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Reconceptualising antenatal care


I had an interesting conversation at a conference I attended recently about the way in which antenatal care provided by midwives and doctors continues to focus on the physical wellbeing of mothers at the expense of their psychological wellbeing as they make the transition to parenthood. The discussion went along the lines that by giving so much attention to taking blood pressure, testing urine and palpating abdomens, we probably save a small number of babies from intrauterine death or disability. However, were we to become much better at nurturing the mother psychologically, and her partner and family, we might be able to save far more babies from childhood trauma and an adulthood of mental ill health. Quite a thought.

We moved on to talk about the key part ultrasonographers could play in building the relationship between the baby and his or her family were the focus to shift from the physical to the psychological. The discourse of the scan appointment would be around how the baby is responding to his mother’s voice, and the pressure on her tummy. A conversation about the baby’s experience in the womb at this stage of pregnancy would ensue, and about his relationship with the outside world (able to hear mum’s and dad’s voices; enjoy music; startle at loud noises; bask in the light filtering through mum’s tummy when she sunbathes or takes a shower….) Ultrasonographers might require a little training in preparation for such consultations, and need a little more time to carry out scans, or they might feel perfectly ready to do this nurturing work straight away.

Such ‘psychological’ care would be far less expensive than standard physical care. As T. Berry Brazelton has advocated all his long career, health professionals could help mothers and fathers understand and celebrate their babies’ amazing abilities, rather than directing them solely to consider whether their babies are ‘all right’. Instead of asking mothers to keep a kick chart, they would ask them to keep a diary one day a week of their baby’s activity – asleep or awake; kicking; hiccoughing; responding to music or to dad’s voice, and so on.

The principal goal of midwives, doctors and all maternity care staff would be to build parents’ capacity to nurture their new baby, and to recognise and accept his or her individuality. Highlighting the uniqueness of every baby in the womb would then downgrade the invidious comparisons that mothers and fathers so often make once their baby has been born (i.e. other babies sleep more/less; cry more/less; fuss more/less; settle better/worse etc.).

Instead of antenatal care being a 9 months preparation for 18 hours of labour and birth, it would be a preparation for 18 years of bringing up this child up to be a happy, well-balanced, loving and enthusiastic member of our society.

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