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Perinatal care: reflections on dads' engagement.

Last year my professional and personal lives collided: I was leading NSPCC's work on pregnancy and babies when I became pregnant. This collision has been an interesting and challenging experience--one which many readers of this journal will have encountered.

In some ways my work was helpful: I knew why different professionals were there, why they asked the questions they did, and how they might help me. But there was definitely more pressure. Every parent frets about whether they are doing a good job, it is even worse when you understand just how much early parenting matters!

My role exposes me to the best and the worst of services. I've seen good practice, but I also know of problems and gaps in services from my research and campaigning. I was intrigued about what I would experience as a service user, and early on had to consciously try to engage with services as a 'normal' parent, and not some sort of mystery shopper!

When I became pregnant, I was half way through a big project about how to work with dads in pregnancy and infancy--so I was particularly interested in how services treated my husband.

We all know dads matter. It is so simple, but so easily forgotten. Dads matter in their own right. Whatever your gender, new parenthood is a time of emotional turbulence; stress, sleeplessness and enormous changes in your roles, relationships and responsibilities. Dads also matter because they make a huge contribution to babies' wellbeing. A wealth of research demonstrates that when fathers are sensitive, supportive and involved, it has a hugely positive impact on babies' life chances. And dads matter because they are usually mums' primary supporters. Dads influence the wellbeing of their partner and the likelihood that she will maintain healthy behaviours that benefit their baby. More detail on the research on the importance of dads can be found in our NSPCC 'Dad Project' report (look closely, you can also see a photo of my husband on the cover!).

Before I wrote this article, I talked to my husband (it would be wrong to write about how dads should be more directly involved without involving a dad!) I asked him how he felt he had been engaged by professionals since I became pregnant. His first response was: 'I haven't. He felt he had always been treated as an observer to my or my son's care. Some professionals were friendly and warm, some polite, and some completely ignored him. No one ever talked to him in his own right, as a parent with his own insights and perspectives on how things were going, his own questions and concerns, and his own, hugely important, contribution to our son's life.

My husband remembered warmly those professionals who had actively included him and given him a role--the midwives, for example, who encouraged him to dress our son after his birth and after his postnatal check. We both also remembered times where he was totally excluded by professionals. Two examples stood out:

The first was our 20 week scan: A chance for both of us to learn about how our baby was developing. The letter about the scan was addressed only to me. Its tone was official, and it contained the sentence "If you feel that you need a chaperone for this procedure you may bring someone with you or if you would like us to provide one please let us know ..." There was no mention of my husband being welcome or even encouraged to come along and this sentence almost suggested he was there only as my chaperone--a role which others could easily substitute. The welcome he got from the sonographer in person was no better: She never once addressed him directly.

The second example was the home visit after our son was born. When the midwife arrived, I was feeding him on the third floor of our home. As she walked into the bedroom she said: "Now, you are doing that wrong.', she grasped my baby and moved him across my chest. "He or she should be like this" There was so much wrong with this: The lack of greeting, the immediate criticism, the uninvited physical contact. But it also revealed something else: between meeting my husband at our front door and getting to my bedroom, the midwife had not asked him about our baby. If she had, she would have known his gender, at the very least, before she arrived at my bedside.

I know many people reading this will be angry because this is not reflective of their practice. There are professionals who are doing a fantastic job working with dads. But sadly I do not think our experience is unusual. It is 25 years since Professor Michael Lamb described dads as the "forgotten contributors to child development" but in many places, this quote still feels very relevant.

The difference that can be achieved by involving dads was illustrated to me in our experiences of feeding our son. When I was pregnant, my husband and I went to an evening workshop on breastfeeding run by the NCT. As a result, he was able to give me very practical support in the early days of breastfeeding; he could look at our position and help me to get the latch right. When I was tired and emotional, he could remind me of the information we had learned together.

Sadly the same was not true when it was time to wean our baby. The local health visitors ran a workshop on weaning which was held mid-morning on a Monday, so difficult for many fathers to attend. The workshop included a film of a child gagging on food and I asked if there was a link for my husband to watch this online but they could not give one. When the right time came I gave my son a finger of toast to eat, which he gagged on. My husband expressed concerns about the danger he might be in, and I--thrown by the experience--questioned whether we should be giving him finger foods or just stick to puree. This was a simple illustration for me about how much harder it is for mums to stick to professionals' advice without dads also being informed and on-side.

As austerity continues to bite and services are cut, the contacts that professionals have with families must have maximum impact. Without reaching out to dads, we are leaving 50 per cent of parents unsupported and unengaged. That is an enormous missed opportunity.

SALLY HOGG

NSPCC lead for babies and vice chair of the UK maternal mental health alliance
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Title Annotation:CLINICAL FEATURE
Author:Hogg, Sally
Publication:Community Practitioner
Geographic Code:4EUUK
Date:Oct 1, 2015
Words:1100
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