By Duncan Fisher, Editor, Child and Family Blog
After three years of development, the new NICE guideline on antenatal care has been published.
I was appointed as a lay member to focus on the issues of how maternity services can engage effectively with families. I came to this through my own family’s experience of maternity services over 20 years ago and have been working on maternity policy ever since. At the same time as working with NICE, I have been serving on the World Health Organisation’s Postnatal Care Guideline Development Group.
Supporting families has always been a challenge in maternity care. In a health setting, where the woman is the sole client, partners are classified as supporters of the mother, not as the other parent of the baby, as they most often are. This has been frustrating to witness over the years, as we know that children form attachments to more than one carer, be they women or men, and that this starts right at the beginning of life. This is important because it is the foundation for the child to develop resilience, ever more important in these troubled times.
I have been studying and reporting on child development research now for two decades, working with leading researchers across the world. Our understanding of the processes involved has transformed in the last decades. We know that the human condition is for children to be raised collectively within a ‘community of care’, encapsulated in the old saying, ‘it takes a village to raise a child’. Communities of care around children come in a vast variety of forms.
We have learned that caring for an infant – particularly things like skin-to-skin care - stimulates strong hormonal changes in male parents as well as female. Bonded carers produce more oxytocin and prolactin, hormones associated with caring, and less testosterone.
We have learnt that neurobiological changes take place in men like they do in in women and that these changes correlate with the child’s emotion regulation and social skills in their later years. We have learned that these changes only happen in men when they actively care for children. The more men care, the more these changes happen.
If we know all that, why then have maternity services not focused more attention on the importance of early bonding with other parental figures, not only the mother? How then can we solve this ongoing issue and better engage partners, particularly those partners who are also parents of the baby?
Well, we may never solve it completely – the health of the mother and baby is always going to be the top priority of a health-based care system, above issues like child development. But we can make adjustments to the system, so that families, particularly the most disadvantaged, get the support they need.
This is what the new NICE antenatal care guideline does. It breaks new ground by thinking coherently about how to engage with families during pregnancy and birth. It specifies that partners are whoever the mother-to-be wants, and that they should be welcome from the outset, including in antenatal waiting rooms. They should be fully engaged if they come to antenatal appointments with the mother -to-be. The possibility of their virtual attendance at appointments is suggested.
More specifically, in relation to parenting and baby-parent bonding, the guideline recommends that all families are informed about possible relationship changes within families, how parents-to-be can “support each other”, and the importance of early bonding between baby and parents: “Babies form attachments with a variety of caregivers but the first, and usually most significant of these, will be with the mother and/or father.”
This is real progress and I hope will change the maternity experience for the better for families.