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An Earlier Connection: Making the Case for Engaging Families as Soon as Possible in Pregnancy

Dec 8, 2021

Paula Zeanah, University of Louisiana at Lafayette; Joy V. Browne, University of Colorado Anschutz Medical Campus; Denise Findlay, University of Washington; and Debbie Cheatham, ZERO TO THREE, Washington, DC


The article addresses clinical, neurodevelopmental, and psychological experiences of pregnant parents to build the case for shifting therapeutic approaches to promote the earliest possible connections between parents and their infant. The article emphasizes the rationale for therapeutic interface with families in pregnancy as it relates to stress reduction, behavioral changes, and protective factors for the fetus. Using home visiting as a service model, we focus on the relationship-based nature of the work, challenges, successes, priorities, and strategies for engaging parents in behaviors and activities that promote infant/parent mental health during pregnancy and early infancy.

Pregnancy is a time of profound psychological transformation for women; the anticipation of becoming a parent can bring openness for new parents to make positive changes in their lives that will benefit the developing child. Therapeutic engagement with families during early pregnancy, when key neurodevelopmental processes are underway, and during the perinatal and newborn periods, when the dyadic interactional processes begin taking shape, provide a foundation of infant/ parent mental health. Physicians, nurses, Women, Infants & Children (WIC) program staff, childbirth educators, and home visiting program staff have the best opportunities to engage women early in pregnancy and sustain this connection into the baby’s early infancy. However, the involvement of other providers and programs is also critical.

Previously, the belief was that less complex neurological systems, like those for sight, hearing, and motor activities, developed before complex stress response systems. However, recent findings suggest that the differences between stress-exposed babies’ brains and their peers emerge almost immediately (Banich & Compton, 2018). For example, maternal depression and intimate partner violence experienced during pregnancy can induce epigenetic changes resulting in stress-response neurodevelopmental patterns (Glover, 2014). Therapeutic programs aimed at improving child outcomes as soon as a woman discovers she is pregnant or even prior to conception may yield the best results.

There are many pathways in which people become parents that can impact how the prenatal period and the process of readiness for parenthood are experienced; however, the focus of this article is the typical experience of mothers during pregnancy with limited attention to the experience of fathers.

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