母子保健クリニック

概要

Comparing a Novel Antenatal Program with a Standard in Disadvantaged Women at Psychosocial Risk: A Randomized Controlled Study

 Ortiz Collado Maria Assumpta

Purpose: To evaluate participant’s satisfaction with two models of antenatal childbirth preparation program and effects in women at psychosocial risk. The risk variables included depressive symptoms, stressful events, lack of social support and, low economic level.

Design, setting and participants: A blinded randomized controlled and multi-centre trial comparing a novel program intervention to standard program. Women found to be at psychosocial risk were distributed in two groups: an experimental group (EG) or a control group (CG) and evaluated in two times measurement: 1) during pregnancy (<20 weeks) before the routine ultrasound visit and, 2) four weeks after delivery by parcel post. The sample was 184 pregnant women and their partners.

Intervention: 10 group sessions in experimental group, focusing on body awareness sensations with humanistic mind-body approach (like mindfulness) in direction to constructing of an individualized childbirth model. Sessions lasted two hours and 15 minutes each during pregnancy, with one individual telephone conversation between sessions. In the control group intervention, the participants were free to choose the standard model of antenatal education: 10 two-hour sessions focused on childbirth preparation and breast feeding, including obstetrical prophylaxis and relaxation.

Results: Satisfaction was higher in the experimental group for questions about understanding symptoms of pregnancy: 4 in the CG and 38 in the EG (p=0.05 Pearson Chi-Square and p=0.05 Fisher’s Test); understanding all information received: 3 in the CG and 37 in the EG (p=0.02 Pearson Chi-Square and p=0.02 Fisher’s Test); expressing feelings: 0 in the CG and 18 in the EG (p=0.04 Pearson Chi Square and p=0.03 Fisher’s Test); and communicating with the baby: 3 in the CG and 38 in the EG (p=0.05 in Pearson Chi-Square and p=0.05 Fisher’s Test). The difference in preterm births between groups is significant (P=0.003) with only three premature baby in the experimental group and thirteen in the control group. The weight of the babies was lower in the control group compared to the experimental group (p=0.01).

Conclusions: A novel antenatal program that included a psychosomatic approach about all pregnancy sensations (mother and baby) produces higher satisfaction in participants. Program can help to preventing the risk of prematurity in women at psychosocial risk but needs to be studied with a larger sample. Early detection realized on the occasion of the routine ultrasound visit, before 20 weeks pregnancy was an advantage, and suggests effectiveness in the selection of cases at risk.