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Posts Tagged ‘birth’

The Albany Mums protest - with their families

March 8th, 2010

snapshot-2010-03-07-21-27-272At the weekend I went to the demonstration in London against the destruction by King’s College Hospital of the Albany Midwives, a beacon of family and community based midwifery. I even spoke at the demo from the top of a double decker bus in front of the Department of Health - the listeners were certainly a lot more responsive than at any of the many meetings I have been to inside the Department!

The demo showed once again that maternity is a family issue. I took my camera and had some fun.

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Parenting together , , , ,

Community based “New Family Markets” instead of NHS antenatal education?

December 16th, 2009

shepherds_bushAntenatal 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 , , ,

Should men be at the birth of babies? What I said in the debate with Michel Odent.

November 27th, 2009

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I’m back - book written!

Yesterday, at the invitation of the Royal College of Midwives, I debated with the famous French obstetrician, Michel Odent, “should men be at the birth of babies?”  The debate was discussed in the national papers, on the BBC TV news (twice), on radio stations (four times on Radio 5 Live), in the Australian media and yesterday in Time magazine in USA.  Two men debating childbirth in front of 400 midwives.  One man long enough in his profession to have delivered the other!

Here is my speech - you won’t find anything about what I actually said in the media (a point for later discussion!)

I said:

The best thing ever written on fathers at the birth was written in 1959 in a book Childbirth without Fear by Grantly Dick-Read, one of the most influential thinkers in this field last century.  This debate today in 2009 represents our failure to get this issue right for 50 years.

In the 1950s, birth had only recently been taken out of the home.  For the previous 200,000 years of human history, mothers were surrounded by loved-ones during childbirth; knowledge about childbirth was embedded within extended families.

Now, suddenly, birth was taken out of the home.  Yes, the maternal mortality rate dropped 60 times, but at a price.

Maternity units in those days were pretty gruesome.  One of the earliest campaigners for better maternity services was Dr Norman Morris, a Professor of Obstetrics in London.  In 1960 in The Lancet he described antenatal clinics as “drab and colourless…with an atmosphere of coldness, unfriendliness and severity more in keeping with the spirit of an income-tax office”.

He describes how women in labour were undressed, shaved, given an enema - and in some places castor-oil - then left alone on a large ward with other abandoned women in different stages of labour, without kindness or sympathy.

He quotes a young mother: “My mental condition was indescribable!  I thought all this might injure my baby and they could not be bothered to offer one word of comfort or explanation.  From 7am till noon, I did not see a soul.  I could not bear my husband near me for a long time after the baby’s birth.”

Most mothers lived then, as they live now, in small family units, with only their partners immediately at hand.

Following the instinct to have someone who loves them at the birth, it was absolutely inevitable that many mothers would want to take the fathers with them.

And still to this day, fathers are there by invitation, as is any other birth partner.  It is the mother’s right to choose.  And it is our duty to trust the mother’s instinct.

Michel Odent says that mothers are acting according to dogma: the choice to have fathers at the birth is not real, because women do not know what the full consequences of each choice are.  He is certainly right about the lack of information, but my proposition is that mothers are acting according to instinct in what is, in human historical terms, a highly unusual situation - the coincidence of institutionalised birth and the division of families into small units.

So what does Grantly Dick-Read say?

First, he saw that what fathers think and do matters.  He writes (and remember, he is writing in the 1950s when everyone having a baby was married - supposedly!):

“The importance of the husband’s attitude towards, and understanding of childbirth, cannot be exaggerated.  His words and actions, and even the atmosphere in the house that he may create in silence, have a profound effect upon his wife. Her health and happiness during pregnancy, and certainly her approach to labour, will be influenced for better or for worse by harmony or discord that she feels in her husband’s mind.”

I have spent the last 10 years looking at the influence of fathers on maternal and baby health.  I organised a major review of evidence when I was at the Fatherhood Institute; and Chester University is about to publish another.  And, all the evidence shows that the relationship between the mother and father, and the father’s beliefs and actions and the mother’s perceptions of the fathers’ beliefs all have a profound impact on every aspect of the health of the mother and baby:
* on breastfeeding
* on smoking
* on mental health
* on the mother’s bonding with her baby
* on the mother’s birth experience

So, what about fathers at the birth?  Grantly Dick-Read answered the question 50 years ago better than ever I could.  He wrote:

“The question that has now occupied so much attention in so many hospital and maternity organisations - ’should the husband be present?’ - depends entirely upon the husband.”

The top priority, says Dick-Read, is for the father not to be ignorant.  He writes: “The totally unprepared man has no place at the birth of his child…. If he has not occupied himself to be interested and to have an understanding of childbirth at least equivalent to his wife, he should remain absent until such time as the obstetrician requests him to greet his wife and their newborn child.”  These were the days when the obstetrician was definitely in charge!

A father who is knowledgeable, who offers practical help with, for example, breathing and massaging - of these, Dick-Read says: “These men cannot be superseded in the value of their service by the most patient nurse or obstetrician.”

Dick-Read says the surest way to bring peace and confidence is information.  The role of the health professional is, “with kindly-stern authority, to urge that the husband learns with his wife, the phenomena and common sense of this natural human function.”

Dick-Read points out that it is not just the ignorance of fathers that can be a problem.  He writes: “Mothers, husbands and friends must be recognised as agencies for the production of fear in the minds of the vast majority of young married women…. We recognise that very few daughters learn much that is likely to be helpful from their mothers.  The days of large families have passed.”

When it comes to the culture of fear around birth, we are all in this together and we can only get out of it together.

Since 1959, researchers have confirmed everything that Dick-Read has said:
* Women who have a close support person tend to have a more positive birth experience, and that is often the father
* When birth partners, including fathers, know a lot about pain control, women have shorter labours and are less likely to have epidurals
* Practical support is more effective than purely emotional support
* A partner’s fear at the birth increases post-operative pain

So Dick-Read divides men into three categories:
* Men who have learned about the birth and can be helpful and confident.  These men should attend the birth.
* But some men try to learn and just cannot overcome their fears.  They should not be present:  “We sympathise with them” says Dick-Read, “but for their wives’ sake, we keep them downstairs.”
* Men who have not shown interest and are not prepared.  They should not be allowed in.

The days when we had the authority to direct parents so definitively have long gone!  Obstetricians no longer rule the roost like they did.  So the onus is even more on engaging with both the parents and helping them come to the right decision for them, so that labour is shortened and made more positive by the father’s positive contribution - or by his absence.

Michel has also claimed that attending the birth is a major cause of depression in fathers post-natally; and that the impact on the couple’s sex life is commonly negative.  No evidence has been found for a correlation between a ruined sex life and fathers’ presence at the birth; and a study in 2000 by Greenhalgh and others found that any correlation between negative birth experience and fathers’ depression in the postnatal period disappeared once pre-existing depressive symptoms were controlled for.

As I am sure you are told repeatedly in your training: “correlation does not imply causation!”  Men are present at the birth - yes.  Postnatal depression in new fathers is a real problem - yes.  But the evidence does not demonstrate that one causes the other.

So why are we still stuck 50 years later discussing this issue?  For something to be stuck that long means there is an underlying problem that we have not perceived or addressed.

At the heart of the problem is that the NHS is structured to deal only with “patients” and “visitors”, not with a natural family event such as a birth.   Only mothers are registered with the health service.  The NHS only has a formal relationship with the mother.  The NHS will only talk to mothers - like the recently republished NHS Pregnancy Guide, which comes across as horribly patronising to fathers.

This approach simply cannot work for midwives, because you are eyeball to eyeball with fathers every day, however much the system pretends they are not there at all. The Royal College of Midwives once issued a statement that comes from the midwife’s particular exposure to reality on a day-to-day basis: the birth of a baby is also the birth of a family.

In honour of the 50th birthday of the final edition of Grantly Dick-Read’s Childbirth without Fear, Family Info is today launching a new edition of the Dad card with revised advice for fathers attending the birth, based exactly on what Grantly Dick-Read said.  Fathers should make sure they know what their role is.  And they should consider not being at the birth if they really don’t think they can play this role.  They should ask the midwife for information and advice on this.  The card will be distributed by midwives to 600,000 families a year, following Cathy Warwick’s call to all maternity services to distribute it.  The Dad card backs the RCM’s Normal Birth Campaign - because without the support of fathers that campaign cannot succeed.

Today the Conservatives are announcing, at this conference, their new maternity policy.   It includes the proposal that the standard care pathway should include at least one antenatal appointment where the father is specifically invited to attend and where the issue of his influence is discussed with both mum and dad - his influence on breastfeeding, mental health, smoking - and above all, his role at the birth.

This would be the first ever formal engagement of maternity services with the family of the mother.  It would require defining procedures, measuring performance and ensuring the necessary skills.  All for the first time.

This is directly in line with the Nursing & Midwifery Code of Conduct for Midwives, which states that midwives, as health professionals, must “work with others to protect and promote the health and wellbeing of those in your care, their families and carers”.  The Code states also that midwives must deliver “care based on the best available evidence or best practice”.

I want to end with a story.

I took my young daughter rock-climbing recently.  Before she set off up the rock face with me hanging onto the end of the rope, I received 15 minutes of instruction - how to hold the rope, how not to get it trapped, how to provide the right kind of support to my daughter on her way up and on her way down.  There is no way I would have put myself in this position without knowing what I was meant to do and feeling confident that I could do it.  I could really hurt her through my ignorance.  Birth is just the same - I need some instruction and without it, I am at risk of causing pain and misery.

My knowledge of rock-climbing up to that weekend away was absolutely zero - I had hardly done it before and I did not come from a family with lots of rock climbers.  Dick-Read wrote in 1959: “the ignorance of the average man about childbirth is incredible”.  And it is still the case today; just as most people have no idea about rock climbing. So, we fathers need the basic training so we do the right thing.

Thank you for choosing to be midwives.  It is the most wonderful job.  Remember Grantly Dick-Read’s words:

“Your concern is not only to see the child into the world but also to enable these two people to be united in the most wonderful, awe-inspiring experience that can possibly fall to the lot of wedded human beings.”

You will see more fathers than any other health professional or social worker or teacher.  But the NHS has not given you the tools you need to do the job you have to do.  I hope that can change - and in less than 50 years more!

Parenting together , , ,

Interesting on-line conversation about parental separation and child poverty

July 20th, 2009

snapshot-2009-07-19-08-18-41My last blog is the first blog of mine that has stimulated discussion on-line, with particularly insightful comment by Karen Woodall who leads the Centre for Separated Families.  I am so excited about this that all I want to do in my blog this week is recommend that people read the comments on my last blog!  And do contribute!

Fatherhood , ,

The best on-line discussion on fatherhood I have seen - Daily Mail on-line

June 12th, 2009

71hxecl41The Daily Mail, along with various other national papers, reported last week on a new genre of confessional literature - by new fathers experiencing negative feelings after their baby was born: The fatherhood taboo.

One of the authors of the three books, is quoted as saying, “New mums are better at parenting than new dads, but there’s a reason why: they are programmed to mother.”

This resulted in an outpouring of comments in the following days, most characterised by generosity and common sense - 176 comments in total.  It is the best discussion on fatherhood on-line that I have ever seen.  Participation was 50/50 men and women.  About one quarter of respondents agreed with the statement and the rest disagreed - vehemently.

Read more…

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Why should overstretched maternity services extend to support fathers with depression?

May 17th, 2009
Tradition: the sacred mother-baby bond.  Joseph is there in the dark, top right if you look very carefully!

Tradition: the sacred mother-baby bond. Joseph is there in the dark, top right if you look very carefully!

Last week was Mind’s Mental Health Week and it focussed on men.  And this week I am speaking at the Primary Care 2009 conference on postnatal depression and fathers.  (I am told my audience will be about 1000 people!)  Here is my full presentation, which is summarised below (references at end of blog).

Eight studies on PND and fathers have been published since 2008 and in June the Daily Telegraph and the BBC highlighted the issue: Father’s baby blues blight children.

Read more…

Fatherhood , , ,

A new antenatal service for mothers and fathers - delivered by a mother and a father

May 4th, 2009

image630Just occasionally, something really new and significant emerges and I think the new website www.mumdad.info, is such a thing.  Harps and Randip Chhokar have set up a new antenatal class service that is specifically for both mothers and fathers, called MumDad Antenatal.  The classes are facilitated by both Harps and Randip, parents of Anand (2) and Amrit (1).

Randip writes: “When Harps came up with the idea of providing an antenatal course which specifically caters for Mums and Dads I was thrilled to be involved. We live in an era where both mothers and fathers take equal responsibility for family matters and practical postnatal assistance by dads is vital for a happy family life.  I help to prepare dads for some of the practical issues that they will face.”

This is the future of maternity care.

Fatherhood , ,

The Government’s breastfeeding strategy needs to engage with fathers to increase the lowest breastfeeding rates in Europe

April 21st, 2009
This is the only image of breastfeeding with a father present that I could find on Google.

This is the only image of breastfeeding with a father present that I could find on Google.

The evidence is strong: engaging with fathers in the promotion of breastfeeding increases breastfeeding rates significantly - and in some trials, spectacularly.  The UK won’t get off the bottom of the European league table of breastfeeding rates until we accept the enormous influence that fathers have over breastfeeding and the positive difference it makes when fathers are engaged by health professionals.

I write this blog inspired by two new articles on fathers and breastfeeding, published in the last few weeks.

The Academy of Breastfeeding Medicine, La Leche League International, the International Lactation Consultant Association and the World Alliance for Breastfeeding Action published a statement for the March meeting of the UN Commission on the Status of Women, called Breastfeeding and the equal sharing of responsibilities between women and men.  It maintains that “it makes good sense to share of the responsibility [with men] of assuring that women can succeed at breastfeeding.  It calls on “community leaders everywhere to promote an attitude of support for mothers and fathers in the crucial task of raising the next generation”.

Meanwhile an article, Fathers’ perspectives on breastfeeding: ideas for intervention by Nigel Sherriff, Valerie Hall and Martina Pickin (British Journal of Midwifery, 17.4, April 2009) looks at how fathers experience breastfeeding support in Brighton and concludes that a key requisite for the engagement of fathers is specific information and practical advice.

We have a problem in UK.  In 2005, 78% of mothers initiated breastfeeding and 50% were still breastfeeding at six weeks.  This is the worst rate in Europe.  In Norway the equivalent figures are 98% and 95%.

We know that fathers have enormous influence on a mother’s breastfeeding; what they think and do makes a big difference to what the mother does.  We know that the father’s support makes a particularly significant difference in low income families - where breastfeeding rates are lowest.  (See summary of Fatherhood Institute - The Costs and Benefits of Active Fatherhood, page 23.)

More particularly, controlled trials reviewed in Costs and Benefits have shown that engagement with fathers makes an astonishing difference to breastfeeding rates. Involving fathers in a single two-hour antenatal breastfeeding session increased the rate of initiation from 41% to 74% [1].  In another trial a 40-minute session for fathers about how to help manage common breastfeeding problems increased breastfeeding rates at six months from 15% to 25% [2].  A workplace programme in US - 45 minute group class, a book and handouts, a men-only antenatal session - increased breastfeeding rates at 6 months from 21% to 69% [3].

This evidence is corroborated by similar findings in smoking cessation, mental health promotion and birth preparation - all of which yield better results when fathers are engaged.  This evidence is also summarised in Costs and Benefits.

The Government’s Child Health Promotion Programme last year did call for routine engagement with fathers in breastfeeding (page 26), but this reference was dropped in this year’s Child Health Strategy, which states only that information about breastfeeding should be given to mothers (section 3.43) and makes no reference to fathers in relation to breastfeeding. The Child Health Strategy refers to UNICEF’s Baby Friendly Initiative, but this tool is also father-free, with no reference at all to fathers in all of the standards of good practice that it puts forward.  These approaches do not stack up against the evidence nor are they in line with the Government’s own policy of “mother focussed, family centre maternity care”..

The Brighton study by Sherriff et al. provides a useful insight about how local services fail to engage routinely with men.  Antenatal classes sometimes omit breastfeeding and sometimes organise sessions when fathers cannot make them.  Even if breastfeeding is covered, the influence of the father and the practical support he can provide are not addressed.  Health visitors’ concerns about the baby’s weight, combined with the lack of information, can push fathers towards bottle feeding as the only response the parents can think of.

Here are some suggestions for revising the breastfeeding strategy.

1. Engagement with fathers in breastfeeding promotion should be routine and the norm.  Mother-only support should be specialised provision for the minority of mothers whose partners are genuinely absent or are unsupportive even after effetive engagement approaches have been tried.  New family centred methods should be piloted, evaluated and promoted.  Good practice already exists locally and some NCT antenatal teachers have been engaging fully with fathers on breastfeeding for years.

2. The way in with the father is his profound instinct to protect and care for his baby.  The father needs to know how big an influence he is and how, by his practical actions, he can keep his baby healthy.  He needs to know what these practical actions are.

3. In all materials about breastfeeding, the active involvement of fathers in breastfeeding should be shown - discussing it with the mother, being actively present when breastfeeding is happening, being knowledgeable about how to overcome problems, discussing matters with the health visitor.  The father’s role is more than to do the washing up when the mother is breastfeeding.  This presentation of the father’s role is entirely different to how he is commonly presented in breastfeeding promotion.  In one key video now being promoted, an evidently very involved father disappears the moment the health visitor arrives and there is no interaction between her and the father for the duration of her visit.  There needs to be an audit of current materials.

4. When developing new materials, they need also to be tested on couples, not, as is currently the practice,  just on mothers.

5. Breastfeeding promotion needs to avoid suggesting that feeding is the only way to bond with a baby - this creates an incentive for fathers to start bottle feeding.  Breastfeeding should be shown in the context of other activities that a father can undertake to support his baby’s development and become important to their child - gaze, massage, etc.  There is a rich source of material in the modern study of adult-child bonding and attachment that busts the myth that babies can or should only bond with one adult.

Notes
1. Wolfberg, A.J., Michels, K.B., Shields, W., O’Campo, P., Bronner, Y., & Bienstock, J. (2004). Dads as breastfeeding advocates: results from a randomized controlled trial of an educational intervention. American Journal of Obstetrics and
Gynaecology, 191(3), 708-712.
2. Piscane, A., Continisio, G. I., Aldinucci, M., ‘Amora, S., & Continisio, P. (2005). A controlled trial of the father’s role in breastfeeding promotion. Pediatrics,
116(4), 494-498.
3. Cohen, R., Lange, L., & Slusser, W. (2002). A description of a male-focused breastfeeding promotion corporate lactation program. Journal of Human Lactation, 18(1), 61-65.

Fatherhood , ,

Monty Python’s version of medicalised birth

April 10th, 2009

Monty Python’s classic sketch on hospital birth - The Miracle of Birth.  A holiday treat for Easter.

How contemporary this parody remains.  It even shows how the medicalised approach chucks out the family - “you are not involved!”

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US fathers call for paternity leave campaign

April 4th, 2009

10 minutes before sitting down to write this week’s blog, Jeremy from the Fatherhood Institute sent me this link to the latest Dad Labs video on paternity leave.  I just have to pass it on!    I think Dad Labs is one of the best websites in the world on fatherhood - it is worth seeing all the videos they produce, no less than four a week.  (They are all streamed onto the home page of www.dad.info too.)  Enjoy it!

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