Perinatal psychological support, counseling and education
Natalya Guba, Natalya Mosol
Zaporizhzhia National University, Zaporizhzhia, Ukraine
Introduction. Perinatal mental health has become a significant public health concern. Recent studies and Mental Health surveys in many countries indicate growing demand for psychological support during pregnancy and postpartum period. Up to one in five women and one in ten men are affected by mental health problems during pregnancy and the first year after birth (the perinatal period). Women usually feel more vulnerable and anxious, and some may develop depression. Without appropriate diagnostic, assessment and support, the negative impact of mental health problems during the perinatal period can have long-term effects and influence not only women, but their partners and children too. The emotional and mental wellbeing of a pregnant woman are main factors determening the healthy pregnancy and well-being of a child after birth. Mental health issues can impact on a mother’s ability to bond with her baby and to respond to the baby’s emotions and needs.
Perinatal counseling can be applied as early intervention for new and expectant mothers and their families. It’s also important to provide parental education. Psychological and pedagogical studies conclude that young families have difficulties with the childcare and majority of parents know little about how children grow and develop. Supporting the mother (and father as well as other family members) and the developing infant through perinatal period is recognized to be a key time for intervention in order to mitigate the negative outcomes.
Purpose. To establish a scientific basis for perinatal psychological support as an important part of perinatal care, to analyze existing perinatal practices, and to describe content and features of perinatal psychological support.
Approach A theoretical review of perinatal support was done. "To support" means to accompany somebody at certain life stage or in certain life situations. The important goal of psychological perinatal support is promotion of health and well-being of a woman and a child. Theoretical and practical issues of perinatal psychology were developed by D. Chamberlain, N. Fodor S. Grof, E. Paul, T. Vernie, S. Ward. Development of perinatal psychology practices in Ukraine was strongly impacted by psychology of parenthood and reproductive psychology (G. Filippova), perinatal psychotherapy (I. Dobryakov), transpersonal directions of perinatal psychology (G.Brekhman), resource psychotherapy (N. Kovalenko), practice of preparation for parenthood (M. Lantsburh, I. Bratus') and others. The analysis of perinatal practices was done on the basis of the data collected. The program of perinatal psychological support was approbated.
Appropriate diagnostic and assessment can help family physician, gynecologists, and psychologists or psychotherapists to determine and to take into consideration psycho-emotional state of pregnant in order to provide the woman with timely, qualified psychological support. The described below diagnostic tools can be applied for assessing psycho-emotional state of pregnant woman: Individual Typological Questionnaire (ITQ) by L. Sobchik, Personality Questionnaire of Bekhterev Institute (PQBI), Eysenck Personality Questionnaire (EPQ), Strelau Temperament Inventory (STI), Taylor Manifest Anxiety Scale (TMAS), Taylor Manifest Anxiety Scale (TMAS), Test of self-esteem evaluation of differential functional state (well-being, activity, mood), Zung Self-Rating Depression Scale, The Perceived Stress Scale (PSS), Test of attitude to pregnancy by I. Dobryakov, Marital Satisfaction Questionnaire, Projective method "Me and my child" by G. Filippova). These diagnostic tools have been used to evaluate the effectiveness of the approbated program of perinatal support.
Results. Perinatal psychological support is a complex of measures aimed at providing psychological assistance to women and families at the stage of planning pregnancy, during pregnancy and after birth of a child. The psychological support of women and families during pregnancy, childbirth and during the first year after birth is the main goal of perinatal psychology. Practice of perinatal psychology combines the following activities: perinatal psychological diagnostics, psychotherapy, psychological correction and prevention. The practical tasks of perinatal psychology include optimization and correction of actual problems of mental and physical reproductive health of parents and child development; preparation of couples for conception, pregnancy and childbirth; parental education; early prevention of medical and psychological disorders.
Perinatal care is aimed to protect the health of mothers during pregnancy, childbirth and postpartum period and to ensure healthy neonates. Perinatal care includes having access to a range of good-quality information and services: family-planning counseling, information, education, communication and services, including access to safe and effective contraceptive methods; education and services for prenatal care, safe delivery and post-natal care, parental education. The human, clinical and financial case for ensuring women have access to timely and effective perinatal support during the perinatal period is clear and compelling. Complex support of pregnant women and their families should be provided by team of specialists (gynecologists, psychologists, psychiatrists, pediatricians).The System of Perinatal Care has gaps in providing psychological support. In Ukraine work with the family expecting child is mostly medically-centered. Future parents don’t have complex support (especially psychological assistance) during pregnancy, childbirth and first year(s) after birth. There is also lack of parental education programs.
The main areas of existing perinatal practices are: perinatal education (training of future parents, preparation for childbirth and parenthood, forming of parental awareness), individual and family counseling and psychotherapy, psychological assistance. Psycho-correction work helps future mothers to prepare for psycho-physiological maternity stress, forms readiness for motherhood, and promotes the development of parenting competence. Different diagnostic methods are actively used for determining the level and dynamics of anxiety, the type of pregnancy, the attitude toward parenthood.
So far the important tasks of perinatal psychological support are: educational work, formation of readiness for future parenthood, development of parental competence, correction of the psycho-emotional state of pregnant woman, harmonization of relations in the family, establishing positive parent-child relationship. The critical importance of the early years for lifelong health, learning and behavior, and the recognition of parents as children’s first teachers are foundational concepts in providing the effective family services and parental education. The analysis of international and Ukrainian practices shows that both state and public services can provide effective programs for families and parents. In Ukraine perinatal counseling and parental education are provided by such agencies as Social Services for Family, Children and Youth, Centers for Reproductive Health and Family Planning, Schools of Conscious Paternity at the Antenatal clinics. In recent decades local family centers and non-governmental organizations have emerged to run such services (Associations of Conscious Parents, Community-based Family Centers etc).
Limitations and strengths of the study. It is important to evaluate the impact of perinatal psychological support and to count the cost of undiagnosed or untreated perinatal mental health issues and potential economic benefits of perinatal psychological support. A comprehensive inventory should be used to identify gaps in existing services of perinatal care system and areas of need.
The future prospect of our research is to investigate the impact of psycho-emotional state of pregnant on the personal well-being of a woman and a child.
Practical and social value. Early diagnostic and adequate treatment of perinatal mental health issues is crucial and economically reasonable. Effective perinatal support during pregnancy and the early postpartum together with facilitating transition to parenthood has the potential to promote more healthy individuals, families, communities and societies.
Conclusions. The findings of the research open up the possibility to provide better value, evidence-based perinatal support. So far, perinatal period can be defined as the start determining the potential of human health. Pregnancy and the postnatal period therefore provide the ultimate opportunity for preventative care to improve well-being of woman, children and families. The Perinatal Care System has gaps in providing psychological support. Analysis of perinatal psychology practices makes it possible to determine the following forms of prenatal psychological support of women and families: preparation for childbirth and parenting; individual and family psychological counseling and psychotherapy, psycho-correction work, parental education.
Pregnant women and future parents should have more psychological support across maternity services and mental health settings. The promotion of perinatal health requires coordination and collaboration among national agencies, institutions and professionals at both state and local levels.
Keywords: perinatal period, pregnancy, perinatal psychology, psychological support, perinatal counseling, parental education.