Social support and pregnancy outcome

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Abstract
Summary. A total of 509 women with a history of a low‐birthweight (LBW, <2500 g) baby were recruited from the antenatal booking clinics of four hospitals and randomized to receive either a social support intervention in pregnancy in addition to standard antenatal care (the intervention group) or standard antenatal care only (the control group). At recruitment to the study, mean gestational age was 6 weeks, mean maternal age was 28.0 years, 86% of the women had one previous LBW baby, 11% had two and 2% had had three or more. The study population was socially disadvantaged: 77% of the women were working class, 18% had unemployed partners and 41% were smoking at booking. Social support was given by four research midwives in the form of 24‐h contact telephone numbers and a programme of home visits, during which the midwives provided a listening service for the women to discuss any topic of concern to them, gave practical information and advice when asked, carried out referrals to other health professionals and welfare agencies as appropriate, and collected social and medical information. Pregnancy outcomes were assessed using obstetric case‐note data (obtained for 507 women) and a postal questionnaire sent to all mothers 6 weeks after delivery (94% replied). Babies of intervention group mothers had a mean birthweight 38 g higher than that of control group babies; there were fewer very low‐birthweight babies in the intervention group. The number of hospital antenatal clinic visits was the same in the two groups (mean 5‐1) but more women in the control group (52%) than in the intervention group (41%) were admitted to hospital in pregnancy. Spontaneous onset of labour and spontaneous vaginal delivery were more common in the intervention group, who also used less epidural anaesthesia. The numbers of babies resuscitated at birth and babies admitted to the neonatal unit were similar in the two groups but the babies in the intervention group required less invasive methods for resuscitation and less intensive and special neonatal care. Intervention group mothers and babies were significantly healthier in the early weeks than those in the control group as judged by reported physical and psychosocial health and use of health services. Women's attitudes to the social support intervention were very positive, 80% of those who filled in the postnatal questionnaire singling out that the fact that the midwife ‘listened’ was important.