Editor's Blog

Parent Education for All

David Cameron has said that he supports state-sponsored parent education classes for all parents. Pregnancy is known to be a ‘teachable’ moment, perhaps the teachable moment in most adults’ lives when they are uniquely prepared to take a look at who they are, how they have become the people they are, their lifestyle and the direction they want to go in as mothers and fathers. It is a shame that provision of antenatal education has, in fact, declined since the 1980s when I enjoyed excellent sessions led by an obstetric physiotherapist at the hospital where I had my baby, and by the NCT in the home of my local teacher.

Universal antenatal education fell into decline in the ‘90s and ‘00s because its primary purpose was seen as preparing women and their partners for labour and birth. There was some teaching of essential babycare skills and maybe a little time was given to discussing the signs of postnatal depression. Unfortunately, the evidence that antenatal classes impacted on mode of birth, i.e. whether women had spontaneous vaginal deliveries or caesarean section, suggested that they were ineffective in this regard. However, many studies were of poor quality as were the antenatal classes themselves given that midwives and health visitors were expected to lead them irrespective of the fact that their basic training rarely, if ever, included instruction on how to facilitate groups.

In the last three decades, powerful evidence indicating the adverse effect of maternal stress on the unborn and newborn baby’s developing brain and central nervous system, and of the importance of sensitive, responsive parenting in enabling the baby to develop a sense of his/her self in the world and to feel secure, has led to a resurgence of interest in early parenthood education. Programmes targeted at the most vulnerable women and families such as Mellow (Christine Puckering), the Incredible Years® (Carolyn Webster-Stratton) and Triple P (Matt Sanders) have evaluated well, even though the standard of evidence may not be of the highest. The best-known programme is the Nurse-Family Partnership, or the Family-Nurse Partnership as it is called in the UK – a programme for teenage mothers at risk of poor life outcomes for themselves and their children. This programme involves weekly visits from a specially trained Family Nurse, starting in pregnancy and continuing until the baby is two years old. The UK programme has been the subject of a randomised controlled trial (RCT) which reported recently and, unfortunately, found no benefit for the young women who participated in it in terms of mode of birth, breastfeeding duration or timing of subsequent pregnancy.

Many have said that the outcomes examined by the RCT were too limited. The findings do not mean that the young women found the programme irrelevant; in fact, as might be expected, they valued highly the continuity of their relationship with their Family Nurse, whom they saw as a nurturing, reliable person, a steadfast presence in their often traumatised lives. They enjoyed being listened to non-judgementally and being helped to understand how their mothering affected their baby’s physical, emotional and social development.

Cameron is not, however, suggesting an increase in targeted parent education programmes, but in universal provision. The advantage of universal education is that it is non-stigmatising; if everybody goes to parenting classes, then nobody feels that they are being singled out because they are considered poor parents. And why wouldn’t the nation’s parents sign up for parent education? We take lessons to learn to drive a car, or to become proficient in a particular trade or profession, so why not for the most important job that we have to do in life – bringing up the next generation’s citizens?

There will be those who argue that parenting is instinctive and that health visitors should not rush in where there is no need to tread. And, of course, the history of human evolution includes the development of skills to nurture a baby that, compared with its primate cousins, is unusually dependent at birth and for an unusual number of years afterwards. But anthropologists such as Sarah Blaffer-Hrdy remind us that human parenting evolved over the millennia when humans lived in groups where parenting was shared, parenting wisdom passed from one generation to the next, and the quality of parenting monitored by the tribe or village. Nature didn’t envisage 24/7 isolated nuclear family parenting, nor the proliferation of advice based not on observation and experience of parenting but on personal philosophies of power and control. John B Watson, the parenting guru of the 1920s advised parents to shake hands with their children rather than kissing them in the morning and of the Danger of Too Much Mother Love. Almost a hundred years later, I still regularly hear parents-to-be talking about the importance of not responding too quickly – or at all – to crying babies for fear of ‘making a rod for their back’. Given the overwhelming evidence that ‘terror without resolution’ is profoundly harmful to babies, there is certainly scope for education that shares with parents what neuroscientists and developmental psychologists now know about the need to respond to infants’ distress.

Cameron is talking about parent education across the parenting span of 0 to 18, and I know of many mothers and fathers who would warmly welcome some guidance in supporting their teenage children through the years of transition to adulthood. However, while there is indeed a surge in brain development in adolescence, the critical period of development occurs in the first 1000 days of life from conception to when the child is two years old. The Early Intervention Agenda for children should, therefore, be truly ‘early’ – actioned in pregnancy - if it is going to make a difference. Its impact will depend on the development and evaluation of existing and new parent education programmes and quality training of those who are going to deliver them. And Mr. Cameron must remember that the best parent education in the world will have little impact on the quality of parenting if parents are stressed out of their minds with worrying about ‘heat or eat’ and how to pay the last three instalments of the mortage. Stress has the power to seriously disrupt ‘good enough’ parenting and to compromise interactions between parents and their infants with lifelong consequences for everyone.



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