Messages to health and allied health professionals

Parents provided a range of suggestions to various health and allied health practitioners regarding their experiences with these practitioners during pregnancy, IVF or surrogacy; labour and birth; and early parenthood, including in relation to antenatal and/or postnatal depression. They outlined both positive and more challenging experiences, and suggested a range of ways health and allied health support services could be tailored to meet the varied needs of expecting and new parents during pregnancy and in early parenthood.

Care during pregnancy, IVF and surrogacy

Many mothers highlighted the importance of continuity of care (see page 9) from GPs, midwives or obstetricians during pregnancy. Joanne appreciated seeing the same GP throughout her pregnancy under a shared care arrangement, while Maree found seeing different obstetricians and midwives during her pregnancy ‘a bit impersonal’.

Beth described her efforts to have ‘continuity of care’ during both her pregnancies.

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A number of mothers appreciated receiving ‘supportive’ or ‘nurturing’ care during pregnancy, but felt that many health professionals were focused on the physical dimensions of pregnancy rather than on providing ’emotional care’.

Because of the ‘distance’ in the relationship with her obstetrician Josie was unable to discuss her ‘mental wellbeing’ and only ever talked to him about physical matters.

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A desire for more emotional support was also mentioned by women who experienced complications during pregnancy, including threatened early labour or pre-term labour and birth.

While in hospital for threatened early labour, Sarah M found being visited by a church volunteer ‘unhelpful’ and would have preferred a non-religious counsellor.

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Miscarriage was another area several mothers felt was not always handled as sensitively as they would have liked. Louise, who experienced multiple miscarriages, felt that the ‘medical way of dealing with miscarriage’ was ‘detached’ and did not allow women to have ‘an emotional experience’ of miscarriage. When greater sensitivity was shown, mothers were very grateful.

After giving birth to her daughter who had died at 17 weeks’ gestation, Sian was grateful for the understanding from doctors and nursing staff of her need to hold, spend time with, and be given ‘mementos’ of her baby.

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Many women and men who experienced IVF were satisfied with the care they received, despite finding the process of IVF itself ‘inhuman’ or ‘clinical’. Several spoke highly of their IVF counsellors and were grateful for their assistance with decision-making.

Having children via overseas surrogacy was complicated and required a significant investment of time and money. Looking back, Daniel said he and his partner would have appreciated ‘more objective information upfront about the risks’ and ‘more support for when things go wrong’. Matthew appreciated being able to communicate with agency staff and the surrogate mother herself during her pregnancy, rather than ‘busy’ doctors.

Quite a few mothers suggested that antenatal classes could be improved by providing more ‘realistic’ information about the diversity of labour and birth experiences and breastfeeding, and a greater focus on caring for a newborn. Erin said she had been unprepared for labour: ‘…even though I’d done the antenatal classes and everything, no one had told you how awful it is. It was such a shock. I didn’t expect to feel such – such pain’. Michelle felt unprepared for caring for a baby: ‘I don’t think [antenatal classes] prepared us for what was to come… I just naively expected that it was all going to fall into place’.

Care during labour, birth and the early postnatal period

Many women were ‘traumatised’ or emotionally distressed by their labour and birth experiences. This was often ‘made worse’ by the lack of opportunity to ‘debrief’ with midwives or obstetricians afterwards.

Cecilia felt ‘violated and invaded’ as a result of interventions that took place during the birth of her baby, and suggested that attending medical staff need to debrief with women after labour and birth.

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In contrast, a few mothers had very positive experiences of their attending health professionals during labour and birth. Jodie described feeling ‘pampered’ by her midwives, while Rumer said of her doula: ‘she [had] a really collaborative way with the staff… she managed to get them to lower the curtains and things and communicated all of my preferences to them and was just very gentle about it’.

Lara described feeling ‘supported’ by her midwives in her preference to not have any intervention in her labour and birth.

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Care during early parenthood

As with pregnancy, parents felt that more emotional support from health professionals such as maternal child health nurses, GPs or lactation consultants would have been helpful during early parenthood. As Sarah M said about lactation consultants: ‘Their job is to focus on getting a mum into the prime condition of breast feeding, doing perfect breast feeding. And the focus is not on the mum’s emotional needs at all’.

Several women commented on their experiences of being screened for postnatal depression. Some had positive experiences, while others were more critical.

Louise felt that in screening for postnatal depression, it would be useful for maternal child nurses to have a ‘conversation’ with mothers, rather than just ‘handing over’ a screen.

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A number of parents suggested that health professionals could provide more ‘open’ environments to talk about emotional issues during early parenthood. A few women said ‘appropriate’ questions about their feelings in a caring environment might have made them more willing to disclose emotional distress to a health professional.

Elly described making appointments with her GP to talk about how she was feeling, yet when she arrived was too nervous to bring it up. She also avoided answering truthfully on the Edinburgh Postnatal Depression Scale (EPDS).

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Support for breastfeeding from health professionals was very important for many mothers. Some appreciated receiving assistance from breastfeeding clinics or lactation consultants, while others said they would have liked more support. (See also Caring for a baby – feeding and settling.)

Many mothers felt that maternal child health nurses supported and assisted them with their baby in early parenthood. Alice said: ‘my maternal and child health nurse was wonderful. She was always happy and cheery and never told me that I was doing a wrong thing, just suggested other ways of doing things’. Others, such as Joanne, felt maternal child health nurses could provide a more ‘caring’ environment, or suggested that they could give more time to emotional needs of the mother, rather than maintain their ‘exclusive’ focus on the baby.

Care for parents experiencing antenatal and/or postnatal depression

An important message to the wide range of ‘frontline’ health professionals (particularly midwives, maternal child health nurses and GPs) that parents came into contact with during pregnancy and early parenthood was the need to build ‘rapport’ and ‘trust’, to encourage parents to disclose if they were struggling emotionally. Josie said: ‘Maternal health nurses are another point of contact but when they give you a brochure that explains something about postnatal depression, I’m not sure how much connection or friendship you can draw there’.

Georgia explained how she didn’t reveal that she wasn’t coping with parenthood to the first maternal child health nurse she saw, but was open with her second nurse as they had a better ‘rapport’.

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Parents (mostly mothers) who experienced perinatal depression were generally positive about the support provided by mental health professionals (psychologists, counsellors or psychiatrists). Several said it was ‘helpful’ to be able to ‘talk things through’ or develop ‘strategies’ to respond to problems they were facing. The few mothers who used mother and baby units had positive experiences with the support they were offered there.

Accessibility was an important consideration for parents in contact with mental health professionals, including cost. Mental health plans or employer-subsidised counselling services were appreciated for these reasons.

Maree described how the availability of counselling through a mental health care plan helped her recover from antenatal depression.

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See also:

* Experiences of health services during pregnancy, IVF and surrogacy
* Experiences of health and allied health professionals during labour and birth
* Staying in hospital or a birthing centre after having a baby
* Caring for a baby – feeding and settling
* Experiences of health professionals in early parenthood
* Experiences of health professionals for antenatal and postnatal depression
* Experiences of hospitalisation for postnatal depression