Jane DeBaecker Clinical Midwife Consultant, CHC Maternity Unit
Sally McRae Antenatal Educator and Midwife, CHC Maternity Unit
The Calvary Health Care (CHC) Public Hospital in Canberra in the Australian Capital Territory has approximately 2,000 deliveries a year. Most mothers are aged between 26 and 35, and for the majority it’s their first baby. Content from the Bringing Baby Home (BBH) program has been incorporated into antenatal education since 2006, and the BBH workshop has been offered almost every month since 2008.
At their booking-in visit, women are told about all Parent Information sessions and written information is provided that describes Bringing Baby Home (BBH) as an evidence-based program to assist couples navigate the transition to parenthood. Although it’s made clear there’s a relationship focus in BBH, often couples enrol not having really read or digested the information. Particularly for the quarter of our women for whom English is not their first language, the title Bringing Baby Home makes them think that they’ve come to learn to change nappies, wrap their baby, and settling techniques. Thus it is our job as facilitators to ‘sell’ the program,tm to them in the first 15 minutes, otherwise at the tea break they will leave! Few first-time antenatal couples believe that their relationship needs focusing on. There has been a government-funded awareness campaign about post-natal depression, and promoting the benefits of BBH in relation to this gets some interest, but what really resonates with women and their partners is information about the long-term benefits to their infant of attuned and harmonious parenting.
Mothers and fathers-to-be want to understand the benefits of harmonious couple
relationships in terms of their baby’s well-being.
Although parents might initially have signed up by mistake, our experience is that once they start the program, they stay. Even when we began in 2006 by just adding some of the BBH information on the value of fathering, emotional flooding, and tips to maintain communication to our usual antenatal classes, there was an obvious difference. The couples were more engaged - the foot shufflers who excused themselves half-way through to catch the bus home were now asking if anyone could possibly give them a lift so they could stay. The men were much more enthusiastic. Rather than sitting back with their arms folded, they started to offer comments and ask questions.
The added benefit with the BBH workshops is the space they allow partners to play with ideas and practise skills as a couple, building their strengths as a team. Nearly every section in the BBH course is accompanied by an activity that the couple do together. An early segment focuses on communication, keeping their friendship strong and knowing what’s going on in each other’s lives despite the changes and fatigue of parenthood. A matching activity uses a deck of question-cards to explore what they know about each other now, ranging from the low-stakes safe, ‘What’s your partner’s favourite colour?’ to more personal topics, ‘If you had to move, where would your partner most like to live?’ One partner reads the question and predicts their partner’s response; the other confirms the answer - or provides gentle correction. The card-deck allows couples to self-regulate – potentially sensitive topics can be skipped over, perhaps to be explored later. Even if couples do not take on board everything we offer in the BBH program, they almost universally find spending two whole days really connecting with each other in the lead up to parenthood is a wonderful thing.
There is a lot of material in a BBH workshop, and it can be challenging to present it in a way that a fatigued, heavily pregnant woman can absorb, not to mention the partners who have sometimes been ‘dragged along’ because they have been told they must attend! Supplementing the program with local visual media or statistics that complement and reinforce the BBH material has been helpful, as has including some real-life scenarios to which small groups can apply their knowledge. Working in small groups allows couples to socialise, and normalise fears and concerns with other expectant parents. As facilitators, coming to appreciate that learning is often more effective from activities than it is from words on slides has sorted out some of the initial problems.
The BBH program builds the
couple’s strengths as a team.
The BBH program is father-inclusive, and BBH content is also informing the culture and practice on our postnatal ward. Midwives are helpful people, and concerned for the infant. If, upon handing a parent their new infant, the parent looks a bit anxious and fumbly, it’s quicker, easier and can feel safer for midwives to take the infant back and put the nappy on themselves, but they are less likely to take over with a new mother than a new father. However, the research is clear that involvement of the father with the infant is the biggest predictor of parental relationship satisfaction post birth. The positive consequences of harmonious parent relationships, with involved fathers, are visible 40 years later, and this has to start somewhere. An awareness of cultural norms means they can be changed. On our post-natal ward, when the child’s father is present, he is encouraged and supported to become competent in baby-care and the first bath waits till he’s available to do it.
Involvement of the father with the infant is the best predictor
of couple satisfaction following the birth.
In times of limited resources and ever-increasing demand, antenatal education is often not the highest priority, and the institutional barriers to change include lack of financial resources and staff busy-ness. We have been fortunate with the support from our executive, initially to allow us to try out BBH and then with funding for the workshops. While providing the whole workshop required additional resource, we’ve demonstrated that some content can be presented within an existing antenatal program without compromise, and our follow-ups have shown benefit from this.
Our observation is that investing the resources in the antenatal period also saves us effort in the peri-partum period. At Calvary, the midwives on labour ward know who the BBH couples are, not because they’ve got a list, but because the men are engaged, responsive to their partners’ requests and effectively support them. The couple is synchronous, and if they have a birth plan, it’s arranged around values and goals, not rigidly anchored in particular interventions.
On the post-natal ward, the midwives notice that couples have strategized about sleep deprivation and management of the milk coming in on day two. There is a thoughtfulness in the way they communicate with each other and their infant. The fathers are very involved and hands-on with their babies, confident they too have parenting capacity and a right to be there. The parents understand the normality of babies wanting to be held and soothed a lot of the time, and know that the early days can be tough going, but are developing ways to manage it.
Trained by and working in hospitals which maintain close connections with systems of institutionalized medical care, it is sometimes easy for us to overlook health, and to forget that health is not purely, or perhaps even primarily, about the physical. One of us began our involvement in antenatal education as a pupil midwife over 30 years ago, and delivered classes in the mid-‘70s. Returning to antenatal education in the ‘90s, little seemed to have changed. While believing that the essence of post-partum care is to enable new parents to fall in love with their baby, the reality was that we were failing to prepare them for the risk that they would fall out of love with each other. The Bringing Baby Home program has largely addressed this gap in our practice.
One of BBH’s initial attractions was its grounding in evidence. While our feeling was that the program was effective, our commitment to evidence-based practice has included follow-up studies to ensure that this north-American program is relevant and effective in our culturally diverse population. This has also given our clients a voice. Four weeks after the birth of her baby, a new mother said,
There have been a lot of ups and downs, but because I did the BBH workshop, I was prepared for that.
At 12 months, answering the question, ‘Was the workshop helpful for you?’ one first-time parent replied,
Absolutely. It showed me how to be a father.
We have moved from two people who love each other to parents who love each other and their child.