**11. Conclusion**

**Figure 2.** The "talkstory" process.

A "centering pregnancy" model is an innovative model for prenatal care. It focuses on "woman-centred care" by integrating antenatal care, health information and group support. It acknowledges a woman as an expert regarding her needs. The approach is practised, for example, in Canada, where women are involved in their basic assessment by weighing one another, checking one's own urine sample, and intragroup checking of blood pressure. Each

Although the "centering pregnancy" model might free midwives or clinicians from routine investigations and as such allow them more time to address issues like psychosocial care, it carries a limitation in a sense that women should be literate, and the process should still be

A Hawaiian-style "talkstory" originated from a needs-assessment project undertaken in Hawaii during 2000, where women indicated that their psychosocial needs were largely unmet.

A Hawaiian-style "talkstory" could offer an ideal approach in offering culturally focused antenatal care as it is a culturally based interactive communication approach, aimed at addressing the pregnant woman's psychosocial needs. It could be mostly effective during the initial antenatal care booking as the woman is taking the lead in sharing her childbirth experiences. **Figure 2** explains the talkstory process as a guideline for midwives who might

supervised by a midwife or a clinician until women are familiar with all aspects.

woman also records results in her own antenatal card [47].

**10.7. The Hawaiian-style "talkstory"**

30 Selected Topics in Midwifery Care

be interested in its implementation.

The issue of psychosocial risk assessment and support seems to be a concern both nationally and internationally. The process of adapting to pregnancy and the resulting life changes are often difficult, even if the pregnancy is planned as pregnancy involves intense emotional, spiritual, psychological and social factors that need a midwife's caring awareness and responsiveness. A pregnant woman should be assisted to recognise and incorporate these changes into her self-image, her social network and her lifestyle. When the pregnancy is unplanned, the psychosocial changes may be more profound and lead to uncertainty, anxiety and depression [19].

[5] Willinck L, Schubert R. Antenatal psychosocial risk assessment project. Australian

Psychosocial Antenatal Care: A Midwifery Context http://dx.doi.org/10.5772/intechopen.80394 33

[6] Clinical Guideline 2003. Antenatal Care Routine Care for the Healthy Pregnant Woman. London: National Collaborating Centre for Women's and Children's Health Commissioned by the National Institute for Clinical Excellence: Royal College of Obstetricians

[7] Baldo MH. The antenatal care debate. Review. Eastern Mediterranean Health Journal.

[8] Mehdizadeh A, Roosta F, Chaichian S, Alaghehbandan R.Evaluation of the impact of birth preparation courses on the health of the mother and the newborn. American Journal of

[9] O'Keane V, Marsh MS. Depression during pregnancy. British Medical Journal. 2007;

[10] Dodd JM, Robinson SJ, Crowther AC. Guiding antenatal care. The Medical Journal of

[11] Gelder MG, Lo'pez-Ibor J, Anderson NC. New Oxford Textbook of Psychiatry. Vol. 2.

[12] Goodman JH. Womens' mental health. Journal of Obstetric Gynecology and Neonatal

[13] Handley MC. Emotional responses to pregnancy based on geographical classification of

[14] Woodward V. Caring for women: The potential contribution of formal theory to mid-

[15] Parry DC. We wanted a birth experience, not a medical experience: Exploring Canadian women's use of midwifery. Health Care for Women International. 2008;**29**(8):784-806 [16] Stahl K, Hundley V. Risk and risk assessment in pregnancy: Do we scare because we

[17] Dejin-Karlsson E, Ostergon PO. Psychosocial factors, lifestyle and foetal growth: the added value of of both pre- and post-natal. The European Journal of Public Health. 2003;

[18] Hollander D. Poor psychosocial support raises the odds of having an underweight

[19] Langer A. Support During Pregnancy for Women at an Increased Risk of Low Birthweight Babies: RHL Commentary. The WHO Reproductive Library; Geneva: World

[20] Namagembe I. Prevalence of Stress, Depression, Alcohol Use, and Social Support among HIV Infected and Uninfected Pregnant Women in Uganda. Washington, DC: APHA

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There is a growing need for understanding the place and significance of maternal psychology and other psychosocial factors in the management of pregnant women by midwives or clinicians. Strategies for supporting maternal and foetal mental health need to be developed, as the importance of a good-quality pregnancy extends beyond antenatal care. Psychosocial risk assessment during pregnancy is further considered as the first strategy to support maternal well-being as this will allow the pregnant woman to cope with her pregnancy [26].

In theory, risk assessment is a logical tool for rationalising service delivery to ensure that those in greater need receive special attention and care. However, it is becoming increasingly clear that with incorrect and inadequate psychosocial risk assessment, scarce resources may be diverted away from pregnant women who are in real need. However, in the absence of evidence of an effective risk screening process, risk assessment cannot be relied on as a basis for matching needs and care in maternity services [7]. Ideally, psychosocial risk assessment should be included within the overall risk assessment or could be administered as a separate tool in the form of a checklist.
