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FOR MIDWIVES / PRENATAL CARE Click to learn more… |
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Mothers & Midwives Campaign Prenatal Education FAQ Sheet
What ACNM’s Deanne Williams says about Nurturing Baby and Me During Pregnancy
Unfortunately, your midwife can’t be with you 24 hours a day, but the physical and psychological benefits that come with a regular practice of emotional relaxation are the next best thing! Special tools, like the Nurturing Baby and Me During Pregnancy program, provide easy and enjoyable exercises you can use to release your daily stressors.--Deanne Williams, CNM Executive Director, American College of Nurse-Midwives
How Nurturing Baby and Me promotes prenatal care and fetal development Advances in prenatal technology and brain science research are changing how we think about pregnancy and the womb world. We are only beginning to explore whether, and if so how, babies can sense, feel and learn during the prenatal period. Early evidence suggests that the unborn are more aware than many of us thought.  This book is designed to help you know some special ways to love
and get to know your new family member, and how to have a
more peaceful and relaxed pregnancy. Our program will introduce you to
stress-reduction techniques, visualization and breathing exercises,
stimulation of the fetus through music, talking and touch, and ways to
involve the baby’s father in the pregnancy journey.
Though it’s tough to draw firm scientific conclusions in this area yet, it’s interesting to think about whether a program in prenatal enrichment can help babies to get the best start in life. For many parents, it’s not so important to have “scientific proof” – what’s important is to start your journey knowing you are parents already. In places where programs like this one have been tried (see the Resource List at the back of the book for more information), researchers felt they saw benefits like this:
Benefits For Mothers:
Benefits For Baby:
Benefits For Family:
Look Inside the Nurturing Baby and Me Guidebook
Listen to the pregnancy coach guide you on a pregnancy massage exercise  The exercises and music on the Nurturing Baby and Me CD were specifically developed to relax and gently guide you. Wherever you find this CD symbol, play that track. It will make your experience more fulfilling , more easy and fun. All you have to do is listen and go with the flow….
Listen to Nurturing Baby and Me music to soothe you and nurture baby development Music is one of the best ways to help the body recover from stress. The right relaxing music can help ease your body and mind, and a calm mother can also mean a calm baby. Later in the program you’re going to use music and song to reach and perhaps even entertain your unborn. If you play this specially composed music often during your pregnancy and play it during birth, there is a good chance baby will not only recognize the music he heard in the womb, but be soothed by it.
What midwives and experts are saying about Nurturing Baby and Me
Research Results Nurturing Baby and Me During Pregnancy Program Healthy Families Hampton Pilot Field Study Summary Report (4/28/06)* Introduction: Science has shown that unborn children are aware, react to the environment, learn and feel in the womb. Therefore, everything a pregnant woman thinks and feels is communicated to her unborn child. Because of this: parenting starts at conception.A recent Center for Disease Control (CDC) report stated that American women are becoming sexually active at earlier ages and are marrying later, increasing both the risk and hazard of unmarried childbearing in the US. One of every three births in America is to an unwed mother. In 1992 there were 1.2 million births to unmarried women, almost double that in 1980. Unmarried mothers tend to have poorer birth outcomes than married mothers because they are disproportionately young, poorly educated, and more likely to be poor. Although teenage birth rates declined again in 2004, it was at a much slower pace then seen in years past suggesting the possibility of a future increase. 41.2 births per 1,000 in 2004 were to females aged 15-19. With an increasing number of mothers being unwed, young, poorly educated, and financially unstable, the statistics on these populations becomes increasingly important. A new report from the National Center for Health Statistics, Centers for Disease Control and Prevention, shows that a substantial number of U.S. adolescents and young adults, aged 12-21 years, are engaged in behaviors such as smoking, binge-drinking, and violence that can influence health and longevity, both in the short term and later in life. If these behaviors are being practiced by pregnant teens, this ultimately affects the unborn child as well. These effects transcend the birth and infancy of these children. Research has shown that these “high risk” mothers (low income, low education, adolescent) have tendencies for child abuse and neglect (Lesser, et. al., 1999). Furthermore, a 1999 report from the Alan Guttmacher Institute reported that poor and low-income adolescents make up 38 percent of all women ages 15 to 19; yet, they account for 73 percent of all pregnancies in that age group. If these groups of mothers are given an intervention such as an outreach home visitation program prior to birth, it has been shown to greatly decrease probabilities of these behaviors (Honig, et. al., 2001). In addition to the precarious situations and stressors that the growing population of “high risk” mothers experience, “ordinary” expectant mothers also experience their own share of stressors. A new study, out of Advances in Nursing Science Physiologic Health Outcomes,” indicates that maternal prenatal stress may be hazardous to infant health. Changes in maternal hormonal and immune function as a result of stress may adversely affect the immune function and neurodevelopment of the fetus (Ruiz, et.al., 2005). By affecting neurological development, this has the potential to have profound effects on the baby’s later growth and future relationships. This prenatal stress may have many contributors including the traditional “American Lifestyle”. More and more often, women are taking high level, strenuous jobs or jobs involving long hours on working on your feet. Research has shown that these behaviors can increase preterm births and low birth weights (Gabbe, and Turner, 1997). By giving all mothers both “high risk” and “ordinary” a tool to promote stress reduction and prenatal bonding, mothers are potentially less likely to engage in harmful behaviors and more likely to engage in behaviors that promote healthy development and secure attachment. Currently, little has been done to focus on mothers and the possible benefits of a prenatal intervention. One major study (Manrique, et.al., 1998), conducted in Venezula with 680 low-income, at-risk families over a period of six years, demonstrated that a prenatal program consisting of stress-reduction techniques, visualization and breathing exercises, stimulating the fetus through music, talking and touch and involving the father, provided the following benefits:For Mothers: 1) better able to handle labor, 2) had greater success at breastfeeding, 3) felt more attuned to baby’s signals and needs, and 4) had more confidence as a parent. For Baby: 1) enhanced motor development, 2) enhanced language development, 3) earlier social engagement (smiling, playing peek-a-boo), and 4) more content and better able to control emotions. For Family: 1) showed greater bonding, 2) provided great family cohesion.
The prime objective of the study is to determine if the “Nurturing Baby and Me During Pregnancy Program” would add value to the current HF prenatal curriculum used by well trained home visitors: “Great Beginnings start before birth” curriculum. The program consists of a guidebook and audio CD aimed at improving maternal/child relationships after birth (see Tools below). Since we are measuring the differences between parents receiving the guidebook and parents who did not, we need to gather all the survey data from both groups and compare. The study was designed to have parents use the guidebook for a period of about six months and take the first survey at the eighth month of pregnancy. Additionally, a second follow-up survey will be given to all mothers at 2 months after birth to assess the long-term effectiveness of the tools. Hence, programs and tools which are effective at building strong emotional bonds between a parent-to-be and her unborn child will help to protect that child after birth and enhance development throughout life. The hypothesis is that if a pregnant woman communicated with and felt more bonded their unborn child, they would become more involved in their pregnancy and it would help them become a more skilled, responsive and nurturing parents and this could be beneficial to all parents after birth and to the long-term trajectories of positive child development.
Methods: Subjects: 31 participants are currently enrolled in the program. The subjects were recruited from new parents enrolled prenatally in the Healthy Families (HF) site in Hampton, Virginia. 17 mothers are currently participating in an evaluation of our new prenatal parenting book, which was given to them by the home visitor and used in conjunction with the HF Great Beginnings Start Before Birth Curriculum. The control group consists of a matching group of 14 parents who did not receive the new book intervention during their enrollment in the HF site, but received the HF Great Beginnings Start Before Birth Curriculum prenatal home visitation program taught by the curriculum-trained home visitors. Note: The HF Great Beginnings Start Before Birth Curriculum involved a home visitor engaging with these mothers and introducing them to many of the same experimental activities to enhance prenatal bonding and stimulation and information that was contained in the book. Mothers are given stress reduction and strategies for engaging fathers. Fetal growth and development, along with emotional and physical changes experienced by the parents are explored. The curriculum links parents and infants to early preventive medical care, improves service utilization, and results in improvement of overall healthy status. Overall, it helps promote parent-child bonding and attachment, a process that begins even before birth. However, with the curriculum they were NOT given any tangible tools like the book and CD’s themselves which the mothers could use between visits. Based on data from HF, it is known that the parents participating in the Healthy Families Home Visitation programs are more likely to be immigrants, single or teen parents who have been screened for and face multiple challenges including isolation, housing, poverty, substance abuse and domestic violence. These parents are under extraordinary personal and social stress that can drain much of their emotional energy and put their child at greater risk for abuse. Tools: “Nurturing Baby and Me During Pregnancy Program”: Nurturing Baby and Me During Pregnancy Program consists of a 128-page printed guidebook with 94 color photos and an audio CD with 12 exercises and 45 minutes of music. The guidebook follows a week-by-week framework with information and exercises keyed to typical developmental stages. The program content is broken down into simple weekly goals, easy-steps and a daily 15-minute exercise. The key, unique features of the program include: An 80-minute audio CD featuring a soothing pregnancy coach that guides moms through the exercises. In greater detail, the book/CD have 1) interactive massage, games and dancing exercises, 2) scientific research, written in simple language, explaining what baby can hear, feel and respond to in the womb, 3) 3-D sonograms which show baby's developmental milestones, 4) stories from real parents who have enjoyed connecting with their unborn children, 5) original four-color photography featuring a broad mix of women and families modeling the exercises and connecting with their unborn babies (and the reader), 6) journal pages to express feeling and make treasured memories to look back on, and 7) specially composed music to soothe Mom and stimulate baby during pregnancy and comfort both of them during delivery. This tool was given to the 17 mothers assigned to this group shortly after enrollment in the program sometime before the fourth month of pregnancy allowing at least 5 months of usage prior to the pre-natal survey. Pre Natal Survey: A pre-natal survey was given to all 31 participants during a visit from a HF visitor at approximately the 8th month of pregnancy. The survey consisted of 12 questions. The 5 demographic questions asked for current month of pregnancy, age of parent, baby’s birth number, father involvement, and family support. The 7 assessment questions consisted of: 6 multiple choice and one open ended question. The questions were geared to assess the mothers interactions with their baby through massages, reading, and singing and to assess the mothers self report of her knowledge of the baby’s development and the mother’s feelings about being able to communicate and bond with her unborn baby. The final question was an open ended question for comments from the mother. In addition, the mothers receiving the tool, were asked 2 additional questions assessing their use of the book and a question was listed for the home visitor to assess the helpfulness of the tool with the client. Post-Natal Survey: A post-natal survey was/will be given to all 31 participants during a visit from a HF visitor approximately 2 months after birth. The survey consists of 4 questions. There are 3 multiple choice questions assessing the bond between the mother and child, parenting abilities, and the baby’s development. There was one open-ended question for comments from the mother. In addition, the mothers receiving the tool were asked 4 additional questions and the home visitor was asked 1 inquiring about the helpfulness of the tools and whether the CD was used during delivery.Results/Discussion: All samples were small; therefore the study did not have robust power which made achieving statistically significant results difficult. Thus, the results will be presented descriptively. The sample size completing the pre-natal survey was 31. The total number of subjects completing both the pre-natal survey and the post-natal survey was 20 (12 received the tool and 8 who did not). Pre-natal Demographics: The experimental group (the mothers receiving the book/CD) ranged in age from 15-31 years of age with the mean age being 20.5. The control group (mothers not receiving the tool) ranged in age from 16-32 with the average age being 22 years old. For the experimental group, 75% of the mothers were first time moms whereas the control group only had 66.7% first time moms. Of the mothers in the experimental group, 75% of them had support from the baby’s father and 94.1% had family support. In contrast, of the mothers in the control group, 69.2% had support from the father and 100% had family support.Post-natal Demographics (subjects completing both pre and post): The experimental group ranged in age from 15-28 years of age with the mean age being 19.5. The control group ranged in age from 16-29 with the average age being 21.2 years old. For the experimental group, 73% of the mothers were first time moms whereas the control group only had 63% first time moms. Of the mothers in the experimental group, 64% of them had support from the baby’s father and 100% had family support. In contrast, of the mothers in the control group, 57% had support from the father and 100% had family support. The post-natal survey was completed 1.9 months after birth for the experimental group and 2.1 months after birth for the control group on average. Pre-natal Results/Discussion: Education Results: Larger numbers of parents who were given access to the Bonding with Baby book and CD reported connections with their baby. 64.7 % of the mothers given the book vs. 37.7% not given the book strongly agreed they could communicate with their unborn baby. All mothers receiving the book strongly agreed or agreed that they could communicate with their baby. Similarly, 64.7% of the mothers give the book vs. 57.1% not given the book strongly agreed that they could develop a bond with their baby before birth. This result would suggest that the book helped moms communicate more and feel more connected to their unborn babies than the control group. However, the results on the question of the books help in giving mothers a good understanding of baby’s development in the womb were inconsistent with the role of the book in communicating and bonding as 47.1% of the mothers given the book vs. 57.1% of the mothers not given the book strongly agreed that they have a good understanding of their baby’s development in the womb. This unexpected result, which is a mothers self-report regarding her belief not actual knowledge, instigated further analysis into the demographics of the two groups. One major difference was that the group receiving the book had more first time moms who could be expected to have less developmental knowledge and confidence. It was revealed that when the “mothers receiving the book” group was broken down into first time moms and mothers with previous children, 75% of the mothers who have had previous births vs. 41.7% of the moms who were first time moms strongly agreed that they had a good understanding of the baby’s development. Although, this may not account for the entire discrepancy, it seems to account for much of it. Other factors that may explain the result: 1) there was less family support in the group of mothers receiving the tool, so these family members (mothers, sisters, etc.) may contribute to the mothers understanding of development, 2) the mothers receiving the tool are on average younger than their counterparts, which could contribute to overall developmental knowledge, or 3) it is possible that the mothers receiving the book became more knowledgeable from the tool, but it left them realizing how much they still should know about the baby’s development, therefore producing the low self report score of development in the womb. Further results are seen in the following table.
Further analyses: When the physical bonding questions were looked at collapsing across group, noteworthy results were revealed. The entire sample was separated by age. An arbitrary cut-off of 20 years old was chosen since the age of 19 is a common age when children leave their parent’s home. The mothers under the age of 20 tended to report having slightly less physical contact and interaction with their baby. This may be due to younger moms feeling shy or uncomfortable talking, singing, or playing with their unborn baby. See below. In addition, the one mom lacking family support, reported never singing to the baby, reading once per week to her baby, and massaging the baby 2-3 times per week.
Mothers Recommendation Results: Overall, the mothers who received the book and CD found the materials to be a very useful and helpful tool during their pregnancy. One hundred percent of the mother’s receiving the bonding with Baby book/CD reported reading the book and using the book. Over 88% of the mothers receiving the book found it to be helpful with only one mother reporting that it was unhelpful. This mother’s response may be a result of her due date calendar her doctor gave her being 5 weeks off (self reported in the comments section). The CD was found to be helpful or very helpful in reducing stress by 76% of the mothers who received it. Again, only one mother reported the CD being unhelpful in reducing stress. Correspondingly, over 94% of the mothers agreed or strongly agreed that they would recommend the tool to other moms-to-be. Results are in the following table.
Home Visitor Results: Of the at home visitors who answered the question regarding the usefulness of the book and CD, they all reported the book helpful in working with the mothers. Over 33% reported it was very helpful, 47% reported it was helpful, and only 14% reported that it made no difference. No visitors reported that it was unhelpful. Looking at trends in responses, the results lend support for the validity and effectiveness of the “Nurturing Baby and Me During Pregnancy Program” . The prenatal goals were met. A greater portion of the mothers receiving the tool 1) participated more often in the prenatal exercises(70.6% vs. 57.2% performed all the activities at least 2-3 times per week), 2) were stimulated to believe they can communicate and bond with their unborn baby (100% vs. 87.7%), 3) found the book satisfying (94.1% would recommend it) and helped inform and prepare them mentally for childbirth (88.3%). Post-Natal Results/Discussion: Education Results: A larger number of mothers receiving the book reported a very close bond with their baby following birth than those not receiving the tools. 75% of the mothers given the book/CD vs. 62.5% of the mothers not given the tools reported a very close bond with their baby. 25% of each group reported a close bond with their baby and where none of the mothers receiving the tools felt anything other than a close/very close bond, 12.5% of the mothers not receiving the book felt an average bond with their baby. Similarly, the mothers receiving the book/CD rated their parenting abilities better than their counterparts not receiving the tools. 41.7% of the mothers receiving the book vs. 37.5% of those not receiving the book reported an excellent parenting ability. In contrast, 58.3% who received the tools vs. 62.5% not receiving the tools reported their parenting abilities as only “good”. Likewise, mothers receiving the book reported feeling better about their baby’s development than those mothers not receiving the book. 91.7% vs. 87.5% reported being happy about their baby’s development for the mothers receiving the book and those not receiving the tools, respectively. Only one mother in the group receiving the book reported their baby’s development as “okay” whereas, one mother in the group not receiving the book reported being worried about their baby’s development. These results would suggest that the tools helped in fostering a bond between mother and baby and led to greater confidence in parenting and thus potentially healthier development. In addition to the tools (book/CD) promoting and fostering a closer bond and better development of the baby, other factors may contribute to the above results as well. The control group (the mothers not receiving the book/CD) may in fact feel a more distant bond, poorer parenting abilities, and worse development due to a greater number of these mothers having other children to take care of. This may have allowed less time for the mother to bond with the new baby. Similarly, these mothers were also less likely to have father involvement. Without the father being involved and assisting the mothers with other duties these single parents may have less time to devote to communicating with the baby. In addition, the mother reporting being worried about her baby’s development commented that the baby had developmental disabilities due to complications during the birth. In contrast, the mothers receiving the book/CD were on average 2 years younger and were more likely to be first time mothers. Despite these potential hindrances, they reported feeling closer to their baby, and more confident in their parenting abilities. The above results are seen in the following table.
Download the entire Nurturing Baby and Me guidebook (available to ACNM verified members only COMING SOON) COMING SOON Adobe File with reader so can download. Add statement. For review only. No reproduction allowed without permission. C 2006 Developing Hearts Systems, Inc. All rights reserved.
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