Improving perinatal wellbeing: the role of digital support

This week our guest blog is from Nikki Newhouse, an interdisciplinary researcher in human-computer interaction with the Nuffield Department of Primary Care at the University of Oxford and the UCL Interaction Group. She looks at re-focussing wellbeing of pregnant people from avoidance of maternal mental ill health to supporting thriving during pregnancy through better access to digital resources. 

Perinatal wellbeing is the wellbeing of pregnant women and new mums.  It is important both for the new parents themselves and also for future wellbeing of their children as found in the London School of Economics Origins of Happiness research. 

Perinatal wellbeing and the link with pregnancy-related stress

Understanding what wellbeing means in relation to pregnant women and new mums is tricky. For a long time, our understanding of perinatal wellbeing has focused on risk mitigation and the measurement, and avoidance of, postnatal maternal psychological ill health – for good reason. 

Substantial academic evidence describes the potential negative effects of poor maternal psychological health on mum and baby. However, a number of studies provide consistent evidence that pregnancy-related stress is a better indicator of adverse maternal and neonatal outcomes than measures of anxiety and depression. And that’s irrespective of maternal risk status. It does not have to be clinically significant to have an effect.

How is maternal wellbeing assessed during pregnancy?

The issue of clinical significance matters when we consider how perinatal wellbeing is assessed. Although the transition to motherhood is a universal biological event, a woman’s experience of the transition is culturally and socially relative.

Unfortunately, existing approaches to assessing maternal wellbeing are largely limited to quantitative measures of psychological ill-health which are supposed to identify women at risk.  Unsurprisingly, the low-risk majority don’t raise concerns, even though many may be experiencing uncomfortable levels of pregnancy-related stress, which the measures are not designed to identify. 

In addition, such measures are administered by an overstretched midwifery workforce. Midwifery appointments are brief and focus on the physical health status of mum and baby – something mums and midwives alike find unsatisfactory. The reality is that maternity and community services are being stretched at a time when there has never been more understanding of the importance of early, preventative intervention on the long-term outcome of a person’s physical and mental health. 

Can part of the solution be digital?

Internet and smartphone access is common for perinatal women from a wide variety of cultures. We know that women routinely and repeatedly source information and support via the Internet and digital applications during pregnancy and early motherhood. 

We also know that women want health professionals to recommend suitable and evidence-based alternatives to generic digital resources. Many existing resources simply provide a saccharine ‘digital mirror’ of the pregnancy experience and rarely cover the transition from bump to baby. 

Crucially, despite having all the information at their fingertips, new mums still talk about being under-informed and ill-prepared for the realities of life with a newborn. There is a clear opportunity to develop digital tools which might reduce pregnancy-related stress.

Participatory design is a commonly used approach in the field of human-computer interaction which places the target user at the heart of the development process. Iterative methods are used to gather a deep understanding of user needs which are then evaluated ‘in the wild’. 

In our research, we worked closely with a number of pregnant women and new mums and human-computer interaction professionals  who informed the development of a novel digital resource called bump2bump. Bump2bump was then evaluated longitudinally by a group of women as they navigated the transition from late pregnancy to early motherhood. 

Academic outputs are due for publication in 2020, but  early key findings from our work suggest that existing resources do a particularly poor job of preparing women for life with a newborn. 

Our findings impact on research, policy and practice, and indicate that:

• It’s effective to support midwives so that they feel comfortable asking women about what they are looking at online. Structured guidelines for how and what to ask and signpost to are required.
• Women’s use of digital resources changes over the course of their pregnancy and narrows significantly as they approach the birth. This is important for healthcare professionals to know because it means that they might need more encouragement to use resources that focus on practical parenting matters other than birth. Women who have actively engaged with parenting classes describe how important it is to read and watch ‘refresher’ information, or even learn new tips.
• Women can be encouraged to proactively disengage with resources that do not support them or which worry them in some way.
• Information about baby care and breastfeeding,  in particular, is vital to receive in a brief, timely, and practical format.
• Digital content works best when it facilitates face-to-face access to peers with shared values in a clearly defined, narrow geographical area.
• Accurate, locally-relevant resources within a clearly defined, narrow geographical area is important; if possible, with information that has been recommended by other local mothers.
• Resources are most helpful when they provide content in a truthful, non-judgmental, positive and encouraging tone.
• Keep intervention components to a minimum. Think big, start small and scale up.