Leanne is a Health Visitor with over ten years of experience. We spoke about the reality of health visiting and the implications for maternal mental health.
What could we do to better prepare people for giving birth and adjusting to motherhood?
I think we should help expectant parents focus their energy on the things that they can most control.
A lot of parents get really hung up on their vision of the perfect birth, and how everything should go. It’s good to be informed and to understand your choices and preferences but what I always say to the mums I see pre-birth is that you can’t control how things will go when you get to the hospital. You can have an idea but you can’t fully control it. What you hopefully can control is the environment when you come back home. You can prepare the environment you want in the same way you’re encouraged to think about birthing- what music do you want? How do you want the lighting to be? Who do you want with you? Who do you not want to visit, at least at first? You can control all these things and you can make the people around you aware of what you want.
When you think about it, giving birth is a very small part of becoming a parent, isn't it?
It's a major part. It absolutely is. I'm not disregarding that at all, but it's what happens after that that is really life changing.
The reality of Health Visiting and how that affects families
The sad thing about all of this is that Health Visitors are actually commissioned to do these kinds of visits where we go and talk with pregnant mums about their expectations of becoming a parent. But unfortunately because of the way that the service is declining and the staffing and funding pressures we face we can't always offer those visits anymore.
I think if we could offer meaningful engagement early on, maternal mental health would be dramatically improved.
Instead of effective early intervention we’re having to wait for a family to not be OK before we can start working with them.
We know that early intervention would help reduce many of the problems new parents face but we just don’t have the capacity to do it. It’s not possible.
When I started health visiting in 2011 sometimes we would be fully staffed but it never lasted long enough for us to really do the job that was originally envisaged and that we were employed to do. It varies across the country and between the nations- in Scotland they aim to do seven routine visits whereas in England we aim for five but then we’re very lucky if we even manage to do that.
I can't say really we've ever delivered the service in a way that it is fully intended, not since I started in 2011.
The danger of short cuts
As midwives and health visitors are often under such time pressure rushing from family to family, and teams are so stretched inevitably people take short cuts. We give that quick advice but don’t unpack it and explore the nuance. So in depth discussions about the range of ways that people experience labour, the intensity, the highs and lows, and the coping strategies that some people find helpful can get reduced to ‘it’s not too bad!’ or ‘birth should be calm’. But the nuance is crucial.
Sometimes I think I would rather just not give the message at all than not be able to do it right.
The message that birth could be calm, or calmer than an expectant mum might fear, is a helpful message. The last thing that I want as an expectant whether it's for people to just be constantly telling me that giving birth is an awful experience and it's the worst pain that you're ever going to feel in your life. Equally you don't want to be told that it's going to be a lovely, calm experience when the fact of the matter is that giving birth very rarely like that. Getting the message right is so difficult within tight time constraints that health professionals are under and it does have a direct impact on mental health.
It’s the same with the strong encouragement for immediate skin-to-skin contact with a newborn and the emphasis on the importance and beauty of those moments. I’ve had parents who’ve found it really upsetting that they weren’t able to do that, and they were worried about the consequences for their baby. Here, again, how the message is relayed is so crucial. If we end up telling expectants mums ‘you should do skin to skin immediately’ then that is pressuring them to do something which might be beyond their control. But a more nuanced message that promotes skin-to-skin contact with a parent or loved one early on in a baby’s life removes the fear that ‘we’ve missed the moment’.
I’d love to see health professionals being in a position to support people through these nuanced, in depth conversations to help better prepare new parents for the full range of possible experiences that lie ahead.
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