Preparing for the next pregnancy
Parent support groups and parenting professionals sometimes say that preconception health, education and care are not their business. They rightly see themselves as helping people who already have children. That's understandable . . . but not the whole story.
First, many of the parents with whom you work will have more children. Helping them to prepare well for the next baby benefits everyone involved.
Second, truly assisting today's mothers and fathers could, and should:
- Help parents learn from their previous pregnancies and post-natal experiences (what went well that should be repeated, as well as what went wrong that should be avoided or prevented next time);
- Encourage mothers and fathers to make the next pregnancy a meaningful, well-informed, empowering choice (not just something that happens to them); and,
- Understand that parents could, and should, have many opportunities to prepare for - and dramatically increase the chances of - actually getting what they already want (a safe pregnancy, a healthy baby and a rewarding parenthood).
Third, preconception health, education and care happen in various ways across the life course (not just the months before pregnancy). And, parenting groups (not solely health professionals) can positively influence pregnancy and birth outcomes.
To date, preconception (and interconception) health, education and care have been 'under the radar' and too often overlooked. That should change.
I recently wrote two e-publications you might find useful. The main report -'Missed Periods: Scotland's opportunities for better pregnancies, healthier parents and thriving babies the first time . . . and every time' - can be found at: http://www.nhsggc.org.uk/media/237840/missed-periods-j-sher-may-2016.pdf . This 35-page 'Plain English' report (including links to extensive references and international resources) is an evidence-based distillation of this vast and complex field. It deals with mental health, as well as physical health; takes a 'life course' approach; deals with additional pregnancies (not just first ones); and, reveals such 'blind spots' as fetal alcohol harm.
Experts in a variety of relevant fields (and Scotland's Chief Medical Officer, Dr Catherine Calderwood, herself an obstetrician) reviewed these reports in advance and have been publicly supportive.
A brief 'taster' version - 'Prepared for Pregnancy?: Preconception health, education and care in Scotland' -- is an introduction for people not yet inclined to read the more detailed primer: http://www.nhsggc.org.uk/media/237841/prepared-for-pregnancy-j-sher-may-2016.pdf
By seeing yourselves in this picture, parenting practitioners can create unique paths - large and small; national and local - to help mothers and fathers prepare well for the next baby. One fundamental challenge is instilling and reinforcing a sense of 'agency' (especially among mothers), i.e. the basic belief that they can, and deserve to, have control over their own reproductive lives.
While individual choices are crucial, it is also true that larger societal forces, political decisions and structural issues can powerfully shape the lives, and limit the effective choices, for the mothers and fathers with whom you work. Therefore, your advocacy on these major cultural, economic and equality issues is also vital in helping this generation - and the next generation - of Scotland's parents and children.
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Dr Jonathan Sher is an independent consultant based in Edinburgh. He can be reached at: jonathan@deltaforce.net