Effectiveness of a prenatally implemented parenting support intervention on preventing postpartum parental distress and enhancing infant well-being.

The first months after birth can be challenging for parents and affect
well-being. This might lead to high parental stress and to other negative
outcomes for the parents (e.g. to postpartum depressive symptoms). Parents with
high levels of parental stress are also less able to respond
adequately and sensitively to their infant. This might lead to less secure
attachment bonds and to less than optimal infant (brain) development.
Effective interventions to reduce parental stress are available but until now
only used for high-risk groups. Furthermore, those interventions
focus exclusively on the mother. The proposed study focuses on a parenting
support intervention consisting of psycho-education and practical
tools. This intervention is aimed at reducing parental stress for both parents.

The primary objective is to assess the effect of the parenting support
intervention on parental stress. Secondary objectives are the effect of the
intervention on other parental outcomes (anxiety and depression, satisfaction
with the parental role, self-efficacy in caring for their infant),
caregiving outcomes (bonding, duration of breastfeeding and co-sleeping) and on
infant well-being (indicated by their patterns of crying and
sleeping behaviour and the infant*s health).

The proposed study is a randomized controlled intervention study. Random
allocation will take place at the individual level on a 1:1 ratio to either
the intervention or a wait-list control group. Participants are randomized
using random sequence block randomization (blocks of 2, 4 or 6),
stratified by birth order of their child (first or second) and participation of
the father (participate/not participate). Patients will receive the outcome
of randomization by mail. Due to the nature and design of the study, blinding
of the researchers or participants is not possible.

The parenting support intervention is based on the work of Hiscock et al (2014)
about infant sleeping and crying patterns which has proven to
be effective on parents* and infants* health. We add information about how to
respond to signals of distress which is essential for the bonding
process. The intervention will be introduced prenatally, between the 34th and
the 36th week of pregnancy. Parents will receive a booklet and
access to an online video which will be accessible with individual credentials.
During a subsequent prenatal home visit, parents will receive
further explanation about the materials and how to implement the tools
provided. Also, they are given the opportunity to ask questions. Parents
will receive a phone call 4 weeks after birth, to ask how they are doing and to
further support them with implementing the intervention.

Participation in the proposed study contributes to a better understanding of
how parents can be supported prenatally in preparing for parenthood
and the first months with a newborn infant. The main burden for parents will be
to keep the infant behavior diary, and to fill in the questionnaires
pre- and postnatally. In the experimental group, parents also need to read the
booklet and watch the online video before the child is born.