offered three NBO sessions coinciding with episodes of routine post-natal care in the first month of parenthood (in addition to being offered treatment as usual (TAU) in the hospital or in the community for their mental health as required). Standard care may involve regular therapy sessions with a mental health professional and/or medication, depending on the needs of the individual. The intervention will be delivered by a midwife who is an accredited NBO practitioner. Each NBO will be a structured session between clinician and family, consisting of 18 very brief, baby-led and baby-responsive, neuro-behavioural activities and observations, which reveal the infant’s capacities and behavioural adaptation from birth to the third month of life. Each visit for the NBO will take between 30 minutes to 1 hour depending on the baby due to feeding, sleeping etc. Each visit will be timed to coincide with the maternal child health (MCH) home visit when baby is 1-4 days old, and the 2 week and 4 week MCH clinic or home visit. Adherence to the interventions will be monitored via a home visit registry. Fidelity to the intervention will be monitored by fortnightly supervision by an experienced NBO practitioner which will include reviewing a video recording of the second NBO session for all G2 families with the midwife. The midwife will also complete an NBO fidelity questionnaire at the end of every NBO session provided.
Sponsors
Dr Susan Nicolson
Study design
Allocation
Randomised controlled trial
Intervention model
Parallel
Primary purpose
Prevention
Masking
Blinded (masking used) (Investigator, Outcomes Assessor)
Eligibility
Sex/Gender
All
Age
20 Years to No maximum
Healthy volunteers
Yes
Inclusion criteria
Women's eligibility will be ascertained in two stages: First during pregnancy where if eligible they will be recruited and screened and then at birth for all follow up after birth even if they have been randomised. The following eligibility criteria include: During Pregnancy: -Nulliparous -Up to 36 weeks gestation -Able to speak English and to respond to a written questionnaire -Live within 40 minutes’ drive of the hospital from which they are recruited (RWH, Melbourne or Bendigo, VIC). At Birth: -Baby born at term without a severe disability; During pregnancy, male partners will be eligible to participate if they are expectant first time fathers whose female partner has consented to take part in the study, if they are age 20 or more, and if they are able to speak and to respond to a written questionnaire in English.
Exclusion criteria
As above, women will be excluded from the study at two-stages: during pregnancy when recruitment occurs and at birth as per the criteria outlined below. During pregnancy: -Multiparous, -If they are more than 36 weeks gestation, -under the age of 20, -if they are unable to speak or respond to a questionnaire in English, -If they live more than 40 minutes’ drive from the hospital. At birth: if their baby is born <37 weeks gestation or with severe disability, During pregnancy, partners will be excluded from this study if they are not male, if they are already fathers from a previous partner, if their partner declines to participate in the study or is excluded from the study, if they are under the age of 20, and if they are unable to speak and to respond to a written questionnaire in English.
Outcome results
None listed