Effectiveness Analysis of a Psychosocial Guidance System in Maternity Clinics

Research Article

J Community Med Health Care. 2021; 6(2): 1052.

Effectiveness Analysis of a Psychosocial Guidance System in Maternity Clinics

Pawils S¹*, Siefert S², Kolodziej D¹, Manouchehri M¹ and Metzner F¹

1Institute and Polyclinic for Medical Psychology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany

2Foundation SeeYou, Wilhelmstift Catholic Children’s Hospital, Hamburg, Germany

*Corresponding author: Pawils Silke, Institut und Poliklinik für Medizinische Psychologie, Zentrum für Psychosoziale Medizin, Universitätsklinikum Hamburg- Eppendorf, Martinistr. 52 (W26, Zi. 227), 20246 Hamburg, Germany

Received: October 20, 2021; Accepted: November 17, 2021; Published: November 24, 2021


Prenatal stress and early childhood experiences of psychosocial stress can have lifelong health consequences for affected children. Despite the existence of various support services, these services are not always utilized well, especially by families who have a high need for support. The intervention “Babylotse” [engl. Baby pilot] consists of a screening system to connect stressed families with various help settings, according on the needs of the fam-ily. The present quasi-experimental study investigated the effectiveness of this intervention by examining the children’s quality of life one year after taking part in the intervention. The physical development of N = 129 children, as well as the social and living space of the family, were examined, by a nurse at the family’s homes. Parents were interviewed beforehand about their living situation on the phone. There were no significant differ-ences between the children in the intervention group consisting of psychosocial significant stressed families ac-cording to the screening and the control group consisting of families not burdened by psychosocial stress, which suggests the positive effect of the intervention by making up for the existing deficits.

Keywords: Early childhood experiences; Psychosocial family stress; Early childhood intervention; Family intervention


Current research

An increasing body of research indicates that a large proportion of pregnant women and mothers with infants, are affected by psychosocial stress [1-3]. Psychosocial stress factors during and after pregnancy include mental disorders (depression, anxiety), violence and conflicts in the partnership, problems and worries regarding the life situation (such as unemployment and financial difficulties), pregnancy-specific fears and worries re-garding the birth or excessive demands about raising and caring for the children (single parent, with the partner). It is even possible that several risk factors are combined, as multiple factors can often be experienced at the same time [1-3]. These factors not only affect the well-being and health of the mother but can also have an impact on the development and health of the child [1-3]. This can have both short and long-term conse-quences for the children, with effects lasting into adulthood [4,5]. Keeping that in mind, some stress factors can already influence the health and development of the child prenatally, through physiological processes such as through the neuroendocrine system, or health-related behaviours during pregnancy, such as smoking or con-suming alcohol during pregnancy [4,5]. External factors can also have a negative influence on child develop-ment after pregnancy. For instance, growing up in inadequate living conditions, such as poverty and cramped living conditions, can exert an influence [6].

Parental psychosocial stress factors continue to have a negative influence on the healthy development of chil-dren, even after pregnancy [7]. Recognizing psychosocial stress is subsequently important during and after pregnancy to prevent negative consequences for children. Even though a variety of support services (counselling centres, psychotherapeutic care, child and youth services) are already available for the psychosocial care of pregnant women and mothers, we often encounter a so-called prevention dilemma [8]. This implies that partic-ularly highly stressed families are difficult to reach, or the utilization of support services is low among this group [9,10]. This prevention dilemma manifests itself due to various circumstances. These often include shame and fear, a lack of awareness of the problem or a lack of knowledge about available services [11,12]. There are different levels of services available depending on the catchment area. In western countries in rural areas, there is often a lack of offers, while in inner-city areas there is an excess of offers which can have an overwhelming effect [12]. In contrast to the utilization of social support services, medical care during and after pregnancy is frequently used. Nowadays, almost all children in Germany are born in maternity clinics, and pre-examinations by the gynaecologist as well as paediatric check-ups by the paediatrician are also well taken up [13]. Attending these examinations has a high acceptance rate in Germany and is less stigmatizing compared to child and youth services [13]. Women are more inclined to express their desire for psychosocial counselling by gynaecologists in such settings [1]. It can thus be seen that maternity clinics, gynaecologists in private practices and paediatricians represent an important access route to mothers under stress during pregnancy and after birth and offer a central interface to the help system.

The psychosocial guidance system “Babylotse”

The early childhood intervention “Babylotse” [engl. Baby pilot] is supposed to pose an intersection between support systems and medical facilities. In this intervention, systematic access to regional support systems such as family midwives, family mentors or other services such as “early childhood intervention” or the responsible regular systems was developed in Germany. The focus was on families with children between 0 and 3 years of age whose life situation is characterized by a high level of stress and diverse and/or serious risks in its design, the project referred to the findings of the German previous studies investigating psychosocial risks in families early intervention [14]. The risk factors identified there included psychiatric illnesses of the parents, possible drug ad-diction of the parents, cramped living conditions, poor education on the part of the parents and young age of the parents, unwanted pregnancy or situations where parents were bringing up their children alone. In addition, pro-tective factors included good language development, external support systems, emotional ties in the family and characteristics of the child that trigger a positive reaction in its social environment [15].

The Babylotse intervention was first implemented in maternity clinics in Hamburg, Germany. The goals of the assessment of parental risk factors and the referral to low-threshold support programs for psychosocially highly stressed families with newborn children were the following:

• Early identification and, if possible, reduction of high-risk factors for child neglect and abuse

• Establishing empathic initial contact with the family

• Strengthening parental and child protection factors

• Ensuring that the child’s emotional, physical and intellectual development is as undisturbed as possible (Figure 1).