**4.1 Findings**

Early communication influences development and learning processes in children [102]. On a microlevel, Papoušek has described the significance of communicative acting for early emotional relatedness [103]. On a macrolevel, phylogenetic human development concepts have augmented ontogenetic aspects of prenatal and perinatal development, broadening the concepts of postnatal development. Examples of how prenatal psychosomatic factors in mothers-to-be can affect their experiencing and retroact on gestation and delivery have often shown congruence, all the more those with a focus on imminent preterm delivery [65, 104], which is an issue with high significance as preterm infants require special treatment [105]. The issue of neurodevelopmental outcome in preterm newborns is still highly problematic and connected with new morbidity [70, 106–110], therefore new approaches in neonatal intensive care units have been developed and implemented [14, 70]. Recent findings that, e.g., preterm delivery correlates with infant eating disorders [111] should not be surprising; other findings indicate prenatal and perinatal factors in new morbidity [58]. Today's zeitgeist has only begun to be examined: it tends to favor noncommitment [101], pointing to the connection of new morbidity with societal motion [97].

Although for decades there have been efforts reaching out to prenatal aspects of mental health [112], structured programs are relatively new in Germany. As to overall parenting and early childhood, interdisciplinary and cross-cultural collaborations have emerged [113, 114]. On an individual level of childhood education, structured programs have successfully been established in many educational institutions in Germany [115–117]. The majority of early intervention programs available have mostly been adaptations from the USA. Comparisons between USA and German programs have proven to be difficult due to structural differences in health services [118]. In Germany, they mostly focus on the mother-infantrelationship [114], when a focus on postpartum depression and anxiety would be equally relevant. Recent meta-analyses show that programs starting during pregnancy were evaluated as the best when they had a high frequency of home visits [119, 120]. There are findings of advantages of close and personal relating to one another, which comes close to a therapeutic setting. Moreover, maternal symptom burden was relieved the most in a setting with psychotherapeutic elements established for mothers having to cope with preterm delivery [121]. Generally, maternal symptom burden relief has been the most observed effect in programs while there were only small effects in interventions on maternal competencies re-enforcement. *Challenges for Behavioral Neuroscience: Prenatal, Postnatal, and Social Factors DOI: http://dx.doi.org/10.5772/intechopen.85368*

Also, only small effects on child development have been observed, and these have been lower and more heterogeneous than the effects on mothers-to-be. Then again, having more than 20 sessions has proven helpful for the infant's physical development [119].

The early intervention approaches depicted below are not supposed to be therapy for mothers and infants. Instead, these are psychodynamics-oriented programs and concepts, which focus on potentially significant topics in pre- and postnatal stages of development. They have evolved from many of the findings above and have purposely been designed to support mental health of parents and children: from the unborn during pregnancy to the newborn and after, and to parenting in general. The programs take care of the microlevel of inner family issues. Here they are presented in order of diachronic developmental aspects reaching from prenatal to postnatal development.

### *4.1.1 "Mutter-Kind-Bindungsanalyse" (mother-infant bonding analysis)*

Mother-infant bonding analysis [122, 123] is a procedure of accompanying women in pregnancy enabling them to get in contact with their unborn; an approach for which Phyllis Klaus's work paved the way [124]. It is not a structured program in the narrow sense of the word but a fairly structured interventional sequence of individual sessions. By these, early before delivery first steps of building a relation between mothers-to-be and their unborn are encouraged. Through relaxation on a couch, women focus on their perception of signals from the unborn. These will show in the shape of emotions, images, thoughts, and fantasies on a socalled "inner screen," which both unborn and mother are related to. This communicative channel can be seen as "umbilical cord" of psyche, enabling a dialog, which is supposed to promote the intrauterine development of the unborn. The bonding analyst will support mothers-to-be get in contact with the unborn by encouraging them, by interpreting, and by helping to overcome blockades if necessary. Twenty to thirty sessions during the second half of pregnancy are usually taken, that is from twentieth to fortieth gestational week. Exactly this time frame is known as the unborn's highest brain sensitivity and vulnerability period [125]. The history of mother-infant bonding analysis goes back to the early 1990s when Budapest-based Jenö Raffai recognized in his work with patients the importance of the prenatal mother-unborn-relationship for the infant's and the adult's further development. Together with the Hungarian psychoanalyst György Hidas, he conceptualized a research and treatment method that developed into bonding analysis. Especially the focus on children's personality development through the well-being of mothers in pregnancy and birth-giving might serve as the prenatal reference to autobiographical memory [126].

#### *4.1.2 "SAFE"*

The structured program "SAFE"—Sichere Ausbildung für Eltern (Secure Education for Parents) [127] aims at what is best for mothers in pregnancy, during delivery, and in parenting issues. The main issue of the program is to avoid transferring of traumatic childhood experiences toward the infant. "SAFE" helps parentsto-be develop confidence in dealings with the infant. As early as in pregnancy they learn to recognize and react appropriately to the signals the infant shows. This is helpful in developing a secure mode of attachment in infants since securely attached infants show more capability of empathy, are more creative, and are more capable of cognitive processing, as well as they search easier for help when needed. The well-examined program also addresses real-life issues like; e.g. "do parents have to

be always present?" or, "what to do when parents are having different needs from those the baby does," and "when does pampering start, and which limits does an infant need, and when?" The program is for parents-to-be up to the seventh month of pregnancy, and it is continued after delivery until baby's first birthday; parents may continue up to the second or third birthday. There is a training of sensitivity toward the infant within a group in 10 days of class. Groups are run by two mentors in whole day seminars, 4 days during pregnancy, six after delivery. Stabilization and imagination exercises in stressful situations are conducted, especially in adaptation phase after delivery. A parental sensitivity training video supports the reading of signals and needs of the baby. A scientific foundation via attachment interviews with parents, diagnostic questionnaires, and other evaluation tools has recently led to first results [128].
