PEPP: Living well with a first baby
Almost all first-time parents attend antenatal education, but it is well known that information provided in these classes about life after childbirth is not usually retained. However, postnatal classes are not widely available and parents have to depend on informal sources and self-education to acquire the knowledge and skills that are essential to care well for a baby and adapt to new responsibilities and an increased workload. None of the trials of antenatal interventions to prevent postnatal depression has been successful and few involved the father. It is generally agreed that events after the birth of a baby are salient determinants of postpartum mood disturbance. We conceptualise postpartum mood disturbance as reflecting in part, high learning needs, which if unmet lead to severe fatigue, reduced sense of effectiveness, diminished confidence and lowered wellbeing.
The Psycho-Educational Program for Parents (PEPP) was designed by A/Professor Jane Fisher and Dr Heather Rowe to attend to these important gaps with support from beyondblue, the national depression initiative and the Victorian Centre of Excellence in Depression and Related Disorders. PEPP addresses two risk factors for maternal postnatal adjustment difficulties and mood disturbance, but is designed as a universal program which does not use psychiatric language or concepts.
PEPP aims to promote confidence and reduce distress by providing couples with crucial knowledge and an opportunity to learn essential skills in a half day seminar offered at a critical time. The two-component program is conducted by maternal and child health nurses for first time parents and their newborns, who attend in groups of up to five families four to eight weeks after discharge from maternity hospital. The first component outlines infant temperament, crying, soothing, sleep needs and the use of settling strategies to achieve a sustainable routine of daily care. The second focuses on matters relating to the new, unpaid workload of infant care and household tasks, and strategies to address these fairly and in a non-confrontational manner. The sessions involve group discussion and active participation, including practising infant settling and are accompanied by worksheets and a book for participants to take home for ongoing reference.
Mothers, fathers and newborns: Preventing distress and promoting confidence
The effectiveness of PEPP as a mental health promotion strategy is being investigated in a controlled trial entitled 'Mothers, fathers and newborns: Preventing distress and promoting confidence', funded by the Australian Government Department of Family, Housing, Community Services and Indigenous Affairs under the Invest to Grow initiative.
The trial has been conducted in seven study sites in Victoria, including three regional and four metropolitan areas. Project partners, including local maternal and child health nurses in each study site have been enthusiastic supporters and feedback from participants indicates that the program has been well-received. Outcomes are assessments of parents’ emotional wellbeing and parenting confidence and the health and behaviour of their infants six months postpartum. The implementation stage of the trial has been completed and data analysis and preparation of the findings for publication are currently in progress.
A Program Reference Group, with representatives from each of the participating Local Government Areas, and from General Practice, Maternal and Child Health Nursing, Psychiatry, Clinical Psychology, Parenting Education, Biostatistics, Lactation Consultancy has met twice a year to provide expert input into the implementation and evaluation of the PEPP trial.
With support from the Jack Brockhoff Foundation, a website www.whatwerewethinking.org.au has been developed to make PEPP more widely available to both parents and primary health care professionals. It was developed in collaboration with Melbourne interactive media designer Penny Harris of PenPen Productions.
Enquiries about this research trial may be directed to Alaina Vaisey, PEPP Research Co-ordinator at (03) 8344 0769 or amvaisey@unimelb.edu.au