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Australian researchers have found a simple way to improve the mental health and wellbeing of mothers living in adversity – offer them regular maternal and child health nurse home visits during pregnancy and continue those visits until the child turns two.
The study, led by the Murdoch Children’s Research Institute (MCRI) and run in partnership with the Australian Research Alliance for Children and Youth (ARACY), Western Sydney University and The Royal Children's Hospital, began when researchers were thinking about how to help mothers and their babies living in adversity.
They wondered if they could make an impact by making better use of our existing universal nursing system – the maternal and child health (or child and family health) nurses many mothers access after their child is born across Australia.
“One in five Australian children are born into disadvantage and we started wondering what would happen if these nurses could support women who are at risk, from pregnancy to the time their babies were two? And what if we could do it in a way that works for women, by going to their homes or meeting them at the park? Actually working with them so that they can be the best parents they can be,” says Professor Sharon Goldfeld from the Murdoch Children’s Research Institute (MCRI).
The research team created a new early intervention program called right@home, building on the Miller Early Childhood Sustained Home Visiting program. It was designed for mothers experiencing adversity to help them develop parenting skills like feeding, bonding and creating a better home learning environment.
Women's mental health gets worse as their babies get older. This won’t surprise anyone who has had children, but there is very little research on this. Typically, mothers have a little bit of a spike [in poor mental health] in the postnatal period, then it gets better. But after that it actually gets worse.
How extra nurse visits helped new mothers
The study was the largest multi-site randomised controlled trial of a nurse home visit program in Australia, involving 722 women recruited from 10 hospitals across Victoria and Tasmania.
The results, published in Pediatrics, showed that the intervention group (who received 25 home visits up until the child turned two), reported lower rates of depression, anxiety and stress and better wellbeing one year after the visits ended compared to those who received the standard free centre-based nurse consultations in Victoria (nine visits) and Tasmania (six visits).
Mum Carla Bonacci, who joined the program a week before her daughter, Carlisseia, was born, said she would have struggled without the regular home nurse visits.
“I really needed the support, especially during the first few months after giving birth,” she said.
“The nurses guided me through from helping with feeding and bonding to managing my daughter’s sleep.
“Being a single, first-time mum, I wasn’t confident but they gave me that reassurance, which has greatly helped my mental health and allowed me to be the best mum I can be.”
Why the impact is profound
Professor Goldfeld says the fact that the study was big and run in so many locations, making its results statistically and practically significant.
“When there are so many variables at play such as different nurses in different areas in two states, it means something really has to work to show even a small difference at a population level. So, the fact that it worked so well, and in so many ways, is amazing,” she says.
Professor Goldfeld was particularly satisfied to see the impact the extra nurse visits had on the new mother’s mental health.
“Women's mental health gets worse as their babies get older. This won’t surprise anyone who has had children, but there is very little research on this. Typically, mothers have a little bit of a spike [in poor mental health] in the postnatal period, then it gets better. But after that it actually gets worse,” she says.
However, the study showed that women receiving the ongoing nurse visits in their child’s first two years did not experience that dip in poor mental health: instead, the decline was prevented.
“Their mental health actually flattened off, and their wellbeing improved, even with all the other factors in their lives,” says Professor Goldfeld.
The COVID-19 pandemic, with its many economic and psychological stressors for families with young children, has meant that programs like right@home are becoming increasingly important.
Researchers would now like to see it embedded into existing services so that more vulnerable women can receive the benefits of the extra support.
Supporting our most vulnerable new mums
Professor Goldfeld says existing maternal nursing services may not need to change for most families.
“For the vast majority of families the system we have now is absolutely fine. Then, there's a smaller number – maybe 15- 20% of the population – who have things happen along the way that mean they need a little bit of extra help,” she says.
But Professor Goldfeld says it’s the smaller number again – about five to ten per cent of the Australian population – whose pregnancy risk profile means they would benefit from this type of intensive, long term program, including mothers who may be very young, be unsupported more generally, have mental or physical health problems, or be unemployed – just a few of the ten risk factors identified by researchers.
“For these mothers, we work with them so they can give their babies and their families the best possible start,” Professor Goldfeld says.
She says this kind of proactive program is powerful because it heads off problems before they become too much.
“It's not about actually waiting till there are significant problems and then trying to ‘fix them’. It’s actually about a system that, through working with in partnership, can prevent women living in adversity actually falling off a cliff. Instead, they are empowered to have the life that they want,” Professor Goldfeld says.