Parents provided a range of suggestions to various health and allied health practitioners regarding their experiences with these practitioners during pregnancy, IVF or surrogacy; labour and birth; and early parenthood, including in relation to antenatal and/or postnatal depression. They outlined both positive and more challenging experiences, and suggested a range of ways health and allied health support services could be tailored to meet the varied needs of expecting and new parents during pregnancy and in early parenthood.
Care during pregnancy, IVF and surrogacy
Many mothers highlighted the importance of continuity of care from GPs, midwives or obstetricians during pregnancy. Joanne appreciated seeing the same GP throughout her pregnancy under a shared care arrangement, while Maree found seeing different obstetricians and midwives during her pregnancy 'a bit impersonal'.
described her efforts to have 'continuity of care' during both her pregnancies.
> Click here to view the transcript
I didn't have a midwife. There was no continuity of care at the birth centre that I went to. I found it quite - having no idea about having a baby or even having really thought much about it, I found it really intimidating being six weeks pregnant and just calling a few different birth centres I suppose. And people, they were just like, "Well, you've just got to book in now". And I was thinking, 'But it's nine months away. I don't even, book in for what?' It was very difficult. I found it hard.
But I was lucky and I found a general practitioner who was, sort of local and she was also, she'd done obstetrician training. It was interesting because as my pregnancy progressed, or my research progressed, and I sort of was quite apart from her, she was very hard science, and I was a bit more hippie, I think. And so with my final appointment with her, she said, "So come in on the 9th January, if nothing's happened, and we might do a sweep or something, and think about some sort of induction". And I just looked at her and went, "Oh, right", and I just nodded and smiled, and thought, 'That's just never going to happen'.
And when I rang to book my birth into the birth centre where my first baby had been born, they said, "No the catchment region has changed. You have to go somewhere else". And the somewhere else was somewhere I really didn't want to go. They didn't have a birth centre. They just had a maternity ward. I don't think they had any continuity of care, which the birth centre where my first baby had been born had just introduced. So you got to see the same midwife throughout your whole pregnancy, whereas in my first pregnancy, I just saw whoever was there, and also did shared care with my GP. So I made a big fuss, and did a lot of harassing via phone and email, and made a really big annoyance of myself, and in the end, they just went, "Okay. Okay, just go away, and you can have your baby where you had her before". And I said, "Good".
A number of mothers appreciated receiving 'supportive' or 'nurturing' care during pregnancy, but felt that many health professionals were focused on the physical dimensions of pregnancy rather than on providing 'emotional care'.
Because of the 'distance' in the relationship with her obstetrician Josie
was unable to discuss her 'mental wellbeing' and only ever talked to him about physical matters.
> Click here to view the transcript
The obstetrician does come across a little bit like your supervisor rather than a peer, as friendly as he can be and as lovely as he is you feel there is a distance... and also I have heard from women who are either in a shared care or who see their midwives more often they perhaps have more detailed chats and you would feel less judged asking questions that sound so trivial. Whereas I do filter a lot of my questions before I ask my obstetrician... because I can see that, you know, they do get annoyed with internet searches such as this or that and he has to clarify that it's nonsense. I often thought that when they ask you how you feel that maybe that that is a question for both mental and physical wellbeing. But I always only comment on the physical wellbeing. But there are days where I wonder whether I should just book an appointment with my GP and say, "I just feel so overwhelmed, I need a day or two from work", and discuss that with her. She is the GP I've been seeing for the past 10 years and she would certainly understand that maybe I am going through some emotional turmoil. I do not bring it up with my obstetrician and maybe that's because he sees women every day feeling the same way, complaining about the same things...
A desire for more emotional support was also mentioned by women who experienced complications during pregnancy, including threatened early labour or pre-term labour and birth.
While in hospital for threatened early labour, Sarah M
found being visited by a church volunteer 'unhelpful' and would have preferred a non-religious counsellor.
> Click here to view the transcript
I think that they could do some more in regards to women on the ward who are trying to prevent their pregnancy from coming early. I think that they should have more counselling. I was visited by a religious lady a couple of times and I'm not religious. So it didn't help me at all, so I would have preferred to have an actual counsellor come - and sit down and just let me cry.
Because there's a whole floor devoted to people who are doing that, I don't know if it's becoming more common, in the world, that babies are born prem or not. But there were a lot of us up there and we were all struggling with our emotions. And I know I cried myself to sleep every night, and so maybe volunteers that have the experience or have a professional background. More so than than someone from the church coming, because for me that didn't help.
She brought a colouring book for me, and said that it would be nice if I made a drawing for my daughters or and that didn't help. So it was a lot - she was drawing on the things that - the tools that she had, they didn't help me.
I think that they need to be a little bit more intelligent in the way that they actually get assistance from either volunteers or from professionals. A little bit more intelligent about the actual feelings and the hormones, as well, the feelings generated by the hormones of being pregnant and that kind of thing. I think there needs to be not just someone from the local church coming and trying to provide some comfort.
I had, it's a learning hospital, and I did have one particular moment where I couldn't stop crying, and that was after - I was still pregnant, it was after a pretty major bleed and I was drawing closer to my daughters' birthdays and I was feeling very worried that I wasn't going to be home for their birthdays, but also scared that I wanted this baby to be born so I could go home and be with my daughters, but I didn't want the baby to be born because I knew that he was going to be born prem. So I was just feeling a lot of everything and I couldn't stop sobbing at one stage and they sent a student in to sit with me and try and make me feel better. And she was a lovely kid but ... she was learning off me. And I didn't need someone to learn off me, I needed someone to help me. So ...
I think - do you know it's funny, I didn't find the fact that I didn't get any proper professional counselling on the ward as a big deal, but then when I talk about it and I say that the only person that - two people that came around was a student - to talk to me about my emotions was a student and a person from the church, that doesn't sound like enough support. It really doesn't. And I'd never thought about it until I said it out loud then.
You've got to pump that mum up with as much emotional support as possible, because she is going to be going through one of the hard - because if she is there, holding off a pregnancy, most cases she is going to have a baby that goes into special care and she - it's gonna be one of the hardest things that she ever goes through. So emotionally, you need to get her up here. You really do. Get her prepared so she can just do it. She could cope with it.
I know that, I'm part of a group called Life's Little Treasures, which is a Facebook group and it's a group that organises fundraisers and that kind of thing for prem babies. So I think that that's a really good thing to be part of. And that, you're able to post a lot of questions and that kind of thing and be there as support for other mothers who are going through [having] babies in special care. And that's really great. But that was set up by mums, it wasn't actually - I don't think that that was actually set up by the hospital or anything like that.
But for me, I think it needs to be - that kind of assistance needs to happen even before the baby's born because ... you're grappling with a lot of feelings, a lot of fear.
Miscarriage was another area several mothers felt was not always handled as sensitively as they would have liked. Louise, who experienced multiple miscarriages, felt that the 'medical way of dealing with miscarriage' was 'detached' and did not allow women to have 'an emotional experience' of miscarriage. When greater sensitivity was shown, mothers were very grateful.
After giving birth to her daughter who had died at 17 weeks' gestation, Sian
was grateful for the understanding from doctors and nursing staff of her need to hold, spend time with, and be given 'mementos' of her baby.
> Click here to view the transcript
If it had to happen at least I'm grateful that it happened in this point in time in history. There's people I've met that lost babies 20 years or more, even 10 years ago, it was pretty horrific and they didn't get to hold the baby or do anything like that. There wasn't the understanding in the medical fraternity at the time about what women and parents need at that point, which is most people want to hold their child and they want to spend time with them.
At the hospital, they even do little hand and footprints for you. The nurses, if you want, so they took my daughter off to get hand and footprints and they give you a little sort of booklet with the weight and the time they were born and just because there's an understanding now that people need mementoes. Most people find after it's happened, that's when you get home and, and when you're dealing with the enormity of what's occurred and the initial trauma wears off and you're just dealing with the reality of the fact that, you know, I'm not pregnant and there is no baby to care for. Having those mementoes reinforces the fact that (a) it really did happen and it really was a person irrespective of when in the pregnancy it was, whether it's recognised legally or not, made a huge difference.
So they took photos in the hospital, the nurses as well and it just - all of that stuff has really helped. So I've got a special box with all of her things or a couple of boxes actually and I still, you know, will buy bits and pieces when I'm out buying something for my son. Maybe it's the first letter of his name or something, just an ornament to have in his room and I'll get one for her as well. So it's just an ongoing process of trying to include her in our family even though she's not here with us but, you know, she's with me all the time.
Many women and men who experienced IVF were satisfied with the care they received, despite finding the process of IVF itself 'inhuman' or 'clinical'. Several spoke highly of their IVF counsellors and were grateful for their assistance with decision-making.
Having children via overseas surrogacy was complicated and required a significant investment of time and money. Looking back, Daniel said he and his partner would have appreciated 'more objective information upfront about the risks' and 'more support for when things go wrong'. Matthew appreciated being able to communicate with agency staff and the surrogate mother herself during her pregnancy, rather than 'busy' doctors.
Quite a few mothers suggested that antenatal classes could be improved by providing more 'realistic' information about the diversity of labour and birth experiences and breastfeeding, and a greater focus on caring for a newborn. Erin said she had been unprepared for labour: '...even though I'd done the antenatal classes and everything, no one had told you how awful it is. It was such a shock. I didn't expect to feel such - such pain'. Michelle felt unprepared for caring for a baby: 'I don't think [antenatal classes] prepared us for what was to come... I just naively expected that it was all going to fall into place'.
Care during labour, birth and the early postnatal period
Many women were 'traumatised' or emotionally distressed by their labour and birth experiences. This was often 'made worse' by the lack of opportunity to 'debrief' with midwives or obstetricians afterwards.
felt 'violated and invaded' as a result of interventions that took place during the birth of her baby, and suggested that attending medical staff need to debrief with women after labour and birth.
> Click here to view the transcript
And then all of a sudden all these doctors were in the room and you know, your feet have to go up in stirrups and I was, "No, get those fucking", - so trying - you're in this incredibly vulnerable and pained situation, people are coming in, making decisions about your wellbeing, which of course they have to, they're the doctors, but there's a massive tension between what you want and what they're saying is best for you and the life of your child, 'How dare you even say anything against it because are you a bad - are you an evil mother', you know?
And men. I didn't want men. I didn't want male doctors and there was - it's got nothing to do with it, where he was from, but he was a Chinese male doctor between my legs and like, 'Who are you, where - what are those scissors doing? Get those fucking scissors away', and them sort of just telling you what they're going to do and you're saying, "No" but you're having also the happy gas at the same time so you've consented because you're somehow like - you're on another planet.
Yeah, real murky situation, it's really massive tensions around feeling violated, feeling really violated and invaded and like all your self-agency and control is taken away from you by these anonymous medical figures who then afterwards don't even come back to debrief with you or tell you why they made the choice that they did or even acknowledge how there was that discrepancy between how you might have been feeling and what they chose to do in the end and just, I guess, sitting - taking 10 minutes to sit down with you and sympathise with you and acknowledge your feelings and emotions, you know.
That wouldn't take much, but that would have made a massive difference, I think, because there's just that sense of this anonymous person has come in and this person has all the control and all the power in this dynamic. All your power is taken off you. They make the choices of what happens to you and your body and your child. Not allowed to say anything against it, and you kind of don't because they're saying that your child's life is at risk so you shut your mouth, but emotionally you're feeling like you're being violated, you know?
So even if that situation can't necessarily be avoided because medically they deemed that that's what had to have happened, then there needs to be some serious mopping up afterwards, you know? They need to seriously get in there and sit with the other and talk to you and, I mean, even through - it must have been on my records that I was booked into the family birth centre and have been consulting with a team of midwives for the past nine months.
So that would lead one to the logical conclusion that she's obviously - she, the mother, is therefore obviously probably of a persuasion that she potentially wanted quite a natural birth - they could make some conclusions about what I was hoping for versus what I experienced and therefore there's some emotions that need to be addressed and acknowledged there. I think that is a bit of a no-brainer and I was just so angry that that never happened.
I think that that really magnified the trauma because you just feel completely unacknowledged, there's no space to talk about what you experienced, no one really listens. I do remember voicing it to a few people, but not really, because the key thing - you can sort of start saying that and it's, "Oh well, but you have a healthy little baby girl", and now you move on to talking about the baby.
I remember actually feeling quite a lot I don't want to talk about the baby, I want to talk about me, like - baby, sleeping over there in the crib, whatever, that's - talk about me and what happened and what I just went through and like I said, having an unsupportive partner who after the birth was finished. He was like, "Oh", his back was so sore and so he had to go off and have a lie down.
In contrast, a few mothers had very positive experiences of their attending health professionals during labour and birth. Jodie described feeling 'pampered' by her midwives, while Rumer said of her doula: 'she [had] a really collaborative way with the staff... she managed to get them to lower the curtains and things and communicated all of my preferences to them and was just very gentle about it'.
described feeling 'supported' by her midwives in her preference to not have any intervention in her labour and birth.
> Click here to view the transcript
And we were starting to learn that many, many women who engage an obstetrician end up having interventions that we believe may often be unnecessary and that if I did have medical issues that urgently needed addressing during the birth that, in a public hospital those issues would still be addressed, but not just because the obstetrician needed to get to his golf game you know. So that's part of sort of what informed us.
To go public and to also be very clear within our own minds that we wouldn't accept any interventions in the birth unless it was absolutely necessary.
There wasn't really resistance really. I mean it was our choice to engage or not engage an obstetrician and I think that when we actually got to the hospital I think the midwives actually got the fact that we actually were fairly well informed, and had thought about this a lot and I think they actually were like good on you girls. If you can birth this baby naturally and you don't need us to be doing all these things to you then good for you. So we felt supported by the midwives in that, so we didn't really feel at any time like there was resistance to that.
But we were assertive enough to make those, and informed our self well enough and I guess had enough sort of life experience to be able to make those decisions and choices. And again I understand that not everybody has those resources to draw on in making decisions because their either much younger, or they do have more serious health concerns threatening the pregnancy or the birth, or they're just within a culture that doesn't question the mainstream medical models you know. There's a whole lot of reasons why women might not have made the choices we did.
And I was lucky enough that I didn't have complications so it didn't even get to the point where I had to make a really difficult decision about whether I would have such an intervention or not. But I would have had it if it had meant that it was any question of [son's name] being born well.
Care during early parenthood
As with pregnancy, parents felt that more emotional support from health professionals such as maternal child health nurses, GPs or lactation consultants would have been helpful during early parenthood. As Sarah M said about lactation consultants: 'Their job is to focus on getting a mum into the prime condition of breast feeding, doing perfect breast feeding. And the focus is not on the mum's emotional needs at all'.
Several women commented on their experiences of being screened for postnatal depression. Some had positive experiences, while others were more critical.
felt that in screening for postnatal depression, it would be useful for maternal child nurses to have a 'conversation' with mothers, rather than just 'handing over' a screen.
> Click here to view the transcript
Maybe in terms of lessons learned and health professionals I guess, GPs being aware of that 'cause they're generally the ones or obstetricians or whatever that you've gone through and checking in maybe at that six week check-up and the nurses as well I guess play an important role there too. I think the nurse - that a friend of mine said, "What's maternal about maternal child and health?" I think that has changed since having our daughter. I think there's a visit now that's just about you, I think it's the postnatal depression screen.
So I guess that's good that that's incorporated now, but it could sort of I think be more of a conversation, because you're sort of handed a screen and that would be good to have a bit more of, I think, maybe the nurses need a bit more training in that regard.
But in terms of getting it right, in terms of the support, my experience was interesting in that after doing that screen, it obviously came out that I had had a bit of a hard time and the nurse said, "Well make sure you talk to your GP about that". And then I'd seen a GP - lactation consultant about some breastfeeding issues and she said, "Well make sure you talk to your nurse about that". So it's sort of like, 'Who is taking responsibility?' Everyone knows how to diagnose and to be aware, but what comes next?
A number of parents suggested that health professionals could provide more 'open' environments to talk about emotional issues during early parenthood. A few women said 'appropriate' questions about their feelings in a caring environment might have made them more willing to disclose emotional distress to a health professional.
described making appointments with her GP to talk about how she was feeling, yet when she arrived was too nervous to bring it up. She also avoided answering truthfully on the Edinburgh Postnatal Depression Scale (EPDS).
> Click here to view the transcript
So you didn't consider - you said about going to the GP but you didn't - you didn't seek any kind of assistance?
So I made appointments and then I would go in there. I'd be sitting in the waiting room and then I'd think, 'Oh God I'll have to come up with something else, I can't tell them', and I didn't want to walk out. You know, I don't like cancelling appointments on people, so I'd say, "I've got this you know tiny little dot on my leg". Twice I did that and a different problem each time and they were sort of like, "Oh yeah, okay", and give me something or tell me - recommend me something but I couldn't tell them either time.
They didn't ask, they didn't probe a little bit further?
No. So they always ask when you - well, once you've had a baby and you go to the child maternal health centre all the time when the baby is very young and they often do the Edinburgh scale thing and I would have always thought I was answering truthfully but the questions for me, no disrespect to Mr Edinburgh who obviously invented it and thought it was great but, I'm like, "Yeah well of course I'm not enjoying life as much as I used to, I mean I've got a new baby". I thought that the answers were so silly that you couldn't really determine of - so I'd say, "Well, given that I have a new baby I guess - I guess life's okay", and so I'd sort of tick, 'No, I'm okay', 'I'm okay', 'I'm okay', because I assumed that what I was feeling was okay given that I had a baby but if the question was, "Okay is it like how it used to be?" well, 'God damn no', but - so I just walked away thinking, 'I don't - I'm not, I'm not lying on those things but I don't think it really indicates how people feel' but then you read plenty of things where someone has been picked up as having - being recognised as being low or having a noticeable change as a result of those scales.
Support for breastfeeding from health professionals was very important for many mothers. Some appreciated receiving assistance from breastfeeding clinics or lactation consultants, while others said they would have liked more support. (See also Caring for a baby - feeding and settling.)
Many mothers felt that maternal child health nurses supported and assisted them with their baby in early parenthood. Alice said: 'my maternal and child health nurse was wonderful. She was always happy and cheery and never told me that I was doing a wrong thing, just suggested other ways of doing things'. Others, such as Joanne, felt maternal child health nurses could provide a more 'caring' environment, or suggested that they could give more time to emotional needs of the mother, rather than maintain their 'exclusive' focus on the baby.
Care for parents experiencing antenatal and/or postnatal depression
An important message to the wide range of 'frontline' health professionals (particularly midwives, maternal child health nurses and GPs) that parents came into contact with during pregnancy and early parenthood was the need to build 'rapport' and 'trust', to encourage parents to disclose if they were struggling emotionally. Josie said: 'Maternal health nurses are another point of contact but when they give you a brochure that explains something about postnatal depression, I'm not sure how much connection or friendship you can draw there'.
explained how she didn't reveal that she wasn't coping with parenthood to the first maternal child health nurse she saw, but was open with her second nurse as they had a better 'rapport'.
> Click here to view the transcript
I - physically an illness to me is something - was back then something physical, it wasn't something mental. It just was something I couldn't approach or probably deal with, that that might be the case.
The second time round, different mental health nurse who I just seemed to get along [with]. The first one was an old lady. Didn't have children. I didn't really relate to her, nor did many others that I know of. Just there was no connection there, so there was no real free talk and I think I felt that if I'd say something to her, I'd be showing signs of failure. And maybe with her I just couldn't do that. It was just like almost talking to my mother or something. Like, I can't show signs of failure. Not that I ever felt that I couldn't with my mother, but you sort of feel like an older person you don't want.
You've got a new child, you're a new mum, you don't want to be a failure. With my second child, different maternal health nurse. Younger, lovely, had a great rapport with her, beautiful lady. And got along with her really well and was able to open up to her. Sort of straight away we went through the test. I answered that truthfully rather than emotionally, rather than organising where my answers were. I answered it truthfully and I talked to her. And actually she wrote a letter for me to say that you're suffering from postnatal, could I also - at that time the older daughter was in crèche - could we have - she organised some extra funding so the older daughter could go to crèche a little bit more. Instead of only three days a week I think she organised it for maybe four days a week, or two to three. I can't remember.
So she actually wrote the letter and organised it and had a letter for me to give to my GP as well. So she was right on to it, and I was able to be open with her and say, "Yes I am. Yeah I am suffering from it". And I think it took me to have one experience beforehand to realise that I probably did and didn't deal with it, to this time to be able to be open about it. But even in that timeframe, I think mental illness in the general population, just I think it was campaigns on. And just you know, I think maybe I was just coming more to terms with it. So I think it was a bit of both. I think that just generally, I was a bit more allowing myself to understand that I might have a mental illness and that I'd been there before knowing that, 'You know what, actually it wasn't quite right last time'.
But I didn't know that at the time, I only sort of figured that out afterwards. I thought, 'Okay this is it, but this one's a lot more than it was last time'. So yeah I need to get some help. So it made a difference about the maternal health nurse. To me it made a huge difference because if I'd gone to the first one again I may have opened up a little bit more, but I probably wouldn't have opened up as much as I did.
Parents (mostly mothers) who experienced perinatal depression were generally positive about the support provided by mental health professionals (psychologists, counsellors or psychiatrists). Several said it was 'helpful' to be able to 'talk things through' or develop 'strategies' to respond to problems they were facing. The few mothers who used mother and baby units had positive experiences with the support they were offered there.
Accessibility was an important consideration for parents in contact with mental health professionals, including cost. Mental health plans or employer-subsidised counselling services were appreciated for these reasons.
described how the availability of counselling through a mental health care plan helped her recover from antenatal depression.
> Click here to view the transcript
Well, we moved up here and we had saved up enough money to be able to have the whole summer off, which was really good that we did that. But then we got back from our - we went over to [country name] for a little bit too, came back and then just got jobs. I got a job in [place name] and he has a job in [place name]. And I worked there until I was 34 weeks pregnant with my first child. I got made redundant because they were moving offices and I didn't want to really travel an hour and a half with a newborn. So they said, "Do you want to be redundant?" So I was made redundant at 34 weeks. So I got off a lot earlier than I had planned.
So I think he was really worried about all of that and also we didn't have very much money. So every time I was like, "Oh I need to go see - do this, to", and he was like, "Oh, how much money is that going to cost us?" So he was quite stoked that there's like a free mental health plan - and learning - and every time I'd have a session with a counsellor, he would always say, "Oh, you know, what did you learn today? And what did you cover?" And because I always got given homework, he'd say, "What was your homework? And, do you want to talk about it?" And I think he was really trying to help once we got to that point, but before that point I think that he didn't really know what to do.
I would say, I spoke to these people - go see your GP and so you can get a referral. We have an amazing thing where you get six free consultations after - like, they assess you and you get six free consultations. And most of it - it worked, helped me so much, so you can go through and do it. And I'll be here if you ever need a shoulder to cry on or a piece of cake [laughs] or anything. And I think that making them feel supported is a huge thing. Like it's amazing even what a few frozen home cooked meals can do for someone when they're feeling sad [smiles].
Experiences of health services during pregnancy, IVF and surrogacy
Experiences of health and allied health professionals during labour and birth
Staying in hospital or a birthing centre after having a baby
Caring for a baby - feeding and settling
Experiences of health professionals in early parenthood
Experiences of health professionals for antenatal and postnatal depression
Experiences of hospitalisation for postnatal depression