Planes a corto y largo plazo

A discussion of all programmes that address the nursing partnership to parent would be too large a field for this study that aims to look specifically at how midwives and child health nurses support the wellbeing of parents in the perinatal period

(conception to the end of the first year post birth). Many nursing/parent

programmes, such as the studies of Olds address older children and target programs for socially and economically disadvantaged women (1994, 1995, 2006, 2007). In contrast, this study has a universal focus. Importantly, parenting /nurse research such as Solchany’s work (2001) that reviews mental illness prevention in parenting is an essential reference were this study reviewing mental illness prevention. However, the focus of this study is mental health promotion and staying well in the first place. The importance of the transition to parenthood, including a mother's view of

parenting, her parenting skills, her self-esteem and her relationship with her partner are well documented and have been recognised as high as policy level in the United Kingdom (NICE NHS 2010). In spite of this, literature suggests that antenatal education continues to focus either on labour and birth and fails to address parents' needs in relation to the reality of new parenthood. More emotional and informational support for parents both antenatally and postnatally has been a recommendation of several studies (Lothian 2008; Jaddoe 2009).

In families, transitions represent periods of change where there are shifts in lifestyles from one stage to another. Research has consistently demonstrated that having a baby is often a stressful event and brings about more profound changes than any other developmental stage of the family life-cycle (NHMRC 2008). Women report significant changes to their lifestyles and routines, easy adaptation is not a usual occurrence, and is commonly problematic (Lothian 2008). Many parents to-be are stressed by the strain of working life and societal expectations, which may interfere with their everyday life during pregnancy. According to national recommendations, the psychosocial part of the parenthood should be in focus, but does not at present appear to be a priority (Young 2008; NHMRC 2008).

In particular, there is little evidence to show how mental health (as opposed to an explanation of postnatal depression (PND) and its signs and symptoms) is promoted in a broad sense in midwifery-led education. However, there have been a small number of universal and selective studies over the past 20 years that have targeted antenatal classes with single entity interventions to decrease formation of PND. For example, researchers have used antenatal classes to see if protective factors included

in activities or through information sharing (education) would have positive

outcomes. Examples have included postpartum psychosocial adjustment of women and men (Matthey et al. 2004), preparing for the early weeks of parenting (Mercer 2006; Schmied et al. 2008a; Milgrom et al. 2010), and raising self-efficacy (de Montigny & Lacharite 2008) in the parents. Furthermore, information to attendees regarding parent and baby attachment has appeared in antenatal classes more

recently. Overall, a Cochrane review by Dennis & Creedy (2004) found that whether these interventions have had significant success in decreasing the development of PND is still unknown, although parental satisfaction has been seen an important outcome in itself. The majority of these types of studies argue that more wide scale and multiple aspect studies be performed before a definitive consensus about effectiveness can be formed (Gagnon & Sandall 2011).

In essence, there has been some research regarding protective factors and thus prevention from developing PND or decreasing stress and anxiety in the perinatal period. However, a systematic review of prevention studies found that there still appears to be inadequate “articulation of mechanisms” (Boath 2005) to tie these single entities together to form a specific framework in perinatal education that supports parents to exploit their potential and their existing strengths as parents (p.191). It could be argued that there still needs to be midwifery-led education that encourages mastery over or making sense of the parents’ living, working, support environment and/or; how parents achieve a sense of autonomy in the perinatal period by self-identifying and confronting and then being supported to solve any issues (Jahoda 1958; WHO 2004).

This lack of promotion of the existing parenting capacity is not uncommon as evidenced in a Canadian literature review that examined mental health promotion (Pollett 2007). A US study examining prenatal guidelines found a “predominant focus on the physical verses psychological needs; an increasing attentiveness to risk as opposed to protective factors and a lack of broad health promotion focus”

(Hanson, 2009, p.460 ). Numerous studies highlight that midwives acknowledge that a risk orientation detracts from the reality that most women have healthy pregnancies and that overemphasising these potential risks can jeopardise opportunities to

limited time constraints and organisational structures and requirements facing current midwifery care (Reiger & Lane 2012; McLachlan et al. 2006; Morrow et al. 2011). This argument is further expanded upon in Chapter Seven.

In summary, research into mental health promotion in midwifery-led education has been represented in single factor preventative studies which report that their

effectiveness is unknown. Education also lies in information sharing about PND and its symptoms. However, there have been few studies that explore the actual status of mental health promotion content in midwifery-led education and how midwives who develop and deliver this content understand mental health promotion.

2.7.4

Current mental health promotion in child health