In this section we’re going to be thinking about methods of working during the postnatal period. As with the antenatal period, the key approaches to working during the postnatal period are delivered by three main methods, media-based methods, group-based programmes and dyadic interventions that are delivered to individual parent-infant dyads. Media-based methods include apps and websites that provide information and support to parents of new babies. One such website and app, called Getting to Know Your Baby provides information and videos that address some of the material that we have covered in this course. A link to this website is available at the bottom of this page.
Other media-based tools include Baby Express, which is an eight-page newsletter sent monthly to parents of infants until the child is one year of age, after which it’s sent once every two months for the next four years. The newsletter’s written by a local health journalist, and provides information on emotional development, parent-child interaction, and play. This intervention aims to enhance maternal well-being and positively influence parenting style. There are also a number of group-based methods of working with parents postnatally. Possibly one of the most popular methods is infant massage classes. This involves groups of around six to eight mothers and babies that are facilitated by a trained infant massage teacher.
The facilitator teaches the massage strokes on a doll and encourages attending parents to sit on the floor with their babies and practise the strokes. Facilitators also teach about infant cues, the use of songs and music and provides opportunities for social interaction between the participating mother-infant dyads. The research shows that infant massage can improve the interaction of depressed mothers. A second type of intervention is group-based parenting programmes. Some of these programmes are provided on a universal basis to all parents of new babies, but some of them target parents who are experiencing particular problems, such as being socioeconomically deprived or having postnatal depression.
So for example, Mellow Babies is a group-based programme targeting women experiencing depression and is underpinned by cognitive behavioural theory. The intervention is delivered over 14 weeks, during which time mothers and infants can attend the group for a whole day on a weekly basis. Babies are cared for in the creche in the morning, providing the mothers with an opportunity to reflect on their own lives, to draw links between their past and present feelings and relationships and to consider ways of managing depression using broadly cognitive behavioural approaches. In the afternoon, participants engage in play time, involving interaction coaching, baby massage, looking at picture books, lap games and nursery rhymes to promote sensitive interaction and attunement.
The babies are then returned to the creche and the afternoon sessions involve the use of videos of mothers interacting with their baby to demonstrate sensitive interaction. The results of a small study involving 20 mothers found significant improvements in maternal depression and in parent-infant interaction. A third group of interventions are provided to parent-infant dyads but not in group settings. And video feedback is possibly one of the best known of these dyadic interventions. Video feedback involves the use of observations from brief periods of videotaped interaction between the parent and the infant being fed back to the parent.
Practitioners help parents to improve their confidence and their sensitivity to infant cues by identifying moments of sensitive interaction on the videotape and giving feedback about these to the parents. Parents are encouraged to think about the interaction and what is happening for the baby, which can help to increase their reflective functioning. In terms of women who are experiencing significant problems such as domestic abuse, substance dependency, or severe mental illness, methods such as video feedback are being used as part of broader care pathways.
This means that video feedback is being used as part of the delivery of a wider set of services that might include the involvement of Child Protection and the courts in the case of women experiencing domestic abuse or substance dependency, or the delivery of other services in specialist inpatient perinatal mother and baby units for women experiencing conditions such as postnatal psychosis. Watch my interview with Hilary Kennedy, who is a leading developer and trainer of video interaction guidance in the UK, and who describes the use of this approach in more detail.
Parent-infant psychotherapy is another example of a dyadic intervention that involves a parent-infant psychotherapist working directly with individual parent-infant dyads in the home, clinic or hospital setting. This technique addresses a wide range of problems that can arise during the antenatal and postnatal periods. Parent-infant psychotherapy comprises a theoretically-guided dyadic intervention that is delivered concurrently to the parent and the infant and that focuses on improving infant attachment security by targeting parental internal working models. The approach is essentially psychodynamic, in that it involves identifying unconscious pounds of relating and using the parent-infant relationship itself as the focus of the intervention. The duration of delivery of parent-infant psychotherapy depends on the presenting problems, but typically ranges from 5 to 20 weeks, usually involving weekly sessions.
Parents may be referred to the service by a primary care clinician, such as a doctor, or may self-refer to privately-run services. Parent-infant psychotherapy services typically target infants less than two years of age at time of referral. This reflects the importance of the first two years of life in terms of children’s later development. A number of studies have shown that parent-infant psychotherapy is effective in increasing the number of children who are securely attached. If you would like to know more about other types of intervention that can be provided during the postnatal period, please read the article that we have provided.
In the next two videos, I talk to Tessa Baradon, who is clinical lead at The Anna Freud Centre, and who tells us a bit more about this approach.