Posted: April 29th, 2018

Long-term impact of social support and midwifery support during pregnancy

Long-term impact of social support and midwifery support during pregnancy

Social support is defined as the provision of emotional, instrumental, informational, or spiritual assistance by significant others, such as family, friends, health professionals, or community members [1]. Social support during pregnancy can have positive effects on the well-being of both mother and child, as it can alleviate emotional and physical stress, enhance maternal competence, reduce the risk of mental health problems, and improve birth outcomes [1, 2, 3, 4]. Midwifery support is a specific form of social support that involves the provision of continuous care by a trained midwife throughout pregnancy, labour, and postpartum period. Midwifery support can foster a trusting relationship between the woman and the midwife, promote woman-centred care, facilitate informed decision making, and empower women to have a positive birth experience [5].

This essay aims to explore the long-term impact of social support and midwifery support during pregnancy on maternal and child health outcomes. It will first discuss the evidence on how social support and midwifery support can influence maternal mental health, parenting skills, and child development. Then, it will examine the challenges and barriers to accessing adequate social support and midwifery support during pregnancy, especially for vulnerable groups of women. Finally, it will suggest some recommendations for improving the availability and quality of social support and midwifery support for pregnant women.

Maternal mental health

Pregnancy is a time of significant physical and emotional changes that can increase the vulnerability of women to develop mental health problems, such as depression, anxiety, or self-harm [2]. These problems can have adverse consequences for the mother’s health and well-being, as well as for the child’s development and attachment [6]. Therefore, it is essential to provide adequate social support and midwifery support for pregnant women to prevent or reduce the severity of mental health problems.

Several studies have shown that low social support during pregnancy is associated with higher levels of depression, anxiety, and self-harm [2]. For example, a systematic review and meta-analysis by Bedaso et al. [2] found that low social support increased the odds of antenatal depression by 18% and antenatal anxiety by 97%. On the other hand, high social support during pregnancy can protect women from developing mental health problems or help them cope better with existing ones [1]. For instance, a qualitative systematic review by Al-Mutawtah et al. [1] revealed that women who received emotional support from their female network connections (such as mother, sister, or friends) felt more confident, relaxed, and happy during pregnancy. Moreover, women who received care and affection from their husband felt more loved, valued, and secure.

Midwifery support can also play a vital role in enhancing maternal mental health during pregnancy. A Cochrane review by Sandall et al. [5] found that women who received midwife-led continuity models of care (i.e., care provided by a known midwife throughout pregnancy) were less likely to experience antenatal hospitalisation, regional analgesia, episiotomy, instrumental delivery, preterm birth, or fetal loss before 24 weeks than women who received other models of care (i.e., care shared by different health professionals). Furthermore, women who received midwife-led continuity models of care reported higher satisfaction with their care, greater sense of control during labour,
and lower levels of fear or anxiety [5]. These findings suggest that midwifery support can improve maternal mental health by reducing the exposure to stressful events or interventions during pregnancy and childbirth.

Parenting skills

Parenting skills are the abilities and behaviours that parents use to raise their children effectively and positively. Parenting skills can influence various aspects of child development, such as cognitive, emotional,
social, and physical growth [7]. Therefore, it is important to provide adequate social support and midwifery support for pregnant women to enhance their parenting skills.

Several studies have shown that social support during pregnancy can improve parenting skills by increasing maternal confidence, competence,
and responsiveness [1]. For example, a qualitative study by Al-Mutawtah et al. [1] found that women who received practical support from family and friends (such as help with household chores or childcare) felt more prepared
and capable to take care of their newborns. Moreover,
women who received health information support (such as advice on breastfeeding or infant care) felt more knowledgeable
and empowered to make informed choices for their babies.

Midwifery support can also play a significant role in improving parenting skills by providing education,
counselling,
and guidance on various aspects of infant care [5]. A Cochrane review by Sandall et al. [5] found that women who received midwife-led continuity models of care were more likely to initiate breastfeeding, have a longer duration of breastfeeding, and have a lower incidence of baby admission to neonatal intensive care unit than women who received other models of care. Furthermore, women who received midwife-led continuity models of care reported higher quality of mother-infant interaction, attachment, and bonding [5]. These findings suggest that midwifery support can improve parenting skills by enhancing maternal-infant health outcomes and relationships.

Child development

Child development refers to the changes that occur in children’s physical, cognitive, emotional, and social domains from conception to adolescence [8]. Child development can be influenced by various factors, such as genetic, biological, environmental, and social factors [8]. Therefore, it is important to provide adequate social support and midwifery support for pregnant women to foster optimal child development.

Several studies have shown that social support during pregnancy can influence child development by affecting the intrauterine environment, the birth outcomes, and the postnatal environment [1]. For example, a qualitative study by Al-Mutawtah et al. [1] found that women who received traditional rituals and spiritual support (such as prayers or blessings) felt more calm and peaceful during pregnancy, which may have positive effects on the fetal development. Moreover,
women who received the all-encompassing natal home (i.e., a place where women feel comfortable, safe, and supported during pregnancy and childbirth) had better birth outcomes, such as lower rates of preterm birth or low birth weight, which may have long-term implications for the child’s health and development.

Midwifery support can also play a significant role in influencing child development by providing evidence-based care that promotes normal physiological processes and prevents unnecessary interventions or complications during pregnancy and childbirth [5]. A Cochrane review by Sandall et al. [5] found that women who received midwife-led continuity models of care had lower rates of preterm birth, fetal loss before 24 weeks, or stillbirth than women who received other models of care. Furthermore,
women who received midwife-led continuity models of care had lower rates of induction of labour, caesarean section,
or instrumental delivery than women who received other models of care [5]. These findings suggest that midwifery support can influence child development by reducing the exposure to adverse events or interventions that may have negative effects on the fetal or neonatal development.

Challenges and barriers

Despite the evidence on the benefits of social support and midwifery support during pregnancy for maternal and child health outcomes,
many women face challenges and barriers to accessing adequate social support and midwifery support during pregnancy,
especially for vulnerable groups of women, such as women from low-income backgrounds,
women from ethnic minorities,
women with disabilities,
women with mental health problems,
women with substance abuse problems,
women experiencing domestic violence,
or women living in remote or rural areas [1, 2, 3, 4, 5]. Some of the common challenges and barriers include:

– Lack of availability or accessibility of social support or midwifery support services due to geographical distance,
transportation difficulties,
cost issues,
shortage of staff,
or limited hours of operation [1, 2, 3].
– Lack of awareness or knowledge of social support or midwifery support services due to low literacy levels,
language barriers,
cultural differences,
or insufficient information or communication [1, 2, 3].
– Lack of trust or satisfaction with social support or midwifery support services due to poor quality of care,
lack of continuity of care,
lack of respect or dignity,
lack of choice or autonomy,
or lack of responsiveness or empathy [1, 2, 3].
– Lack of personal or social resources to seek or accept social support or midwifery support due to low self-esteem,
low self-efficacy,
low perceived need,
fear of stigma or discrimination,
or lack of social network or family support [1, 2].

Recommendations

To overcome the challenges and barriers to accessing adequate social support and midwifery support during pregnancy,
some recommendations for improving the availability and quality of social support and midwifery support for pregnant women are:

– Increase the availability or accessibility of social support or midwifery support services by expanding the coverage area,
providing transportation assistance,
reducing cost barriers,
increasing staff capacity,
or extending hours of operation [1, 2].
– Increase the awareness or knowledge of social support or midwifery support services by improving literacy levels,
providing language assistance,
addressing cultural diversity,
or enhancing information or communication strategies [1, 2].
– Increase the trust or satisfaction with social support or midwifery support services by improving the quality of care,
providing continuity of care,
ensuring respect or dignity,
offering choice or autonomy,
or enhancing responsiveness or empathy [1, 2].
– Increase the personal or social resources to seek or accept social support or midw

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