Childcare professionals could be trained to provide the sympathetic support that new mothers need to give their children a secure start in life. Mary Evans reports
The new children's centres involving inter-disciplinary co-operation between early years teams and health professionals, such as health visitors, could be an effective way to develop vital support for new mothers.
Early years consultant Ann Langston points out that while many of the current childcare qualifications include modules on communication skills and building relationships with parents, the focus is mostly on the needs of the child. 'One of the things that struck me was that listening was something that used to occur as part of the support people had in the community,' she says. 'As children's centres become more integrated, childcare workers will have conduits to the right people. They will be building up relationships with parents and in turn know enough of the structure of the centre to know where there is support.'
A study published last month found that health visitors with extra training in listening skills can play a key role in addressing the relationship problems experienced by more than one in five new mothers. In a project led by John Simons of the London School of Hygiene and Tropical Medicine, 450 women were screened by 25 health visitors who had received special training in supporting new mothers who were having problems in their relationships.
Each health visitor had attended a four-day course run by One Plus One, a charity which researches the causes of relationship breakdown and supports professionals working with families. When the new mothers came for their six- to eight-week check-up after the birth, 22 per cent of them said that they were having relationship problems. At the 12-week check-up, a significant number of those who said they had discussed relationship problems with their health visitor reported that they were less depressed, anxious or worried as a result, and felt better for talking about their problems. The mothers said they had not sought specific relationship counselling, mostly because they thought their partners would not attend.
Registered childminders could play a similar role, says Judy Warner, Midlands regional manager of the National Childminding Association. 'The majority of childminders are mothers and that is perhaps one of the greatest benefits: even before they have any training, they can empathise with new mothers.'
She believes it is less daunting for mothers to talk with childminders about their personal relationships because they build a rapport quite quickly from meeting regularly in the informal surroundings of the childminder's home. Ms Warner cites the case of a young mother living in an isolated rural area in the Midlands. When she suffered severe postnatal depression, she was referred by social services to the local community childminding network. 'She has gained lots of confidence and has built up a strong, close bond with the childminder and has been inspired by her so that she too now wants to become a childminder.'
Every minute counts
Although 60 per cent of the health visitors who took part in the One Plus One study were concerned about the time required for screening, under the current staffing constraints, nearly all of them felt that the pro- cedure had been of great value in revealing problems.
The course they attended was designed to help practitioners learn to time-limit themselves, says Clare Negreira, who led the health visitors on the project and now works as training and resources co-ordinator for One Plus One. 'You feel you can say to someone, "I only have ten minutes now; I can come back another day." You think your clients are not going to accept that, but they do. Those five or ten minutes are very helpful because you have started the work and you have listened.'
Mrs Negreira says that the birth of a new baby is a time of great transition in couples' lives, when marital satisfaction drops dramatically. John Simons, who led the study, adds, 'The stress of looking after a new baby may cause or intensify tensions between parents that can affect both their own well-being and the welfare of the child.'
Ask the experts
One reason that more new mothers may be experiencing problems is our changing times, says Ashoob Cook, director of the London-based nursery chain Happy Child, who trained initially as a psychologist specialising in early years. She says, 'There is not so much family support as there used to be. New mothers are basing their knowledge on what they can print off the internet. They are not relying on their natural instincts, because everybody wants to have facts, figures and information from the experts. If new mothers only looked into themselves, they would find their natural instincts are there.'
Some professional women, she notes, do not seem prepared to adjust and adapt their lifestyles to accommodate a baby.
And the reality of a new baby can be very different from media images, adds Ann Langston. 'The reality is physically and emotionally demanding. Unless couples have had experience of young families, there is no preparation for things like lack of sleep and change of lifestyle.'
Postnatal depression is a common problem often associated with relationship difficulties among new mothers, according to the report of the health visitors study. Here is where the health visitors' intervention gives added value. 'If the contribution of primary care to the easing of relationship problems between parents can be enhanced, the result may have benefits beyond the postnatal period. It is known that these problems can have pervasive and enduring consequences for the physical and psychological well-being of the couple and their children.'
Problem ratings
The health visitors conducted a screening procedure with the mothers at the six- to-eight-week check-up using an eight-item scale for 'relationship dynamics'. Each of the eight items on the scale states a problem, for example, 'I feel lonely in this relationship', which, if it occurs frequently, would be regarded as evidence of a serious flaw in the relationship. The mothers were asked if this problem happened almost never, once in a while or frequently, with a respective score of one, two or three points. A score of 13 points or more triggered an offer to the mother to discuss her problems.
More than a quarter of the mothers said that they had frequently experienced at least one of the eight serious relationship flaws. The range of difficulties varied. One mother had no doubts about the strength of the relationship or about their joint concern for their two children, but she scored 16. This, the researchers concluded, appeared to reflect her resentment of the way her partner's work limited his involvement in family life.
Other mothers reported severe problems but described their relationships in terms that suggested they had found ways of enduring the difficulties. Typical of this category was a couple who had been married for several years and whose family included children from a previous marriage. Despite a history of family misfortunes, the husband's refusal to believe he was the father of the baby, and the mother's score of 18 on the scale, she was committed to the marriage and believed he was too.
Conflict resolution
Some of the more serious problems raised by the women included domestic violence and being abandoned by their partner. One woman, who scored 13, described how she had become pregnant after living with her partner . The stress of fatherhood had proved too much for him and he had moved out soon after the baby's birth. Bitter rows, which end in violence, obviously have a tremendous impact on children, but conflict in itself is a normal part of a relationship, says Mrs Negreira. 'What matters is how a couple deals with conflict. Research shows that if you have a conflict and resolve it in a way that is good, the impact on the children is good in later life. Teenagers who witness good resolution of conflict are very much better prepared for their own peer relationships.' In the long or short term, intervention helps. Ann Langston says, 'Anything which helps parents cope with the enormous privilege and immense responsibility of bringing up a child has to be valuable.'
