A Father’s Voice

National Maternity Voices associate member Paul Webster on why Dads matter too in the maternity experience.

Becoming a parent is a moment of incredible change in all aspects of life; mentally, physically, socially and professionally. Before baby is even born, getting yourself ready for the impending arrival seems like a never ending to-do list. The old saying that preparation is key, brings a flurry of books and articles, advice from friends and family, and purchasing all the gizmos and gadgets that may help make life as a new parent, that little bit easier.

The care that a new mum receives is vital and the support antenatally and postnatally, can bring increased confidence when learning the parenting ropes. Regular midwife appointments, antenatal classes and baby groups, all aid in building a network of communication, of peer connection, of togetherness.

The picture for fathers can look very different. Society tells men how to be a dad. What a dad should do, how a dad should be, the importance of a dad. All these answers are learnt through relationships with their own father figures, with other dads in their peer groups, and through various media outlets. Advertising for baby items are predominantly promoted to a female audience and promote a ‘mother knows best’ viewpoint, leaving men entirely absent.

When the mothers receive regular follow ups and are monitored for anything out of the ordinary, a majority of fathers are missed due to work commitments and unavailability, or simply not asked. The lack of male presence at baby groups, where early bonding with other parents is a possibility, also means the role of a modern father is lost and they are isolated further.

The need for more education, support and communication is required not only for both parents, but also for society as a whole, to help them understand that parenting is a partnership and both have the same responsibilities and are just as important as each other. Education is especially required around emotional support and how the shift in fatherly roles can lead to a need for increased, and more diverse, mental health services. An incredibly positive step is that NHSE announced at the end of 2018, that mental health checks are to become accessible for new fathers, as well as mothers, meaning a family level of mental health care (https://metro.co.uk/2018/12/03/new-dads-to-be-offered-mental-health-checks-and-treatment-on-the-nhs-8203044/).

Post natal depression is a highly documented issue across mothers and regular access to support networks are widely available. However, paternal depression and anxiety are much less publicised, but are increasingly affecting new fathers as they take a more active parenting role.

According to mental health charity Mind, “only mothers can formally be diagnosed with a perinatal mental health problem. However, studies suggest that partners can also experience perinatal mental health problems.”

A baby can be challenging for both parents and there is recognition that mental health issues are also experienced by fathers. Fatherhood brings its own set of challenges, including financial and lifestyle shifts, that contribute to a drop in mood.

According to a study by the National Childbirth Trust, more than 38% new fathers (1 in 3) have worries about their mental health. The NCT also states that general studies have shown that 1 in 10 dads has depression and they appear more likely to suffer from depression three to six months after their baby is born.

Becoming a father can be made increasingly difficult if there is a lack of available support networks, both personally and from the wider community. This can contribute to the thought process that the feelings are a phase and simply coming to terms with the lifestyle change that fatherhood brings.

According to the NCT the symptoms of paternal depression amongst dads can be similar to those found amongst new mums experiencing depression. These symptoms can include:

  • Feeling very low, or despondent, that life is a long, grey tunnel, and that there is no hope.
  • Feeling tired and very lethargic, or even quite numb. Not wanting to do anything or take an interest in the outside world.
  • Feeling a sense of inadequacy or unable to cope.
  • Feeling guilty about not coping, or about not loving their baby enough.
  • Being unusually irritable, which makes the guilt worse.
  • Wanting to cry/crying a lot or even constantly.
  • Having obsessive and irrational thoughts which can be very scary.
  • Loss of appetite, which may go with feeling hungry all the time, but being unable to eat.
  • Comfort eating.
  • Having difficulty sleeping: either not getting to sleep, waking early, or having vivid nightmares.
  • Being hostile or indifferent to their partner and/or baby.
  • Having panic attacks, which strike at any time, causing a rapid heartbeat, sweaty palms and feelings of sickness or faintness.
  • Having an overpowering anxiety, often about things that wouldn’t normally bother them, such as being alone in the house.
  • Having difficulty in concentrating or making decisions.
  • Experiencing physical symptoms, such as headaches.
  • Having obsessive fears about baby’s health or wellbeing, or about themselves and other members of the family.
  • Having disturbing thoughts about harming themselves or their baby.
  • Having thoughts about death.

The NCT goes on to state that one “… symptom of paternal depression can be feeling guilty about not loving your baby enough or feeling indifferent to them. Try and remember that you are important and special to your baby and, if you can, spend time doing simple things like bathing them, changing their nappy or just playing. This might help you feel closer to them.”

Each dad will experience paternal depression differently and being aware of your feelings and knowing when things change, is indication that you may want to seek further advice. A key hurdle to gaining support is that some men can find it embarrassing or weak to share their emotions and open up. If you find that you have feelings of anxiety or low mood that continue over a longer period, visiting your GP can aid in signposting to relevant support services.

Fatherhood related support groups are becoming more prevalent and links to specialist organisations can be found via the Mind website:

  • PANDAS Dads offers specific information for men experiencing paternal depression, via its Facebook page.

(www.pandasfoundation.org.uk)

 

  • The Birth Trauma Association has information and support for partners of someone who’s experienced a difficult birth.

(www.birthtraumaassociation.org.uk)

 

  • The Fatherhood Institute works on policy and research to support fathers.

(www.fatherhoodinstitute.org)

 

  • Light Sheffield is a Sheffield charity that offers support through pre and postnatal mental health issues. They provide support to mums and families, through counselling, peer support or via their online forum.
    (https://lightsheffield.org.uk)

 

  • From Dads to Dads is a website created by Sheffield charity Forging Families, as an informative resource for fathers.

(http://www.fromdadstodads.org.uk)

 

  • Dad Matters, is a Greater Manchester based group, run by Kieran Anders. This is a volunteer group started to include and involve dads in the care of their baby.

(https://dadmatters.org.uk)

Paternal mental health is an issue that requires support, through healthcare services and within the community, but also fathers feeling this way need to feel free to open up to friends, or their partners, without fear of appearing weak. Although there are more available points of contact for dads to reach out, much more can be done within society to give them a place and listen to their voice.

However, with that being said, there are positive ways in which fathers can be involved in helping to improve maternity care for everyone, one of which is by joining or providing important feedback to their local Maternity Voices Partnership (MVP). National Maternity Voices’ definition of a MVP is an “… NHS working group: a team of women and their families, commissioners and providers (midwives and doctors) working together to review and contribute to the development of local maternity care.”

“National Maternity Voices provide support and advice to service user chairs of Maternity Voices Partnerships. NMV promotes awareness of good practice in setting up and developing MVPs among commissioners and provider staff of maternity services in England.”

Therefore, by highlighting the importance of paternal mental health and by making valuable suggestions, dads can work alongside their MVP and bring concerns or constructive feedback to the forefront of the maternity conversation. There is strength in numbers and together, fathers teamed with an MVP, can bring about real change and give their voice an increased volume.

To find out more about Maternity Voices Partnerships, and search on a map to find your local MVP, visit nationalmaternityvoices.org.uk

Maternity Voices Partnerships feature in latest edition of AIMS

The latest AIMS online journal features Maternity Voices Partnerships heavily: Click here to read about:

Implementing Better Births: why Maternity Voices Partnerships (MVPs) are key by Laura James, acting chair, National Maternity Voices

Implementing Better Births via MVPs: an interview with Ceri Durham on how MVPs in North East London are being supported via a community development model

Implementing Better Births: What’s the chance of Better Births? by Mary Newburn – including top tips for activists

The full journal can be accessed here: https://www.aims.org.uk/journal/index/30/2 

 

 

#LdnMatVoices18: London’s second Maternity Voices Partnership Development Day

Laura James and Florence Wilcock

On October 2, around 100 delegates from the 21 Maternity Voices Partnerships (MVP) across the five Local Maternity Systems in London came together at the second annual London MVP development day to share learning and triumphs, reflect on where they are and where they want to be.

London Maternity Clinical Network lead Emily Webster started by providing some context and then we, as co-chairs of the London MVP strategic group, introduced the day by giving an overview of what’s happened in the last year (the capital has gone from around 12 MVPs to 21, with the majority being funded in some way), the aims and objectives of the strategic group, which are:

  1. To ensure every MVP in London receives adequate funding. To this end we have produced the London CN commissioning guidance for effective co-production with MVPs
  2. To network and support the chairs of MVPs, face to face and via social media.
  3. To ensure every woman knows about her local MVP and how to feed into it and become a member if she would like. We have worked to ensure that all London MVPs are on the map on the myhealthLondon website

We also outlined the aims of the day; really encouraging people to reach out, network with each other and have those important conversations, which are sometimes challenging, about where we really are in terms of working relationships and what needs to be done to move forward. Delegates were invited to write any questions that sprung to mind on a ‘park it’ sheet at the back of the room.

The morning kicked off in earnest with headlines from one MVP from each of the 5 London Local Maternity Systems. It was wonderful to hear the work that is being done across London and also fantastic to hear from chairs from MVPs at different levels of maturity:


Next it was the turn of Roz Webb, chair of the Whittington MVP, and Lisa Ramsey, service user voice policy manager at the Maternity Transformation Programme, to showcase 15 Steps for Maternity and the Whittington’s experience of piloting this multidisciplinary toolkit. Roz outlined the challenges but also the fact that spending a whole day together really helped unite the group, which included commissioners, midwives, patient experience leads and service users. There is much more about the 15 Steps toolkit and some case studies on the National Maternity Voices website.

 

After a brief coffee it was time for a series of interactive seminars. The seminar topics were based on feedback from London MVP chairs about what they would like more support with.

To ease logistics, delegates were split into their LMS groups and each of the seminar presenters moved from one room to the next to deliver their workshops. While it did give the impression of speed-dating somewhat, it was much easier having three people move than 100!

Emily Ahmed from Better Births North Central London gave a fantastic workshop on presenting feedback effectively, what some of the barriers might be to influencing change, and what to do about them. She asked us to imagine a time when we have seen feedback used ineffectively and suggested that doing the opposite easily generates a ‘top tip’. Emily also pointed out that we can be much more receptive to criticism if we receive some positive feedback first.

Catherine Williams from National Maternity Voices talked to the groups about promoting and publicising their MVPs. She outlined the fact that Maternity Voices Partnerships are multidisciplinary NHS working groups, not legal entities in their own right, and as such cannot be contracted. She asked us to think strategically about raising awareness of MVP work for example at Trust board, CCG and Local Maternity System levels.  She also signposted the groups to a variety of different resources on the National Maternity Voices website, including a new generic flyer that MVPs can customise easily. She also asked the group to consider this acronym when thinking about promoting their work:

P – what is your purpose?

A – who is your audience?

C – what is your community?

K – know your limits (and then stretch them if you can).

Finally, Ceri Durham from Social Action for Health led a discussion about how to reach out to vulnerable groups and how to attract new members to an MVP. There was a really good discussion about the danger of using the term ‘vulnerable’ and a realisation that what women want and need is the same irrespective of their background: it boils down to safe and personalised care. Ceri emphasised the importance of thinking through what will work for local women and local staff, each MVP will be different. She invited us to get out & think through who is missing in terms of membership e.g. obstetricians in contrast to who is missing in terms of voice e.g. partners.

After an hour and a half of these back to back seminars, it was time for the delegates (and seminar presenters!) to have a well-earned break and a bit of time to reflect on the messages they had heard in the morning.

There was an opportunity over lunch for people to visit market stalls at the back of the room and make further connections. Delegates were able to learn more about:


Local Maternity System conversations:

The afternoon session was an opportunity for each delegate to get into their own Local Maternity System (LMS) and have some dedicated time to talk about the challenges and opportunities of working together at an LMS level. Maternity Voices Partnerships differ from their predecessors, Maternity Service Liaison Committees (MSLCs) as they also have this strategic role on the Local Maternity System board, as set out in chapter 4 of the Better Births resource pack. Given the wide variety in maturity of MVPs across London, some LMS boards have more service user engagement on their boards than others.


Conversations varied at each Local Maternity System table, but all were provided with a range of coproduction tools to aid discussion. Delegates were asked where they felt service user engagement was in their Local Maternity System based on the Ladder of Engagement

There was also opportunity to use a Values and Manifesto tool from https://www.iriss.org.uk/resources/tools/co-production-project-planner to formulate some shared principles for working together and a rogues gallery to learn more about each other and promote collaborative working.

Plenary session:

At the end of the day, each Local Maternity System group was asked to feedback one key learning that they would take away from the group. There were some great action points, including using the 15 Steps for Maternity Toolkit and finding a way of ensuring that MVPs have a voice at LMS level.

A few questions and issues emerged from the ‘park it’ board.

  1. How do MVPs secure funding? Who pays?

 The Better Births resource pack states: ‘The maternity commissioner is responsible for facilitating and organising any agreed funding’. (p.18) This means it is the responsibility of the Clinical Commissioning Groups to ensure MVPs are adequately resourced.

  1. Is there a network for chairs of MVPs?

YES! There is a multidisciplinary London MVP network Facebook group and a national MVP chairs peer support Facebook group. There is also a multidisciplinary National Maternity Voices Facebook group. There is also an opportunity for London chairs to meet face-to-face quarterly. Some have also created their own Local Maternity System networks.

  1. Training for chairs of MVPs

This request for further resources to support chairs is one that has been heard from various sources and requires further collaborative work from the London Clinical Network, the London MVP strategic group and National Maternity Voices. Watch this space!

The day finished with a chance for people to continue those important conversations and celebrate with each other. As people left, the buzz of chat and comments overheard suggested that they were feeling energised, supported and had relished the opportunity to come together. I think we can safely say that #LdnMatVoices18 was a great success. We’re already looking forward to #LdnMatVoices19!

 

 

 

 

 

NHS England Patient and Public Voice (PPV) Partners Training available for Maternity Voices Partnerships

These two-day training courses are for patient and public voice partners involved in NHS England or supporting transformation programmes on a regular basis.

The course aims to support PPV partners to gain a clear understanding of their roles and responsibilities in order to effectively contribute to improving NHS England services.

Through the course we will explore how you can effectively work in partnership with a range of stakeholders to influence change and develop your skills and confidence – making the most of your role.

Travel expenses and overnight accommodation will be provided based on individual need. No involvement payments will be made. Course dates as follows:

  • Tuesday 6 and Wednesday 7 Nov 2018 – London
  • Wednesday 16 and Thursday 17 Jan 2019 – Manchester

How to apply: To register, please contact england.ppve-learning@nhs.net

Details of this course and others can be found on Learning for NHS England PPV partners and staff working with partners (non-accredited courses)

NHS England’s Public & Patient Voice Partners training – from the perspective of a Maternity Voices Partnership Chair

“In my role of established MVP chair and LMS board service user representative; I attended the NHS England PPV Partners training in March 2018. Although it was a big step out of my comfort zone, I am very pleased I went and would recommend it to both new and experienced MVP chairs and reps.

The course is well facilitated by Wendy and Helen who cover a range of topics over the two days, using different learning styles and levels of involvement to keep it interesting and engaging for everyone. Some sections are fairly brief, but plenty of background/further reading is available for more in-depth information. I was pleased to meet members of the NHS Patient Participation Team, led by Gillian Fletcher, who also attended. They are very keen to support MVPs and hugely enthusiastic about their work ensuring the voice of NHS service users is heard and NHS services are co-produced.

As well as the knowledge and skills I gained, it was a great networking opportunity: I met people from all over the country in similar roles to ours within different parts in the NHS. I found it equally assuring and disappointing that they are facing similar challenges to patient involvement in other services and useful to hear how they have overcome the hurdles. Everyone was keen to hear about the amazing work of MVPs around the country and found our networking, support structure and shared learning inspirational.

Travel and accommodation expenses are covered, so if you have the time, energy and childcare available this is a very worthwhile venture!”

Ruth Prentice @Ruthtalksalot

Free accredited training – Understanding the Health and Social Care Environment

Places are available on the Understanding the Health and Social Care Environment (UHSCE) online training course, which is accredited by Certa. The course is divided into three sections: about the stakeholders, about tools and methods for influencing health and social care, and about how you can present your community issues to have maximum impact for positive change. There are two rounds of the course starting on 04 September 2018 and 06 November 2018.

The course ends with a full day of assessed presentations accordingly on 27 November 2018 (for the course starting on 04 September) and on 5 February 2019 (for the course starting on 06 November). The final day gives participants an opportunity to share their projects they have been working on as part of the course, gather practical advice on how to develop their work further, and to network.

The training received excellent feedback from volunteers who participated in previous cohorts. Take a look at the course advert (110KB PDF) outlining what the course will cover and application form (875KB PDF). For more information about the course and how to apply please email: england.ppve-learning@nhs.net or lisa.ramsey1@nhs.net.

There is further information on learning and development and learning for patients and the public (accredited courses) from NHS England.

#NHS70

On the 70th birthday of the NHS, a message from Lisa Ramsey, Service User Voice Policy Manager for the Maternity Transformation Programme at NHS England, who works closely with our national committee on supporting Maternity Voices Partnerships.

“It’s Thursday 5th July and today marks the 70th birthday of the NHS.  We all see improvements that could be made to the NHS, but today is all about celebrating all that is great about the National Health Service.  We are celebrating the mere fact it exists. Having an NHS means when your child has fallen and bumped their head you have 111 to call for advice, when you need help in an emergency you can head to A&E and when you have something you need to see a GP about you can.  The NHS is all of ours to use as sparingly as we can.

How fortunate that #NHS70 is falling mid-way through a 5 year maternity transformation programme.  Maternity care is being transformed across England to become kinder, safer and more personalised. That means looking after maternity staff well and ensuring they train together and work well together. It also means ensuring every woman has the opportunity to know and trust her midwife and see the same midwife throughout her maternity journey.  It means families are prioritised, not just women or babies and everyone’s mental and emotional health are important as well as physical health. It means the experience of being pregnant, giving birth in the place you choose and feeding and caring for a new baby is as important as health.

So today, find someone to have a cuppa with and tweet yourselves to celebrate #NHS70!”

Better Births Two Years on event

National Maternity Voices (NMV) are delighted to be part of the Better Births Two Years on event this Tuesday (27th March 2018) at The Midland hotel Manchester.

Come and find us at the ‘Market Place’ which is running over lunch between 13:00 and 14:15 in the Octagon lounge and Trafford suite. Look out for our pop-up banner and come and say hello if you want to find out more about how Maternity Voices Partnerships (MVPs) can and should be at the heart of Better Births!

We will also be holding a series of pop up talks during lunch in the Midland lounge. NMV committee members Cathy Brewster and Emma Crookes will be talking about what newly formed Maternity Voices Partnerships (MVPs) need to get going at 13:45-13:55 followed by Sandra Guise and Laura James discussing what established MVPs can achieve at 14:00-14:10.

The Better Births 2 years on event will also see the launch of the 15 Steps Challenge for Maternity developed by Lisa Ramsey of NMV in her role as Service User Voice Policy Manager for Maternity at NHS England. The Fifteen Steps for Maternity toolkit is designed especially for use by Maternity Voices Partnerships (MVPs).  These local teams of service users, midwives, doctors and commissioners can use the toolkit to enhance collaborative working so that together improvements to maternity services can be identified and delivered.