Vital first steps

In a quiet room tucked away at the back of the NSPCC’s glass-fronted Bradford offices, the tiny feet of babies Kyra-Mai, born in February, and Lucas, who arrived in March, are dipped in red paint and printed on cards to celebrate their arrivals.

On the wall hangs a flipchart with a question at the top: “How did you feel when you first found out you were pregnant?” The response of one new mother is written below: “I didn’t know whether to laugh or cry.”

The words provide a snapshot of the strain women referred to the NSPCC’s Pregnancy, Birth and Beyond service can experience during this time. The programme, which began in December last year, targets prospective mothers deemed to be “at risk” and provides pre- and post-birth parenting support through a series of eight workshops run jointly by a midwife and a social worker.

Mandy, the 28-year-old mother to 10-week-old Blake, was referred to the project following an assessment by social services before she gave birth. “When I started I wasn’t sure if I was going to keep him,” she recalls. Following the workshops, Mandy was able to look after Blake and allowed overnight contact with her older son, who was previously placed in the care of her sister. “I was determined to show the lengths I would go to keep my children,” she says.

As a former drug addict who has been clean for 18 months, she believes the project taught her to be a “better mum” by emphasising the importance of communicating with her baby. “I learnt that it’s not just about dressing and feeding, but helping him develop by talking to him. I can’t remember doing that with my first son,” she says.

Families can keep in touch with the project once the eight workshops are over, and many develop friendships with their peers. For Mandy the project brought new friends. “When I was on drugs I didn’t socialise for 10 years, but because of the group I have met other mums,” she says.

Mandy was also able to reflect on her parenting skills by watching a film of herself with her baby after his birth – a technique that is proving popular on the pilot scheme. Group facilitator Anne Du Chemin describes watching one mother “just flooding with love” for her baby as she was filmed. “We encourage women to pick out the good points they can see when they watch it,” she says.

Du Chemin, one of two midwives seconded to the project from Bradford Teaching Hospitals NHS Foundation Trust, smiles as she sits at a table surrounded by colourful teaching aids including baby-sized dolls wearing striped babygros and woollen breasts, an umbilical cord and placenta.

Like the mothers, she has also developed new skills. “As a midwife, I am predominantly focused on clinical care and usually work on a busy ward with big caseloads, so there is never a great deal of time to talk about issues mothers may face, such as homelessness, domestic violence or relationships,” she says. “I find the space to have these conversations very appealing because having a baby is about emotional as well as practical changes.”

Du Chemin has gained new insights into how babies develop including attachment theory – familiar territory for health visitors and social workers but not always for midwives. “I’ve learned so much about the importance of women engaging and interacting with their babies from the start and reading their cues,” she explains.

Social work stigma
Grace Widdowson, a children’s services practitioner with the NSPCC, says working alongside a midwife helps to take away the feeling of stigma some women may attach to her role as a social worker. “People are less guarded when they know there is a midwife in the room,” she says.

Du Chemin and Widdowson together help the women referred to them and their partners plan for the big changes a baby will bring to their lives and deal with the day-to-day care of their child. “The best thing is seeing women who feel vulnerable and anxious when they are first referred become confident by the end of the workshops,” Widdowson says. “Sometimes the smallest thing can make a difference, such as learning how to change a nappy.”

Where there are concerns about welfare, staff can send reports to social workers with the parent’s knowledge and agreement. Team manager Morgana Bairstow, a registered social worker, believes trust is key to the project’s success. “Some mums are suspicious and think they will be under surveillance, but we are able to build trusting relationships,” she says.

However, the circumstances of some women can make the balancing act between safeguarding and prevention difficult, when the chances of mothers keeping their babies are “50/50” Du Chemin explains, though such cases are rare.

Attendance to the programme is voluntary and the criteria for referrals is broad. They include younger women for whom English is not their first language and mums-to-be who are experiencing social isolation or difficulties such as mental health problems or learning disabilities. Referrals come from midwives, children’s centres, domestic violence or substance misuse services and women can also self-refer.

The project is part of the NSPCC’s All Babies Count Campaign, which cites statistics that reveal babies under the age of one are more than three times as likely to have child protection plans for physical abuse. They are also more than twice as likely to have a child protection plan for neglect compared to the average child. And almost half (45 per cent) of serious case reviews involve a child under one.

So far Pregnancy, Birth and Beyond in Bradford has helped around 30 women, some of whom have brought their partners along to sessions.

Twenty-year-old Jamie-Leigh, whose baby Kyra-Mai is now two months old, is a care leaver who was referred from a family centre where she was doing an apprenticeship.

“Not having my mum around that much meant I needed extra help, and the hospital midwife never had time to answer questions,” she says. “The project gave me confidence about the labour and the workers helped me ?to choose a water birth – something I never imagined before.”

Like some of the other dads, Kyra-Mai’s father also attended sessions – something the project staff are keen to encourage.  Du Chemin points out that fathers are “often marginalised” in the birth room and can be neglected in hospitals where midwives focus on looking after women. “Partners can be traumatised and need space and time to process their feelings,” she says.

At the project, men are able to attend groups on subjects including changes during pregnancy and the role of men and women in their own families. They are also able to share their story of the birth with other dads.

NSPCC Bradford service manager Sharda Parthasarathi is hopeful that the project, which will run in eight areas across the ?UK for the next two years, could have a “huge” impact on the lives of babies like Kyra-Mai. “We see pregnancy as a magic moment when parents are uniquely receptive to support, motivated by the desire to do the best for their child,” she says.

Secure attachment
The NSPCC project aims to promote “secure attachment” between parents and children as a way of preventing child maltreatment. “Sensitive care giving can be achieved when parents learn to understand their baby’s communication and behaviour,” Parthasarathi says.

The success of the NSPCC’s project in helping to bring down these figures will be measured over the next two years through “rigorous” evaluation and an examination of the financial impact of the project.

“We want to know what families and practitioners think about the new exercises and the new ways of working. We want to know how successful the programme has been in engaging and retaining disadvantaged and vulnerable families,”

Parthasarathi says. “Until now there is a limited evidence base about the cost-effectiveness of specific antenatal education programmes. We hope to fill this gap and demonstrate that a relatively small investment in quality antenatal provision jointly provided by health and children’s services practitioners can yield returns in terms of improved outcomes for vulnerable families.”

For now, new mother Jamie-Leigh is eagerly waiting to see if Kyra-Mai will remember what she learned in the womb.

“I was taught to sing The Wheels on the Bus to her before she was born, which was amazing as I didn’t realise she could hear me then,” she says. “I’m expecting her to start singing it soon.”

The PREGNANCY, BIRTH AND BEYOND programme

Pregnancy, Birth and Beyond will run in eight areas across the UK aiming to give 2,000 vulnerable families support and guidance as they become parents.

Aims