Preventing postnatal mental health problems: Findings from the What Were We Thinking! Program

Content type
Short article

July 2016


Jane Fisher, Heather Rowe , Fiona Darling

The What Were We Thinking (WWWT)! Program

WWWT is a psychoeducation program for all parents of first babies that provides the knowledge and skills required to manage two common risks for postnatal mental health problems: a baby with crying and sleeping difficulties, and disagreements over caregiving roles and household responsibilities. The program's content challenges gender stereotypes and emphasises that caring for an infant requires specific skills and knowledge that both parents need to acquire.

WWWT has three components: a one-day face-to-face seminar for women, their partners and their six- to eight-week-old babies; primary care from a maternal and child health nurse trained in the WWWT program; and printed materials for parents to take home for ongoing reference as needed.

A cluster randomised controlled trial of the impact of the program was completed recently. Maternal and Child Health Centres in 6 Local Government Areas in Melbourne, Australia were randomly allocated to provide routine care either with or without the WWWT program. All English-speaking first-time mothers receiving routine primary care at the Maternal and Child Health Centres were eligible to participate. Over 400 women with new babies were recruited, and completed telephone interviews when their babies were 6 and 26 weeks old. More than 90 per cent provided complete data.

Key findings of the trial

The trial revealed that:

  • the prevalence of depressive, anxiety and adjustment disorders six months postpartum was 60 per cent lower among women who received the full three-component intervention than among those who received usual care;
  • mild to moderate anxiety and self-reported health were significantly better among women who were in the intervention group and received some or all of the components;
  • there were fewer unsettled infant behvaiours in the sub-group whose babies had been unsettled at recruitment;
  • there were fewer emotionally abusive behaviours among couples whose relationships had been optimal at recruitment;
  • approaches to management of unsettled infant behaviour recommended in the program were not associated with problems with breastfeeding or in the mother-infant relationship;
  • The WWWT seminar was appraised as understandable and useful by more than 85 per cent of the parents who participated; and
  • 93 per cent of the maternal and child health nurses who were trained for the trial said that since training they now routinely include partners, relationship topics and gender-informed language in their practice.

This trial provides a considerable advance in the prevention of common postnatal mental health problems among women in primary healthcare, and has promise as a population-based prevention strategy. The program is readily integrated into usual care, requires print materials only and about one hour of health professional contact time per couple - in addition to routine visits - to achieve a similar benefit to that found in a trial in England of, on average, six individual hour-long home visits by a midwife (MacArthur, Winter, Bick, Knowles, Lilford, et al., 2002). It is innovative in including fathers and babies.

Implementation and adaptation of the program

We propose that the program can be adapted for other parents, including those who already have children, parents of twins and parents of babies with special needs. Translated and culturally adapted versions are available for Vietnamese-, Sinhala- and Chinese-speaking families. Adaptations for other languages are planned.

The program has also been adapted under the Australian Government e-mental health ("Teleweb’") initiative into a free Smartphone app and a professionally-moderated WWWT blog. These online adaptations fill an important gap in access to peer support, expert advice and evidence-based strategies for first-time parents as they adjust to their new roles and responsibilities.

The Smartphone app is an interactive platform using videos, quizzes with instant tailored feedback, opportunities to acquire new knowledge and skills and to implement and monitor behaviour change. The blog rests on the evidence that access to other people’s stories provide readers with reassurance that their own experiences and worries are understandable and that they are not alone.

Together, these online platforms aim to promote the mental health, and increase the social participation of new parents, by increasing access to peer support and evidence-informed professional guidance. They were developed in partnership with Jean Hailes for Women’s Health, a trusted and nationally recognised women’s health education, health promotion and research translation organisation.

WWWT training for health and community welfare professionals will be available later this year. The developers welcome interest from organisations or individuals wishing to collaborate to adapt and evaluate the program for culturally and linguistically diverse groups, or implement WWWT in their services.

Further information


MacArthur, C., Winter, H., Bick, D,, Knowles, H., Lilford, R., Henderson, C., Lancashire, R.J, Braunholtz, D.A, & Gee, H. (2002). Effects of redesigned community postnatal care on women's health 4 months after birth: a cluster randomised controlled trial. Lancet, 359(9304), 378-85.