For vulnerable families, continued postnatal care, provided by family midwives, is associated with improved maternal care and parent–child relationship
- Department of Social Policy and Social Work, School of Sociology, Queen's University Belfast, Belfast, Northern Ireland, UK
- Correspondence to: Dr Anne Lazenbatt
Department of Social Policy and Social Work, School of Sociology, Queen's University Belfast, Room 1.027, 6 College Park, Belfast BT7 1LP, Northern Ireland, UK;
Commentary on: Ayerle GM, Makowsky K, Schücking BA. Key role in the prevention of child neglect and abuse in Germany: continuous care by qualified family midwives. Midwifery 2012;28:E469–77.
Implications for practice and research
This paper illustrates how findings from two related studies can enhance nursing and midwifery practice through the evaluation of the effectiveness of a family midwives (FMs) intervention.
Midwives educated about the health impact of infant maltreatment can be trained to support and strengthen maternal competencies in caring and relating to their infants’ needs.
FMs learn more about the multiple risk factors that families have to cope with, can promote stronger infant–parent relationships and support parents in meeting their children's nutritional and well-being needs.
Further research is needed to assess the efficacy of a universal FM service to provide the opportunities for positive, non-violent family interactions, as appropriate treatments to meet the needs of vulnerable infants still remain a challenge.
In Germany over the last few decades, the prevention of child abuse and neglect has been brought to the public eye through child deaths due to maltreatment not diagnosed at an early stage, or acted upon by professionals. Although German law from November 2000 states that children are legally guaranteed an upbringing without violence, 10–15% of parents still use severe physical punishment, leading to deaths each month of nine children under the age of 15 years, with infants most at risk. FMs now have a role to safeguard infants born to vulnerable families, offering home visitation through pregnancy to 1 year postnatally.
Two related studies sought to explore the effectiveness of 33 FMs in Lower Saxony and Saxony-Anhalt, assessing their support with multiple psychosocial risk factors, barriers to use of the service and the pattern of interdisciplinary networking involved. A total of 757 families were included. Descriptive analyses along with a measure of ‘family vulnerability’1 led to a statistical reduction of types of ‘vulnerability’. The main outcome was on measuring the prepost change using analysis of variance in the parent–child relationship, and maternal competencies in caring and feeding their infant. Patterns of interdisciplinary working with other professionals were also calculated. In Lower Saxony, qualitative data were also collected to obtain detailed life situations of 14 mothers and 6 social workers up to 1 year after they received FM support. Information was gathered about efficiency of care, support, access and views on the collaboration of providers. Thirty cases of non-compliance were evaluated through questionnaires and reasons for declining the FM service were gathered.
Many families produced a high ‘vulnerability score’ with four patterns explaining 40% of the variance. The highest frequencies related to infant nutrition, advice to mothers and psychosocial care. Youth welfare services were the main significant collaboration partners especially for those children removed from the family for safety reasons. Compared with at outset, higher mean scores were observed for ‘maternal care for child’. Children taken out of care had significantly lower scores on nutrition and were weaned at an earlier age. Mothers appreciated easy communication and access to the FMs, those who declined the service preferred their personal midwife as they were often afraid of external control.
These two related studies are set against the backdrop of Germany's national campaign to strengthen the prevention of abuse and neglect of infants, and prevent child deaths from maltreatment. Infancy offers a unique window of opportunity for FMs to work effectively with families at risk2 as it is possible to reduce abuse and neglect and strengthen maternal competencies in the perinatal period through the facilitation of trusting relationships and care from FMs. As infant maltreatment is one of the most serious events undermining healthy psychological wellbeing and development, and no other social risk factor has a stronger association with developmental psychopathology,3 it would have been important to ascertain the parent–infant attachment behaviour with respect to physical abuse and neglect. Study limitations include not providing a clear description of the training required for FMs to address the needs of vulnerable families.4 One project did use qualitative interviews; however, it would have been beneficial if enquiry had been used to ascertain whether or not the women were accessing any other services such as substance misuse and psychiatric services and any history of domestic violence.