Parent Education for the Critical 1000 Days

Mary L. Nolan

• Publisher: Routledge
• Year: 2020
• ISBN:
  9781000037548
• Edition: 1
• Topic: Medicine
• Subtopic: Nursing

As research in neuroscience increasingly points to the unparalleled influence of the first 1000 days of life from conception to two years of age in determining the baby's life trajectory, the need for high-quality early parenting education delivered by knowledgeable and dedicated professionals becomes ever more apparent.

This book describes the global aims of early parenting education. It identifies the key areas that research suggests are important: building a relationship with the unborn and newborn baby; preparing for labour and birth; supporting parents' mental health; protecting the couple relationship across the transition to parenthood; and education for special groups such as same-sex couples, women with fear of birth, prisoners, military wives and parents from black and minority ethnic backgrounds.

All practitioners providing early parenting programmes – midwives, health visitors, family link workers, children's centre staff and voluntary sector teachers – will gain new ideas for their practice in this book. Students taking midwifery and early childhood courses will find much to support their studies. Ultimately, the book provides inspiration for all those who are committed to the role of parenting education in reducing social inequalities.

1Introduction

When I started work as a childbirth educator in the 1980s, I ran classes. This was long before Cliff and Deery’s article, ‘Too much like school: Social class, age, marital status and attendance/non-attendance at antenatal classes’, helped us understand that the word ‘classes’ is negatively loaded for many parents. My classes focused on the discomforts of late pregnancy and how to manage them, preparation for labour and birth and a little on breastfeeding. I ran eight-week courses which were well attended and there was plenty of time to share knowledge, ideas and feelings and to support parents to make informed choices about their care. There was also a strong focus on practising skills for coping with the intensity of contractions in labour. Every class would include the opportunity to try out different positions, practise calm breathing and experience massage. Even in the 1980s, the alienation of women from their bodies owing to several decades of increasingly rigid medical control of birth was a challenge for educators seeking to build parents’ self-efficacy for labour and birth.

I enjoyed leading the classes very much and I think the people who came enjoyed them too (by and large!). The 1990s, however, changed the antenatal curriculum for ever. This was the decade of the brain and our understanding of how the baby’s brain (not just her body) develops in the womb, and the factors that impact development, grew massively. We learnt that stress experienced by the mother is felt by her baby as well, and if she is living with unrelenting, severe stress, it is likely that her baby will be born prematurely, and with his stress thermometer set much too high – perhaps for the rest of his life.

What we didn’t know, and still don’t, is how much maternal stress is ‘too much’ for the baby. However, it certainly makes sense that maternal stress hormones will pass to the baby and that nature might make a judgement, based on the level of those hormones, about the kind of environment the baby will have to survive in after birth. If the extra-uterine environment is ‘read’ by the baby in utero as dangerous, nature might sensibly provide the new baby and growing child with a hair-trigger response to every perceived threat; if the extra-uterine environment is read as benign, nature might prepare the baby to be less anxious and more relaxed about the world.

During the 1990s and noughties, knowledge of what was happening in the womb grew exponentially and, very soon, it was being posited that babies’ entire futures, from birth to old age, were shaped by their ‘experiences’ inside the mother. Successful (or unsuccessful) functioning as an adult was being traced back, at least in part, to the nine months spent in the womb.

Families were changing, too. The traditional nuclear family, comprising married parents and the children of that marriage, was now a minority situation; new family structures – more complex than previously – were being created, offering babies and small children different ‘environments of relationships’ in which to grow up. The baby might be born into a blended family where one or both parents had children from previous relationships; or into a family where his principal carers were two women or two men; or into a single-parent family, whether a mother or a father.

The relationship between the baby’s parents was, at the start of the 21st century, increasingly recognised as playing a significant part in the way in which the child developed emotionally and socially. Stress between parents was identified as affecting children; some children would cope well with their parents’ unhappiness, but others, perhaps the majority, would find such stress frightening and respond either by withdrawing into themselves, or by manifesting aggressive, non-compliant behaviours. The mental health of the mother was also very much to the fore. Research had demonstrated that the babies of depressed mothers who were unable to communicate with them in a normal, healthy way – by making eye contact and responding to their cues – were likely to have poor mental health themselves, with boys often more seriously impacted than girls. In recent years, paternal mental health has at long last been recognised as also profoundly influential in the life of the baby and young child. A father who is depressed because his partner is depressed, or because of the upheaval in every aspect of his life occasioned by the arrival of the baby, or who is suffering from posttraumatic stress disorder after being present at a difficult birth will be unable to make a positive contribution to the environment in which his child is growing up.

Most families, given enough support and sufficient income, cope with the changes that a new baby brings, even though there is probably no family which doesn’t experience challenges along the way, and periods of disorientation and distress. However, as the present century has advanced, the need to give extra education and support to families struggling with poverty and other stressors has been increasingly recognised. Research has revealed the way in which such families negatively impact children’s life chances – in school, in employment and in relationships. The new science of epigenetics, although in its infancy, is strongly suggesting the possibility of inter-generational transmission of disadvantage, and the drive for ‘early intervention’ to break into the cycle of disadvantage at the very start of a baby’s life has gained momentum.

Such research has been a powerful motivator for many countries to put what is now called ‘the critical 1000 days’ on to the political agenda. At EU level, it has been accepted that parenting support should be mainstreamed in political consciousness. This means paying attention not only to education for parenthood, but also to ensuring that social security arrangements, healthcare, housing and the media are all supportive of young families. COFACE Families Europe, a pluralistic network of civil society associations representing the interests of all families, describes the need for:

policies and legislation that impact the lives of children and families, in particular in the fields of social protection and inclusion … prevention of and fighting child poverty, reconciling family and work life, migration, inclusive education and early childhood education and care, and parenting support services to families.

(www.coface-eu.org/)

Given the implicit ‘call to arms’ from the research community, new social structures and a new political commitment to early family life, the way in which women and men were prepared for the arrival of a new baby in the 21st century had to be updated, made more relevant and better able to help them anticipate and meet the challenges of the transition to parenthood, rather than focusing solely on labour, as had been the essence of antenatal education in the 1970s, ’80s and ’90s. Preparation for labour and birth remained, of course, important. In a world where the media portrayed (and continues to portray) birth as dramatic and dangerous, often requiring heroic medical intervention to save the life of mother and baby, women were, at the start of the 21st century, approaching labour with at least as much trepidation as their 19th-century sisters who feared, with justification, that they might die in childbirth. Keeping birth – normal vaginal birth – on the antenatal education agenda was vital because research was starting to demonstrate that babies benefitted, in ways not previously understood, from being born vaginally. The baby’s microbiome (which shapes his lifetime health) was, it was discovered, most effectively seeded by the baby having contact with the mother’s vaginal flora during the act of birth. Therefore, as the caesarean section rate soared, the need to support women and their partners to believe in their ability to have a straightforward vaginal birth, and to educate them in how to work with the woman’s body during labour, was as great as it had ever been.

But antenatal education had to be much broader than it had been in the 1980s. The ‘teachable moment’ of pregnancy when human beings are specially motivated to reflect on their lives, on who they are and what they aspire to be, on what they want for their babies and how they might achieve success and happiness for them, demanded a richer educational agenda than educators had provided previously. Now, we wanted to offer parents the precious opportunity, within a safe group of peers, to look at their mental health, their relationships and how to make decisions about parenting in the very complex world their babies were being born into. Educators like myself also wanted to move well away from a deficit model of parenting that focused on what parents shouldn’t do, to a model of loving, respectful relationships between parents and their baby. We wanted to be realistic about the challenges of caring for a baby while celebrating the joys of early parenting. While the research was pointing to the benefits for society of ensuring that children have a great start in life, educators wanted to support positive parenting because children deserve to have cuddles, hugs, conversations, nutritious food and exercise.

The ongoing challenge for early parent educators of synthesising research and new social frameworks into a dynamic, relevant parent education agenda is incredibly exciting. What do parents-to-be want to know about? When do they need to know it? What skills would they like to acquire? When? How do they want to learn? What kinds of transition to parenthood groups provide the best education and support?

There is a cacophony of voices in the parent education arena. Where antenatal classes focusing on labour and birth were traditionally led by midwives, health visitors and lay teachers trained by the National Childbirth Trust, the new broader agenda for early parenting education has brought new educators to the fore who feel they can offer insights and expertise valuable to parents. Staff in children’s centres, parent link workers, nursery nurses and private individuals now provide antenatal and postnatal education and support. No single professional group and no single service can any longer claim a monopoly of wisdom that enables them to provide front-line education for families across the transition to parenthood. Territorialism in parent education is no longer appropriate; ensuring a high standard is. This book hopes to make a contribution towards ensuring the quality of early parenting education.

With so many educators in the field, it is all the more important that educators are clear about their aims, what it is we hope to achieve and how we intend to achieve it. We need to understand the topics that parents say are most helpful to them and how they want to learn, what individuals in different circumstances need in preparation for parenting, and how those needs can be met sensitively without prejudice, intended or otherwise, on the part of the educator.

This book aims to strengthen the confidence, knowledge and skills of those committed people who are working in the very early years with mothers, fathers and families as they make the transition to parenthood. It aspires to help educators understand what they can do to ensure that all babies have the best possible start in life, and spend their first years in an environment that nurtures them and optimises their potential. It aims to do what it can to level the playing field for children at the start of life by supporting educators to assist all parents to provide an optimal home learning and home nurturing environment. It sees parent education in pregnancy and the early postnatal period as an essential component of the ‘action’ that Michael Marmot spoke about in his seminal report (2010:20) on health inequalities in the UK: ‘Action to reduce health inequalities must start before birth and be followed through the life of the child. Only then can the close links between early disadvantage and poor outcomes throughout life be broken.’ This book is about reducing health inequalities through early parenting education that builds the confidence of parents-to-be and new parents, and their knowledge and skills to be the excellent parents that they so eagerly desire to be. It firmly believes that investing early is investing wisely.

References

Cliff, D., Deery, R. (1997) Too much like school: Social class, age, marital status and attendance/non-attendance at antenatal classes. Midwifery, 13(3):139–145.

COFACE Families Europe (2016) Available at: www.coface-eu.org/about-2/what-is-coface-families-europe/ (accessed 12 November 2019).

Marmot, M., Goldblatt, P., Allen, J., Boyce, T., McNeish, D. et al. (2010) Fair Society, Healthy Lives. London: The Marmot Review.

2Aims of early parenting education

Parenting interventions may reduce health inequalities across the social gradient if they result in:

•More parents with good mental health, including in pregnancy

•More children with secure attachment – more parents engaging positively with, and actively listening to, their children

•An increase in the number and frequency of parents regularly talking to their children…and reading to their children every day

•Improved cognitive, social and emotional, language and physical health outcomes for children.

(Public Health England 2014:4)

For at least two centuries, ‘experts’ (e.g. L. Emmett Holt, G. Stanley Hall, John Watson, Dr Spock, Anna Freud, T. Berry Brazelton, Maggie Myles), doctors, nurses, midwives, women’s rights activists and lay teachers have supported the provision of early parenting education in the belief that it is valuable in helping women and men achieve greater enjoyment of parenting, and better outcomes in all aspects of life for their children. This persistent belief in the value of parenting education for the ‘critical 1000 days’ from pregnancy to two years of age should induce both a sense of humility in contemporary educators (we are certainly not the first to have walked this path) and confidence that, for many years, passionate campaigners, researchers and practitioners have seen the potential of early parenting education to make a difference to children’s lives.

Delivering any kind of education, to any group of people, demands that the educators should be clear about what it is that they are trying to achieve. Without having established the direction of travel to their own satisfaction, the sessions they lead will be rudderless, and while they might be entertaining, and even informative, they are unlikely to contribute to any coherent strategy for improving the cognitive, social and emotional wellbeing of the individuals who participate.

Institutions that provide early parenting education, whether they be health or social welfare organisations, businesses or charities, must know what their aims are for the educational interventions to which they commit staff, time and resources. They may need to rely on programmes that do not have a strong evidence base, whether because no research is available, or because studies that have been carried out are of poor quality, or because they have chosen to devise their own programmes for their particular clientele, rather than use existing ones. This is all the more reason for institutions and individuals to be clear about their aims and the theoretical mechanisms by which they think the programme will be effective.

The transition to parenthood has been described as ‘a teachable moment’. Expectant and new parents are especially open to reflecting on their lifestyles and making healthy changes, and to learning new information and practising skills to help them care for their baby (Feinberg & Kan, 2008; Sher, 2016). Therefore, practitioners providing education at this critical period have both an exceptional opportunity and an exceptional responsibility.

Over forty years ago…

In 1976, Steven Schlossman noted that:

Parent education to upgrade child-care practices in the home shows signs of becoming the pet educational reform of the 1970s.

(Schlossman 1976:436)

While Schlossman goes on to demonstr...

Table of contents

• Cover
• Epigraph
• Half Title
• Title Page
• Copyright Page
• Dedication
• Table of Contents
• 1 Introduction
• 2 Aims of early parenting education
• 3 Effective parent educators: Skills and relationships
• 4 Supporting parents’ prenatal relationship with their baby
• 5 Stress and relaxation: Education for a calm pregnancy
• 6 Education and support for normal birth
• 7 Education and support for home birth
• 8 Education and support for women with fear of childbirth
• 9 Debriefing women following childbirth: Birth story workshops
• 10 Education and support for fathers
• 11 Education and support for the couple relationship across the transition to parenthood
• 12 Education and support for same-sex couples
• 13 Education and support for interacting with the baby: Emotional regulation and relationship learning
• 14 Education and support for breastfeeding
• 15 Education and support for young mothers
• 16 Education and support for mothers and fathers in prison
• 17 Education and support for at-home parents in military families
• 18 A note on education and support for parents of twins
• 19 A note on early parenting education for mothers and fathers from minority communities
• 20 The way forward: Preconception education and support
• Appendix: Teaching and learning activities
• Index