This document summarizes the Baby Steps perinatal education program in the UK. It finds that current antenatal education tends to be highly medicalized with limited focus on the wider transition to parenthood. Baby Steps aims to support parents' emotional and physical transition as well as promote healthy child development and relationships. It uses home visits and group sessions to build trust and provide individualized support. Evaluations found improved parental confidence, knowledge, social support, self-esteem, anxiety, relationships and attachment to babies after participating in the program. Several local areas have adopted the program and it is working to develop a replication model and further evaluation.

1. @chrisdcuthbert
Rethinking perinatal education

2. What’s the gap?
A major review commissioned by DH
found that current antenatal education:
• tends to be highly medicalised – with
limited focus on the wider transition to
parenthood
• is highly variable between different areas
• often struggles to engage the most
vulnerable families, who stand to benefit
most
% of mothers who attended antenatal
classes by type of area2
42.4
31.9
22.4
Advantaged
wards
Disadvantaged
wards
Wards >30%
'Black' or
'Asian'

3. Aims and objectives
The overall aim is to:
• to optimise health and wellbeing and promote
protective factors against child maltreatment
The objectives are to:
• support men and women to negotiate the
emotional and physical transition to
parenthood;
• nurture healthy relationships by encouraging
listening and conflict resolution skills;
• encourage the development of sensitive,
reflective relationships with the infant from
the ante-natal period onwards;
• promote healthy child development within a
network of supportive relationships.

4. How does Baby Steps work?
• 2 dedicated co-workers who build consistent
trusting working relationships
• Participative techniques to motivate, influence
behaviours and lift barriers to lifestyle change
(home visits; 6 antenatal and 3 postnatal).
• Engaging meaningfully with men and women
throughout their journey to parenthood so that
all-round family health is enhanced within
social networks.
• Using research evidence into the transition to
parenthood, infant development and family
health and wellbeing
• Identifying need and referring for additional
specialist support
Reflective functioning
Couple relationship
Parent-infant relationship
Knowledge of child development
Emotional and physical health

5. Structure of the programme

6. Confidence
• 99% parents agreed that
attending the Baby Steps
programme had helped
them to feel good about
being a parent
• 96% parents said it had
made them feel more
confident as a parent.
“I didn’t think I was capable of being
a mum or that I deserved to be, I
really didn’t up until going to that
group. They were saying, ‘You are
capable; you’re going to be brilliant.’
What they’ve given me is
confidence in my ability. So,
everything I do with her I’m
confident in. So, I’m using every
aspect of the course.” (Mum – ex-
offender)
6

7. New knowledge and understanding
93% of parents agreed that
the programme had helped
prepare them for the birth of
their child
“When I was in labour and I was
feeling these pains and stuff. I
suppose it helped me deal with it. If
you don’t know what is happening to
your body, I think I would have felt out
of control, but it helped me be in
control of my labour more and keep
calm because I knew what was
happening to my body and why it was
happening.” (Mum – ex-offender)
98% of parents felt they
knew how to look after their
baby as a result of the
programme and were
prepared for going home with
them.

8. Understanding baby
93% agreed that attending Baby
Steps had helped them to better
understand their baby.
They learnt the importance of
interacting with babies, and how to do
this at different stages of development,
including singing to them, playing with
them and holding them up to talk to
them.
“I didn’t realise how close the baby had
to be at first to be able to see you. It
was helpful to be able to know that so
that when I did have my baby I realised
I had to hold him up for him to see me.
That was useful.” (Mum – experiencing
social isolation)
8

9. Social support
• 98% of parents said that
they had made new friends
in the group.
• Six months after the
course 61% of parents
were still in touch with
someone from the course.
• Parents were more aware
of wider support
opportunities with 98%
saying they knew where to
get help.
“I’m always so very excited to come every
Tuesday and see the other mums. It’s like
we’re family, I’m so grateful to have met
them, we’ve become so close, if I’m
feeling anxious I call them and they calm
me down”.

10. Pre-post measures study
• With over 200 parents
• Using standardised measures of:
• self esteem (Rosenberg)
• Anxiety (HADS)
• Depression (DASS)
• relationship with infant (PAI, MORS)
• relationship with partner (RQI)
• birth outcomes

11. Self esteem
11
• Increase in self-esteem was found for mothers across the programme.
• The programme was found to be most effective in improving self-esteem
for the 33 parents who started Baby Steps with ‘clinically’ low self-
esteem.

12. Anxiety and depression
12
Anxiety
• A statistically significant improvement in anxiety was found for
mothers across the programme.
• Anxiety improvements were most marked for those that started the
group with anxiety symptoms in the ‘borderline’ or the ‘high range’.
Depression
• Parents did not come to Baby Steps with difficulties with depression
- unsurprisingly overall there was no improvements in the group
• For the small number of parents who started Baby Steps with
clinical depression, significant improvements were found.

13. Relationship satisfaction
13
• Relationship satisfaction with their partners remained stable across the
programme.
• Relationship satisfaction with their partners improved for both mothers
and fathers in the antenatal period.
• 18 parents came to the group
with severe relationship
difficulties – for these parents
a statistically significant
increase in their relationship
satisfaction was found across
the programme at all the time
points.
“You don’t realise even, you don’t
have to be fighting, but just shouting,
how much shouting can affect the
baby.” (Dad – involvement with
children’s services)

14. Relationship with baby
14
Mothers and fathers both showed statistically significant
improvements in:
• attachment to their unborn baby from before the programme
to just before the baby was born.
• in their relationship with their baby after they were born.

15. Early Adopters
• Wiltshire
• Swindon
• Leeds
• Warwickshire
Better Start
• Bradford
• Blackpool
Next steps
Developing ‘Social Franchise’
model to support replication
Applying for RCT funding