This is a plain English summary of an original research article
Pregnant women with additional health or social care needs, benefitted from attending antenatal groups, research showed. These women found the programmes supportive and enjoyed sharing experiences with other mothers-to-be. They developed more confidence in themselves and their ability to be mothers after going to groups. However, the benefits did not last long-term.
Some women find pregnancy and their child’s early years particularly challenging. Their own health or circumstances (mental health problems, housing issues, or past experiences of domestic violence, for example) can increase their difficulties. Previous research has shown that the first years of children’s lives can impact their lifelong health and opportunities. Women with additional needs may therefore be offered various sources of support with the aim of improving long-term outcomes for mother and child.
This study looked at the experiences of women with additional needs who attended 1 of 2 parenting groups (either Mellow Bumps or Enhanced Triple P for Babies). It found that women were generally positive about the groups. However, their attendance was patchy, and the researchers found little evidence of lasting change. Increased attendance, and longer programmes, may be needed for changes to be sustained long-term.
This study is part of a larger project, The Trial for Healthy Relationship Initiatives in the Very Early Years (THRIVE), which evaluated the two programmes.
What’s the issue?
The first few years of life have a long-term impact on a child’s development and future opportunities. Support for mothers during pregnancy and in the early years could help ensure that children get the start they need.
However, little is known about how parenting interventions work, or what aspects make them effective. Group support may help women feel accepted and supported by their peers. This could in turn increase their ability to cope, and reduce feelings of guilt and social isolation.
Pregnant women with additional social or health needs may benefit most from group parenting programmes. This includes women who have mental health conditions or learning disabilities, and those involved in the criminal justice system or with child protection services. The women could be refugees or seeking asylum, they could be experiencing domestic violence, or have housing issues.
Mellow Bumps and Enhanced Triple P for Babies are existing parenting groups for women with additional needs. Mellow Bumps aims to promote mother-infant bonding in 6 group discussions about past experiences and concerns. Women’s partners are invited to the 4 Enhanced Triple P sessions, which cover coping skills, communication and problem-solving.
Women’s experiences of these groups have not been explored in depth. This research looked at the kind of support on offer, and how the women felt about being part of these groups. It examined whether the women reported any lasting changes, and how the women’s vulnerabilities shaped their experiences.
The study included 319 women with additional needs in Scotland, who were invited to attend one of the programmes. The women filled in evaluation forms after each session (708 forms in total) and completed questionnaires at the end of the programme (117 in total). Some 28 women were interviewed about their experiences after the programme had ended.
Most women attended at least 1 session (60% at Mellow Bumps; 56% at Triple P). However, only 19% of these women attended all 6 Mellow Bumps sessions; 52% attended all 4 Triple P sessions. Group sizes ranged from 2-7; on average, 2-3 women attended each session.
Almost all (98%) who filled in the end-of-programme questionnaire found the groups very or quite supportive. Women enjoyed sharing experiences and concerns, feeling listened to, the friendly group atmosphere, reduced isolation, and forming bonds with others.
However, a minority found the groups too small, felt awkward, or that another participant damaged the group dynamic. Some felt they had nothing in common with other group members. One woman with multiple additional needs felt excluded and judged.
In general, women said that the programmes increased their confidence about being a mother, and made them more accepting of themselves. One said: ‘what is really good is when you realise that everyone is not necessarily the same but everyone has fears. Cos often people think “oh, everyone else is coping so well..”, and once you sit down and started talking about things then you realise everyone’s just as anxious …. it’s okay to not be okay’.
In the longer-term (6 months to 1 year after giving birth), a few women reported lasting friendships, or being more confident to attend post-natal groups. But overall, the researchers found little evidence of long-term effects.
Women with the most additional needs reported getting the most from the sessions. This was especially true of the Mellow Bumps programme, which gave more opportunity to reflect on past experiences.
Why is this important?
The research found that most women with additional needs benefited from and enjoyed taking part in parenting groups. The most vulnerable women benefitted most.
However, regular attendance was a challenge for these women. Patchy attendance meant that different people attended each session, so it was harder for women to bond with each other. Attendance did not always decline over time. Women said that missing sessions was usually due to personal reasons such as sickness or anxiety, or not being able to get time off work, rather than because of the programme. The researchers say the levels of attendance in this study was relatively high for a group with additional needs.
The negative experience of one woman with multiple additional needs (who felt excluded and judged) suggests that group co-ordinators may need to consider how best to involve the most vulnerable women. One approach could be to group women with specific needs or common experiences together.
Women in both groups valued sharing experiences with others. Women in the Mellow Bumps programme said that reflecting on deeper issues (such as their backgrounds or living situations) was therapeutic. Women in the Triple P programme shared more practical parenting experiences.
More group sessions, and higher attendance, could improve the effectiveness of the programmes, but this is a challenge. The study provided taxis for women, and reminder phone calls were made, but attendance was nevertheless low.
Women generally felt supported only while the sessions were running. More long-term interventions could help. The researchers say group facilitators could provide more encouragement for the women to keep in touch, and to join other community parent-child groups after giving birth. This could increase feelings of support and connectedness.
The researchers caution that the women willing to be interviewed may have had more positive experiences than others in the study. The team is currently exploring longer-term outcomes (12 months after birth) and looking at the costs of programmes, compared to usual care (to be published separately). This may help determine which women are most likely to benefit and how much difference parenting groups can make.
In the meantime, these findings could help programme managers and facilitators consider how best to create inclusive environments.
You may be interested to read
This Alert is based on: Buston K, and others. How do Pregnant Women with Additional Health or Social Care Needs Experience Parenting Groups: Evidence from Delivery of Enhanced Triple P for Baby and Mellow Bumps as Part of the Trial of Healthy Relationships Initiatives in the Very Early Years (THRIVE). Child Care in Practice 2021;1-18.
The website for the wider THRIVE study
Funding: The study was funded by the NIHR Public Health Research Programme.
Conflicts of Interest: The study authors declare no conflicts of interest.
Disclaimer: NIHR Alerts are not a substitute for professional medical advice. They provide information about research which is funded or supported by the NIHR. Please note that views expressed in NIHR Alerts are those of the author(s) and reviewer(s) at the time of publication. They do not necessarily reflect the views of the NHS, the NIHR or the Department of Health and Social Care.