About this presentation

• Brief summary of three quantitative research projects into parents’ experiences of pregnancy and the early years commissioned by the Department of Health

• Looks at parents’ needs at different stages of the journey– How they feel– What support they want from health services– What they think of the support they received

• Designed to give commissioners and providers an insight into research findings

• Can help to inform future service planning

Overview of the research

• Three qualitative research projects 1. Healthy Child Programme (May 2009)2. Birth and Beyond (May 2009)3. The maternity customer journey (June 2009)

• Each interviewed a wide cross-section of parents of different ages and backgrounds

• Mix of individual, paired and group sessions

Key findings

• Empathy is essential • Continuity of care matters• Many parents need help to understand their choices• Parents want ‘milestones’ on the pregnancy journey to be marked

The emotional rollercoaster of pregnancy

Recognising and responding to information needs

• Many expectant parents feel overwhelmed by the amount they need to know and the speed at which they feel they need to learn

• The NHS is seen as an important source of information • To take advantage of this, health services may want to explore:

– what information parents want (see next slide)– when the right time is to give parents information – important not to

overload them too early. Pregnancy schedules can be invaluable– how to communicate information – combination of face-to-face with

professionals, online, print, group learning (eg antenatal classes)

What expectant mothers may want to know

Parents told researchers they are interested in information about:• changes to their body and the baby’s growth• screenings and scans• proactive health choices, such as giving up smoking and healthy

eating• labour and birth• life choices – whether to continue in their studies or career, what to

tell their employer• social non-health issues, such as housing and benefits• becoming a parent – practical advice on feeding, bathing and nappy

changing• specific information for partners/fathers

Pregnancy: 0–12 weeks

• First contact with health services is vital– Parents sometimes feel GPs aren’t ‘excited’ enough– Few realise first contact can be with midwives

• Don’t overwhelm with information at this stage– Focus on big things– Direct fathers/partners to information, eg online

• 12-week scan is an important milestone – not just clinically, but also emotionally– Parents value first opportunity to see and bond with baby– Some mothers (especially first-time mums) would welcome more

contact between first contact and 12-week scan

The anxiety of the first 12 weeks

Pregnancy: 12–28 weeks

• This period has several key milestones/dates– booking-in appointment/assessment – 16-week blood test– 20-week scan

• It is also the time when expectant parents start thinking about their birth plan

• They want the opportunity to discuss progress and ask questions about– the baby’s health– screenings and tests– their work (including maternity leave)– birth plans and their choices– other sources of information about parenting

Pregnancy: 29–40 weeks

• Expectant parents are now focusing on the birth plan– Who will be present– Skin-to-skin contact, etc

• They are more receptive to information about caring for their baby (particularly first-time parents) – including antenatal education– Many would welcome dedicated classes for ‘people like them’ –

first-time parents, younger mums, single mums, etc• They want practical information about birth – eg hospital visits,

details on car parking, etc• They may also want reassurance about the kind of support health

services can provide after birth

Labour and birth

• Labour and birth are obviously stressful and emotional• It is important to mothers that they feel

– safe in professionals’ hands– informed– able to ask questions

• Changes to birth plan need to be communicated clearly and simply – important that parents realise it’s a plan, not a blueprint

• When the baby is born, families want– time and space to bond as a family– a starter course in parentcraft to build confidence (practical information

about feeding, changing, etc)– reassurance that the baby is OK– information about aftercare for baby and mother

The growing child: 0–1 month

• Many new mothers find the first few weeks isolating and frightening• They see the postnatal visit from midwife/health visitor as very

important– Practical support for mums who are having difficulty breastfeeding– Especially for first-time mums/those who don’t have strong support

networks• Mothers find the two-week development check valuable

― Check on baby’s health― Check on mother’s health and answer her questions― Some fathers feel they miss out on this as paternity leave has ended –

would welcome evening appointment/earlier visit• Mothers also welcome opportunities to get out and meet other new

mums

Insecure and isolated: the challenges of the first months with a new baby

HIGHS +

LOWS -

Reality hits:

scared and alone

Reassuring when midwif e visits home

Meeting other mums and getting advice at

support groups

Feel under pressure to prove self as parent: unsure if doing it right

Birth

Slowly leaving house and getting

back into community

Post-natal checks

Attention turns to baby

Feel isolated and maybe depressed

Exhausted: not sleeping, f eeding, worrying, lots of visitors, maybe in pain

Moments of joy: getting to know baby and gaining parenting

confidence

Fear of going out

HIGHS +

LOWS -

Reality hits:

scared and alone

Reassuring when midwif e visits home

Meeting other mums and getting advice at

support groups

Feel under pressure to prove self as parent: unsure if doing it right

Birth

Slowly leaving house and getting

back into community

Post-natal checks

Attention turns to baby

Feel isolated and maybe depressedFeel isolated and maybe depressed

Exhausted: not sleeping, f eeding, worrying, lots of visitors, maybe in pain

Exhausted: not sleeping, f eeding, worrying, lots of visitors, maybe in pain

Moments of joy: getting to know baby and gaining parenting

confidence

Fear of going out

The growing child: 2–6 months

• Parents welcome the support they get from health visitors in particular, but can feel unsupported when the visits stop. – Unsure where to turn – particularly about minor illnesses– Need more information about continuing sources of help and support,

and how to use health services • Parents recognise the role of the PCHR (red book) in providing a

schedule of appointments• Eight-week and three-month immunisation appointments provide

contact with health services – Some parents felt that they didn’t have enough information about the

immunisations – Few realised that these appointments were also an opportunity to ask

questions not related to the immunisation itself

The growing child: 7–12 months

• By this stage, parents tend to feel more in control• As their child becomes mobile, they begin to worry about safety in

the home• Some confusion about who to contact with health issues/concerns

– Whether their baby is meeting ‘normal’ development milestones – Drop-in clinics and children’s centres can help

• One-year home visit is welcomed and considered to be well timed

The growing child: 1–5 years

• Range of concerns for parents– Development, especially of speech and mobility– Nutrition– Choice of nursery/pre-school/school– Safety in the home

• Little scheduled contact with health services– MMR jab– Two and half year review

• Some parents feel they receive the two and half year review too late– Sometimes it doesn’t take place until the baby is 2.5 years old– Important to communicate this to parents

Involving partners and fathers

• Fathers/partners can play an incredibly important role in the pregnancy/early years journey– The father and partner may be two different people

• The more that health services can involve them, the better– Consider producing information for fathers– Help them understand their ‘role’– Involve them in choices (with mother’s consent)– Actively acknowledge their worries and give them opportunities to

discuss and resolve them

Supporting single mothers

• Women who don’t have the support of a partner may need more support from health services

• Some may feel vulnerable to being ‘judged’ by health services – and by others

• Valuable support includes– signposting to sources of financial help, information on training,

employment, childcare, etc– antenatal classes for single mums-to-be– inviting supporters such as parents/siblings to key milestone

appointments• Particularly important to think about needs after birth – eg getting

home from hospital

Supporting younger mothers

• Often fear they will be judged and ‘looked down on’ • Vital that younger mothers feel supported by professionals – or risk

of them becoming disengaged with health services • This includes support for their decision about whether to continue

with pregnancy• Likely to have less knowledge of and confidence about pregnancy

and parenthood – Antenatal classes for younger mothers– Signpost to sources of advice on money, benefits, education and

employment

Parents in minority ethnic groups

• Research touched on specific experiences of:– Women who do not speak English as their first language– Somali parents– Bangladeshi parents– Pakistani parents– Black Caribbean parents– Traveller parents

• May provide some useful insights for planning maternity services to meet the needs of women in specific minority groups

• May also provide useful insights into engaging with fathers from different cultural backgrounds

Further details

• Download a PDF summary of the research findings at:– URL