The Mothers School Project is a service provided by the city of Santos, São Paulo State, Brazil, as part of the Mãe Santista program (Mothers from Santos Program) and seeks to help first-time mothers and their families to better understand and prepare for motherhood. Through practical classes and a supportive app, mothers will be able to discuss topics such as body changes or how to bath her child for the first time at home, among others related to motherhood.

The main objective is to decrease infant mortality rates which, despite government efforts, hadn't lowered its stats in the last years. According to our research, the causes that now should be fought are not in infrastructure anymore, but in the quality of information passed on to new mothers and in medical monitoring pre and post-birth.

Mothers School tackles 5 main subjects:

- reproductive health

- pregnancy

- birth

- after birth / postpartum

- beyond pregnancy

The Mothers School project unifies a set of educational activities that are already in place to complement medical treatment and prepare women and their supportive network to motherhood. It assembles several groups that gather in the local health units (such as pregnancy, family planning, breast-feeding groups) and enhance their core structure by developing new subjects to discuss, bringing together a new, coherent material, and highlighting practical activities related to motherhood day to day situations.

Mãe Santista (Mothers from Santos) is one the many programs that Santos' Health Network delivers to the population. It offers complete aid to women on exams, procedures and any other medical assistance, from before birth to puerperal help. In the city, even with 99% of pregnant women attending Pre-Birth routine, infant mortality rates analysis tell us that most of the avoidable deaths occur due to perinatal causes - that is, due to problems preventable by better monitoring during birth and pre-birth.

Santos Motherhood health care program::

Guides women to have routine gynecological appointments and exams

Offers pregnant women 6 Pre-Birth appointments minimum

Offers puerperal women routine appointments right from the first week after birth

However, it is known that only appointments are not sufficient to fulfill all women doubts. Therefore, there should be other moments and professionals available to clarify doubts and any other subjects that might occur during motherhood. These other discussion spaces are the educative groups aforementioned.

A survey undertook by Santos Health Department (2015) stated that the majority of local health units did not have any kind of educational groups. On the other hand, units that actually have educational groups don't have master guidelines and updated support material. This was the context in which the project was born.

The project used Design Thinking methods and tools and was organized around the double-diamond chart. It was divided into four phases: Exploration and Diagnosis; Co-creation; Prototyping; and Implementation

Exploration and Diagnosis phase is the moment in which the main challenges are defined, ensuring the team will examine the context from every possible point of view. This was necessary once the city's infant death rates and context needed to be clarified so that the actual major issues could be tackled in the co-creation phase.

During the co-creation phase the challenges were identified as to orient workshops scope and guidelines. With Tellus support, public servers designed a proposal that could gradually renew the motherhood educational groups and other discussion spaces, by adding new practices to the local health units routine. The best ideas were then prototyped and iterated (prototyping phase), and developed into the solutions that would compose the Mothers School main services (implementation phase).

This is the beginning of Mothers School - a cross-sectional program managed by Santos Health Department that accompanies users inside distinct levels of health complexity providing information for mothers and their families.

The project is based in three concepts:

Co-responsible women - empowering women as they exercise their rights while having their needs met and their potential recognized.

Beyond pregnancy - recognizing that pregnancy transforms women and her environment.

Trusted Network - creating an integrated supportive network, prepared and motivated for caring practices as a key to strengthen their environment.

The Mother's School has it's own space inside Instituto da Mulher e da Gestante (Women and Pregnancy Institute), but it also happens "on delivery", at local health units as a support agent to educational groups already in course. The activities may be with homogeneous groups (like only pregnant women) or heterogeneous one, with other relatives. Matter of fact, it is important for the School success that users feel free to ask questions and to interact spontaneously. Therefore, it is primarily the existence of an open space for dialogue and hearing.

Mother's School tackles 5 main subjects:

Reproductive Health - sexuality and its biological, psychological and social elements. Gender discussions. Reproductive planning, including contraception and fertilization methods .

Pregnancy - from accepting pregnancy to emotional and body changes, including nutrition and political rights related to that period.

Birth - kinds of birth and delivery, procedures, birth-time signs, professionals involved.

After Birth / Postpartum - includes not only women care, but child care as well - it is puerperal time.

Beyond Pregnancy - other issues related to pregnancy time such as work and pregnancy, rights and duties, gender violence and much more.

The "classes" happen with a facilitator trained by the Mothers School group manager and takes 30 minutes - even if there is only one person present. Every user, at her/his first class, receives a kit containing a plastic folder, a binder, a pen and cards that detail the contents explored each class.

At every new class the user receives a new card to fill his binder, containing details of the topics discussed and giving tips and hints on what to do in every possible situation concerning pregnancy and early parenthood. This way, if the user was present in every group, she will have her binder full with the cards she received in the meetings. Everything, from classes to materials, is free of charge.

The Mother's School also has an app to help women access information about topics discussed on the groups. They can schedule appointments, access articles and videos, input their pregnant time so they receive tips according to the moment they are experiencing, and also find emergency numbers.

The User Journey

Once participating in the Mãe Santista program, the pregnant woman becomes part of Public Health Support system. When visiting the Local Health Unit in her medical district (or another public health service where she does her pre-birth monitoring) she is informed about the Mothers School. If she wants to participate, she may:

register at the local health unit in her medical district

download the Mothers Schools app and register

On her first class, she receives a binder, which will be filled with cards along the course timeline. Each class she joins, she receives a new card containing the subject discussed.

On backstage, the "teachers" - who are, in fact, facilitators - are trained to know how to deal with and support mothers during pregnancy, enabling them to answer any doubts that might occur. They are experts in public health who are trained to be part of the Mother's School. Due to the practical nature of motherhood, the classes focus on routine situations, such as the first bath at home, breastfeeding, how to make nanny bottles, and related questions.

The Mothers School also features a website where one can search for information, classes agenda and other units where the program is offered. At the end of the course, the mother will have her binder full of the information cards and, if she has had at least 5 appointments with the doctors during prenatal monitoring, she will also receive a layette for her and for her newborn. The layette features a necessaire with products for the mother's personal hygiene, a hair brush, slippers for her comfort while in the hospital and male and female condoms. For the baby, the layette features newborn-size clothes and coat, a blanket and crib sheets, towels, diapers and other helpful items the family may need.

Today, the project continues to grow, and has already shown expressive engagement numbers. In addition to that, the experience has been replicated to another town, Pelotas, through the services blueprint first delivered to Santos. There, all the materials were adapted to the new environment by the public servers themselves.