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THIS THESIS This thesis is a result of the studies that were conducted for the project “Gewoon Gezond Zwanger” of the Academie Verloskunde Maastricht-ZUYD University. “Gewoon Gezond Zwanger” is a health promotion project carried out between April 2011 and April 2015. The project is a response to the concerns of the ‘Stuurgroep Zwangerschap en Geboorte’ (Steering Committee Pregnancy and Birth) 62 regarding the prevalence and the adverse affects of disturbed emotional wellbeing in pregnancy. The steering committee emphasized the need for prevention and reduction of maternal distress in maternity services in order to promote emotional wellbeing during pregnancy and childbirth. The “Gewoon Gezond Zwanger” project adopted this stance. In addition practising midwives expressed their uncertainty about their specific role and responsibilities in providing responsive care for women with maternal distress. The project has articulated the aim to develop an evidence-based and best practice antenatal intervention to optimise maternal emotional wellbeing during pregnancy. The “Gewoon Gezond Zwanger” project followed a bottom-up approach and involved experts in the field in order to design and implement an intervention best adapted to the needs of pregnant women. The general aim of this project was to translate systematically gathered evidence into an antenatal intervention that contributes to the prevention and reduction of maternal distress during pregnancy for women who receive midwife-led care. The “Gewoon Gezond Zwanger” project is funded by Regional Attention and Action for Knowledge (RAAK), registered as RAAK PRO 2-014. RAAK is managed by Stichting Innovatie Alliantie (SIA) with funding from the Ministry of Education, Culture and Science (OCW). In this thesis we regard maternal distress as a spectrum. This is consistent with a broad approach to antenatal maternal emotional health and wellbeing, as opposed to a onedimensional view that emphasizes distinct psychological constructs such as depression and anxiety. A broad approach can be interpreted as viewing all aspects of health and wellbeing without emphasizing a specific construct 63,64. There does not seem to be a need to prioritise or select between the above-mentioned mood disorders, as there is a recognised interrelation between them 15. Restricting measurement to a single psychological construct will under-represent the degree of distress women experience during pregnancy. Therefore, the use of measuring different psychological constructs simultaneously may increase the accurate detection of distress experienced during pregnancy 15. Maternal distress can be objectified by means of psychometric scores measuring the constructs of maternal distress. Theoretical framework Intervention Mapping is a protocol for developing effective health behavior change interventions that are underpinned by models and theories 65; we chose this approach to serve as a framework for the project (Figure 1).


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