The American novelist Don Williams Junior once wrote: ‘The road of life twists and turns and no two journeys are ever the same. Yet our lessons come from the journey, not the destination.’ I’m sure we’ve all heard variations on this well-worn adage, but after reading the Department of Health’s recent report about ‘Parents’ views on the maternity journey and early parenthood,’ the quote struck me as being particularly relevant to the experience of expectant mothers. While the medical profession currently tends to define a ‘good birth’ according to a narrow focus on satisfying clinical outcomes (in the UK, after all, there is no safer time to have a baby), the report emphasizes that birth must be understood as being inextricably related to all stages of the pregnancy journey, from the early days when mothers first find out about their pregnancy right through to the first few years of motherhood.
The report draws on three pieces of qualitative research which explore parents’ interactions with maternity and early years services through the lens of their pregnancy and parenthood journeys. Through a range of research methods that included ‘customer journey mapping’ (where mothers recorded the emotional highs and lows of their pregnancy), face-to-face interviews and group discussions, the research aimed to gain a richer and more nuanced insight into the experiences, expectations and needs of expectant and new mothers and their partners, and the extent to which current healthcare services meet those needs.
The research comes at a time when there is widespread concern amongst healthcare professionals about the rising demand for caesarean sections and other medical interventions such as epidurals. Over the past two decades, the number of women having caesareans has doubled – a trend which an article in The Guardian last year (‘Too Scared to Push’, November 2010) attributed to increasing numbers of women being fearful of normal birth due to a traumatic personal experience during their first labour. The article reports that these bad experiences can often, according to one midwife consultant, be ‘traced back to a lack of information or explanation about what was happening’, highlighting the need for an improvement in support services for mothers and their partners for the duration of the pregnancy.
What, then, can professionals do to improve antenatal services, thereby increasing the chances of a ‘good birth experience’? Here are some top tips from the Department of Health’s report:
Provide continuity of support and advice
Pregnancy is an emotional rollercoaster, but the highs and lows that women experience can be as much to do with how supported they feel as with the physical changes that their bodies are undergoing. Research showed that women generally feel best when around the times that they have appointments and scans, while they experience more anxiety and uncertainty in the periods between. Getting a midwife or nurse to call or text message women during these times when they may feel more ‘alone’ might be an effective way to provide more continuity of support and advice.
Keep it personal
Strong, communicative relationships with healthcare professionals are key to ensuring that expectant parents feel satisfied, well informed and supported in making decisions. Giving parents a list of the names, pictures, job descriptions and contact details of the team of health professionals that will be working with them can help to make parents feel reassured.
Think carefully about use of language
Many of the terms relevant to pregnant women use technical language (e.g. mastitis, folic acid, episiotomy) that must be clearly explained, especially for women that don’t speak English as a first language. But the need to think carefully about language goes beyond a simple translation of medical terms: healthcare professionals should also think carefully about when to use words such as ‘choice’ and ‘planning/ deciding’. For instance, expectant parents need to understand that a ‘birth plan’ is a wish list rather than a blueprint, and sometimes unwanted medical procedures need to go ahead to ensure the safety of the mother and baby. Healthcare professionals must find ways to communicate this with pregnant mothers in order to avoid disappointment.
Provide different forms of information
Since people differ in how they want or need to receive information, it’s important to give expectant parents opportunities to learn in different ways that suit them, including reading, listening/ watching, sharing stories, face-to-face meetings, antenatal classes and hospital tours. Interestingly, the research found that men tend to prefer online sources of information, while women are more comfortable with printed material. Professionals should bear this in mind when signposting and designing information sources; in particular, the NHS Choices Pregnancy Care Planner proved popular amongst parents, but men suggested that they would appreciate a section that’s specifically for them.
Connect women up with available services
It might come as a surprise to some people to hear that it is often affluent women who feel most isolated and lacking in support during their pregnancy. This may be because they have, in the past, had less need to rely on informal support networks, and are unaware of appropriate and effective ways to access public services. Healthcare professionals should ensure that they provide women with adequate guidance on and connections to the full range of services that are available to them, such as Sure Start centres.
In short, the Department of Health’s report underlines the need for those who work in maternity and early years services to view ‘birth’ as part of a holistic process, the outcome of which is inseparable from the rest of the ‘journey’. The extent to which women feel prepared, relaxed and in control during labour – thereby impacting upon the degree of medical intervention needed - will in large part be determined by the quality of advice, care and information that they receive at earlier stages of their pregnancy, through both human and technological interfaces. These lessons will heavily inform the Innovation Unit’s work as we continue – through our Community of Practice – find, share and develop innovative approaches and effective tools and protocols designed to optimise opportunities for normal birth. It is also highly relevant to our M(ums)-Power project, in which – in collaboration with partners such as UCL and Mumsnet, amongst others - we are working with mothers and professionals to transform the dynamic between women who use maternity services and those who provide them.
To read ‘Parents’ views on the maternity and early parenthood’ journey in full, please click here. If you are a parent or professional with thoughts of your own about how to improve the pregnancy and early parenthood journey or optimise opportunities for normal birth, please get in touch – we would love to hear from you.