The Antenatal Teacher
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Hi Natalie, thanks for talking to me. Could you tell me a little about who you are and what you do?
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My name is Natalie Misaljevich, I’m a mum of two delicious little people who are growing up far too quickly, an antenatal educator and a birth doula (birth companion). I teach from our home in Ally Pally and elsewhere in North London for the NCT and Bump and Baby Club, and I support expectant parents as a doula in and around north London.
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As someone working in the antenatal period, I’d like to ask you about one of the themes of the campaign. Many women felt let down by their antenatal education, in that it didn’t speak enough about possible negative outcomes. How do you think we can get the balance right between sharing information and not raising anxiety?
It’s a good question! My approach on this is evolving because I’m aware that - despite exploring the complexities of birth in classes and what can happen when birth isn’t straightforward and how that can feel - sometimes women and couples say they didn’t feel prepared for the realities of their experiences. A good route in can be to talk about a range of scenarios and birth stories with expectant parents, and also the role of birth plans. Are birth plans a friend or a foe; do they raise expectations and contribute towards a gulf of disappointment between hope and reality; is it better just to go with the flow; are they simply a wish list - liable to be thrown out of the window; would it be more helpful to give thought as to what might help or hinder the chances of realising those wishes; could they enable women to explore a range of scenarios and help them to consider what would make their worst case scenario more manageable - and in doing so could that help to reduce anxiety? It’s helpful too to explore the factors that contribute towards women and their partners feeling that birth was a positive experience - particularly when it wasn’t as straightforward as they’d hoped - and what can contribute towards birth trauma, and the support available to women and couples when birth has been traumatic.
Discussing the prevalence of postnatal depression is something I always discuss with parents. Men are often surprised to discover it can affect them too. We talk about how one might recognise the signs and symptoms of PND, the different sources of help and support available, and the benefits of thinking ahead about creating a postnatal wellbeing plan. To be forewarned is to be forearmed! Discussing these issues in class makes it easier for parents to talk more openly about how things are going if they are struggling, and to ask for help when they need it. In fact a parent reached out to me today for recommendations for support with birth trauma and PND - I don’t think that would have happened without the conversations in class some months ago.
Ultimately, it can be a challenge to walk a line between building confidence and ensuring parents are prepared for a variety of situations and outcomes - not least because within a group individuals come with very different starting points, beliefs, hopes and fears. My aim though is to help all parents feel more confident in their abilities to birth and parent - and in their abilities to cope with whatever birth and parenthood has in store for them. That means anticipating both the joys and the challenges - and thinking about the support that could help to make their journeys easier.
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I’ve noticed that there doesn’t seem to be any regulation of antenatal education. How do you feel about that?
Regulation of practice for NCT teachers is rigorous, ongoing, and designed to ensure high-quality provision – which is right, because families deserve the best! Personally it took me four years of part time study and training before qualifying as an antenatal educator and I undertook a further year of study with an emphasis on experiential learning to become a doula. The emphasis on reflective practice means we continue to take our learning forwards. It’s been a big and often challenging journey, but transformative and rewarding too - I feel I’ve grown and developed as a person, as a parent, and as a practitioner – and all of this benefits my work with parents.
As you can see from the themes of the campaign, a lot of women talked about how medical staff influenced their experience – both positively and negatively. Do you have any thoughts on that?
Let me say first and foremost that I think the NHS is a wondrous institution that we are blessed to have, and that I have the utmost respect and admiration for the wonderful midwives, nurses and doctors working within it! The financial and other constraints that are heaped upon the NHS and its staff, however, in my opinion, can cause staff to be amongst other things, time-poor. At the same time, there is a culture of fear and an over-emphasis on risk management in maternity services, which in my opinion does not service to enhance safety or serve families well. This is compounded by a lack of continuity of care, so that at a uniquely vulnerable time, women are unable to build trusted relationships with those caring for them. These factors can combine to result in women and their families being denied genuinely women-centred care. This is a travesty because the evidence is clear that when women are put at the centre of maternity services, and feel supported to make and act on the decisions right for them, safety is enhanced, outcomes are improved, women feel empowered and staff are happier in their work.
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Instead, when for example, a woman develops a risk factor in pregnancy or during labour, all too-often she finds herself on a conveyor belt of routine, one-size fits all care. Guidelines and policies are there to help ensure a good standard of care, but these should act as a starting point for more nuanced discussion whenever possible – which encompasses exploration of the pros and cons of any course of action - and the alternatives - quantifies risks and how these relate to the unique individual concerned, and is honest about the unknowns and grey areas. In the right environment, medical staff can help women to navigate these complexities and to feel empowered and well supported as a result.
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What do you wish that women and their partners knew about birth?
That there is more than one truth about birth! When the stars align with continuity of women-centred care, a woman and her partner feeling confident and ready, who are supported by known and trusted care-givers, whose baby is healthy and well, and in a good position in-utero, the birth experience has the richest potential to be profoundly empowering. It can be transformative, and, as the gateway to new parenthood, can help to build the firm foundations for family life. But this is just one truth, and there are many other, equally valid, and important others. Different starting points, beliefs, circumstances, care-givers, and an element of luck, can all combine to create different stories, different truths. Women and their partners need to know what they can do to stack the odds in their favour AND have a safety net in place to catch them, should they need it.
Lastly, how do you think we can make birth better for everyone?
Far reaching societal change?! If we saw families (in whatever shape or size they come in) as central to a healthier, happier future; if we genuinely valued motherhood and saw all its unseen work; if we truly recognised the rich rewards for - and of - fathers being fully involved in family life (and destroyed the gender pay gap to boot!) and appreciated babies and children as the citizens of tomorrow, then education and health services would look very different indeed! Until then… we have to keep on caring…each doing our bit, making a difference, in whatever way we can, caring for mothers, fathers and babies with love and compassion and a sound evidence-base! The more we all come together and unite to do that, the greater the chance we have of making birth - and life - better for all.
Thanks for talking to me, Natalie.
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