Duncan Fisher

Antenatal education is in trouble.  The latest review of the evidence by the Department of Health is discouraging – put simply, there is little evidence that antenatal education works very well.  This may be because it has always been given a low priority by the NHS – half-hearted evaluations of half-hearted attempts are not going to result in anything inspiring.

We also know that many parents find what is on offer from antenatal education in the NHS to be wide off the mark.  Some maternity services, particularly where midwives are involved high up in the management, have pioneered better antenatal education, but they battle against a system that prioritises only management of medical risk.  That some mothers and fathers find antenatal education valuable is clear from the success of NCT in selling a service to a proportion of parents.  But the interest of parents in things like money and relationships are not going to feature high on the list of medical risks.  Furthermore, the feminisation of the transition to parenthood that comes about from marking birth as a medical event for a “woman” (the NHS never uses the word “mother” or “mother-to-be”), rather than the extension of a family, also means that the perspective of fathers in the transition to parenthood is typically very poorly represented.

I think it is time to start thinking from scratch.  Here is a small contribution.

Health issues

Health is the legitimate concern and responsibility of the NHS.  We must move beyond trying to transact all health business in antenatal appointments for mothers-to-be (sorry, “women”).  Unlike antenatal education, the evidence base for well constructed health interventions that target the family is very strong – spectacular improvements can be easily achieved in over-early hospital admissions during labour, smoking cessation, breastfeeding and so on.  Preparing mothers and fathers for the birth falls in this territory.  We need to expand group work, community drop-ins and workplace supports, all routinely targeting both parents-to-be.  We need to reconfigure health visiting to be a family support that recognises that health is a family issue, not an individual one.  These are big changes - it shakes the very fundamentals of the NHS system, in particular the designation of only one parent as the ‘patient’.

All the other issues: a social enterprise approach?

But let’s not pretend that the NHS can deliver reliably on anything beyond health.  It never could and now we are in the middle of a massive financial squeeze.

Parents know what they need and want.  Those that cannot articulate it could with a little help.  Let them decide what they want and take into their own hands the task of getting it.  Rather like some parents make a choice to use NCT support.

Who can facilitate this?  It has to be someone with an interest.

The good news is that expectant and new mothers and fathers are indeed very interesting.  They are people at a transition point, with a new interest in employment, in the state of their community, in the future of the world.  For individuals in some disadvantaged groups – teenage parents, for example - motherhood or fatherhood can bring about a transformation in the way they relate to work and engagement in their communities.  This is a tremendous resource for every community.  Communities should organize to capture it.

So I propose, instead of antenatal education, regular local “New Family Markets” for expectant and new parents where they can purchase locally available supports and training, using vouchers given to each mother and to each father.  The market would need to be organized by a social entrepreneur embedded within their community.

Here is a random collection of stuff that could be for sale in a New Family Market:

• NVQ in child development (the ultimate way to understand your child as s/he grows up)
• Baby training sessions for all the family - reading babies’ cues, toy workshops, first aid (really they are parenting training sessions, but saying so is not a good marketing ploy!)
• Fitness sessions
• Sports coaching with children (be a professional by the time your child is ready for football, tennis, netball…..)
• Photography (ensure you get a superb record of your child’s growing up and end up with a qualification)
• Cooking for kids
• Careers advice for new mums and new dads and management of caring/earning balance
• DIY
• Specialist services for young mothers and fathers, parents who live apart, etc.
• An introduction to the local support services of Relate
• English as a Second Language
• Financial check-up
• Home insulation help

Prices for these things would vary, of course, because some will already be funded also from other sources; some services could even be free.  It matters not – what matters is that mothers and fathers are deciding for themselves what they want.  And having made their choices, they find themselves rubbing shoulders with other fathers and mothers with similar interests – and the mutual parent support networks come as a free bonus, even networks inclusive of fathers.

As these parents pursue their chosen paths, the social enterprise model will ensure they are continually supported to move to the next rung of the ladder, improving their parenting skills, their local support networks and their readiness for better employment, all in one process.

So instead of a penniless maternity service struggling with antenatal classes, the NHS service focuses on innovations in health promotion, and you mobilize the whole panoply of local labour and training networks around the transition to parenthood.

Parenting together, Social Entrepreneurship birth, family, maternity, work