The changing picture of parenting

Traditionally, pregnancy and parenting experiences were communicated through a framework of influential family members and neighbours. From early life, the burden of child-rearing was shared and learnt through play and chores.

Is this a bygone experience? Not necessarily, but parenting dynamics are clearly different now, in many British homes: households are smaller, more families are geographically separated, and first-time mums are older. These changes have different effects on how parents seek guidance. For example, those without local, unconditional, support may be more reluctant to ask for help until things become critical. Sue Ormesher from Parentline Plus explains that 45% of callers to this helpline are parents who feel isolated.

Other research clearly indicates that family and friends remain the main providers of parenting support^1-3. Such networks are most valued and trusted, especially by those who find social or health-related services difficult to access. In particular, working-class and ethnic-minority families retain their local support networks^2,3, even when physically distant, as shown in a study in second-generation Italian families^3.

Healthcare professionals

Research into parents’ perceptions of healthcare professionals advice has had mixed findings. On the positive side, although a survey by The National Family and Parenting Institute identified family and friends as major parenting influencers, the 2059 respondents clearly valued healthcare professional guidance.⁴ Nearly half of the respondents wanted parenting to be included in the school curriculum and 33% said that parenting classes, run by healthcare professionals, would be very useful^4.

Unfortunately, 1100-plus parents interviewed by the Economic and Social Research Council in 2002² frequently associated healthcare professional advice and guidance with intrusion, unless it was for welfare needs such as housing or education. Working-class parents were more likely to be dismissive and distrustful of authority figures, especially professionals who relied on ‘textbook’ theory when giving practical help, or who hadn’t had children themselves².

Middle-class parents included in this survey were more comfortable with approaching healthcare professionals for advice, perhaps because they knew – or were – professionals of similar educational and social stature. The research describes such parents as occupying ‘positions of power’ when they wanted support, viewing themselves as consumers rather than clients ^2.

While socio-economic status is clearly important in how people value, or mistrust specific advice sources, it is not the only factor. Experiences described by many of the parents whom I interviewed reveal the importance of selfconfidence. Many working-class children of the 1960s–1990s, who helped to nurture younger siblings and neighbours, left their birthplaces for work or college opportunities. By the time they become parents, although they are more likely to see authority figures as equals, few have changed nappies or seen breastfeeding babies for years. Consequently, their confidence in parenting is weak. ‘It’s not easy to tell your family that you aren’t coping, when they live too far away to pop in for a cuppa and a chat,’ says Jo. Especially if, before you became a parent, they viewed you as a capable career woman.

For isolated parents – whether or not they are highly qualified professionals themselves – speaking to a confident, capable, and nonjudgmental healthcare professional is valuable. Tanya, a carer who lives miles from family, summed up the general picture. ‘My first health visitor was inspirational.’ She told me, eyes lighting up at the memory. ‘She was there for me and I trusted her with everything.’

Younger mums like 19-year-old Sally, who I met at a local family centre, have different views. ‘I don’t get on too well with my health visitor’, she confessed. ‘I feel that she is judging me. She seems to be waiting for me to make mistakes so she can correct me’. While researching this article I found indications that teenage mums are more likely to be mistrustful or insecure about external services ⁵, and rely heavily on their own mums for support, even asking them to engage in dialogue with healthcare professionals on their behalf.

SureStart

Service provision for young parents was one of the few areas of concern identified in preliminary evaluations of SureStart programmes, in 2005⁵. Clearly, the vast majority of SureStart programmes have been highly successful at empowering families⁶. However, there are some indications that teenage mums and those on very low incomes still find it difficult to seek (and benefit from) these services. This may be because they view SureStart as a symbol of authority, although the research urges us not to draw firm conclusions as these initiatives are still developing⁷. Ongoing research into SureStart should identify precisely which strategies of information provision are particularly effective for the most wary and vulnerable⁵.

Recognising communication problems

The way that healthcare professionals communicate with families, not necessarily the advice itself, can limit parents from valuing guidance. Barriers might be the result of parents’ wariness and negative preconceptions of ‘professionals’, or cultural differences that are unknowingly overlooked. It is helpful for healthcare professionals to acknowledge the strength of local influences, and work with them when communicating evidence-based information, so that intervention is not viewed as intrusive or unhelpful.

For example, in communities where mothers speak little English, advice is more likely to be valued if the format is clear, written in appropriate languages or with good illustrations – and the target group has been involved in its development. See our Multicultural article at the Professional issues, Policy & Legislation area of www.in-practice.co.uk for more details on these issues.

New media sources

It is unsurprising that seeking advice from a healthcare professional is not always easy, given current caseload burdens and lack of consultation time. A dad vented his frustration: ‘You try your surgery and it’s not important enough for your doctor, but the health visitor is on answerphone. NHS Direct isn’t the right place to ask about bed-wetting or my girlfriend’s morning sickness.’
So, while parents wait to share their problems with a healthcare professional, telephone support lines and websites become attractive options. Several commercial and charitable organisations now operate these services, spending millions of pounds each year to ensure that the information being delivered is current, accurate and objective. Investment is paying off, because these forms of support are welcomed by parents.

Helplines

Nurse Eileen Cook – one of Cow & Gate’s Careline, telephone and e-mail advisors – explained how the service has a fully-trained call team. Comprising both healthcare professionals and experienced mums, the Careline supports people seeking all types of child-related advice. The Careline receives on average 1000 calls per week. ‘Parents really value the information. We get thank-you letters constantly’, she explained.

Like all reputable helplines, the Careline provides information that is not commercially driven and is based firmly on good UK healthcare professional practice. Advisors give information that conforms to UK and WHO health guidance. Typically, parents who call this helpline are in their late twenties and thirties. They are very willing to accept the advice – and tell their friends about the service. ‘Research tells us that a lot of mums contact us because of word-ofmouth’, Eileen explains.

Phone support is also very useful for mums like Jo, who find advice on leaflets or websites quite bewildering. ‘I’ve used a phoneline as a sounding board’ she explains. ‘It’s easier to run through things with a person on the end of the line’. Eileen agrees with this, adding that many callers to the Careline are fearful at first. ‘You have to be quite a confident person to ring,’ she says. ‘Callers often describe their problem as “silly”, but it’s not a silly question it is just that you don’t have the experience to know the answer yet’. Talking through a problem on a helpline can also give a parent permission to go to a healthcare professional, making them feel comfortable that they are not wasting consultation time.

Parenting websites

The internet is rapidly becoming a major information source for families, through home computers and free internet links in the community. To illustrate the growth, in January 2006, Approximately 300 questions were posted on the Cow & Gate website; in January 2007, there were nearly 1800.

‘Even if I’ve got an appointment or I’m waiting for a call back about a problem, I always look on the internet,’ says Tanya. Parents may like to use the internet for information because they feel in control of its provision: they choose which websites to visit, and how much detail to read. Tanya acknowledges that it can be hard to tell whether information is genuine. ‘I go for advice if it’s on a website I can trust – like the BBC one, or other companies or charities I’ve heard of’. Parents often bring web literature to the surgery – which can be disconcerting for healthcare professionals. Don’t dismiss the information source without reading it; say nothing rather than be negative. It’s always important, however, to steer parents away from dubious sites that are anecdotal and sensationalist.

Websites also cater for different types of advice seeker. Reading leaflets or web pages enables less-confident parents to tackle problems without speaking to anyone: in a typical month, 3,387 leaflets are downloaded from the Parentline Plus website. Others are keen to join interactive services and post questions. Many parents seek (or answer) advice on website discussion forms, like those on the Cow & Gate site. But one of the most innovative web services for advice seekers is the very popular Neighbourhood Mums network on the Cow & Gate website. Neighbourhood Mums goes beyond being an electronic place for people to swap pregnancy and parenting experiences. It puts parents in touch with each other, ena

Reality TV

Reality TV shows have become primary sources of parenting information, and the advice they provide is highly valued by families. A National Family and Parenting Institute (NFPI) survey reported that 95% of 494 parents found that TV parenting programmes helped them to address issues affecting their families8. Over half the respondents changed parenting behaviours as a direct result of watching reality shows, and 65% felt that their children’s behaviours had also changed4. Almost half (48%) of the parents said that their confidence increased through watching TV programmes on parenting, and in 37%, communication between family members had improved4.

The influence of reality TV shows is particularly important for parents who are less comfortable with authority figures like healthcare professionals. ‘Parents who feel stigmatised by mainstream support, or who are reluctant to seek help… could find the anonymity of advice from TV parenting programmes useful and supportive’, says Sophie Linington from NFPI.

Summary

Where parents turn for advice can be summarised in the content of an unpublished report by Jan Fry, of Parentline Plus. ‘Most parents need a mixture of information, advice and support across a spectrum of need,’ she comments. Parents need to remain in control – they are the experts on their children.

Healthcare providers need to recognise issues that some parents have with authority figures, and listen to the questions that all parents raise. Informal networks will remain the main – if not the only – place where most seek help. But parents still need healthcare professionals and other support providers for emotional guidance, and to point them in the right direction so that they can find answers from across the range of services available.

The Cow & Gate Careline lines are open 8am to 8pm Monday to Friday and can be reached on 08457 623 623

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References:

Daly A et al. 1998 J Hum Nutr Dietet 11:381-89

Edwards R, Gillies V. http://www.lsbu.ac.uk/families/workingpapers/familieswp14.pdf
Accessed 8 February 2007

Zontini E. http://www.lsbu.ac.uk/families/workingpapers/familieswp6.pdf
Accessed 8 February 2007

http://www.familyandparenting.org/Filestore/Documents/Where_Do_Parents_Turn_For_Advice.pdf
Accessed 7 February 2007

http://www.surestart.gov.uk/research/evaluations/ness/latestreports/
Accessed 8 February 2007

http://www.surestart.gov.uk/_doc/P0002379.pdf Accessed 8 February 2007

http://www.surestart.gov.uk/_doc/P0001867.pdf
Accessed 8 February 2007

http://www.familyandparenting.org/Filestore/Documents/Where_Do_Parents_Turn_For_Advice.pdf Accessed 9 February 2007