Fathers Direct has analysed the new National Service Framework for Children, which defines core standards for health and social services in England.  The analysis focuses on standards relating to ante-natal and post-natal care.  The NSF states: “The National Service Framework supports a cultural shift in all service provision, to include fathers in all aspects of a child’s well-being.”  It refers to this website as the source of further information regarding this cultural change.

The role of parents in caring for children

Parents are the main providers of health care for their children, particularly in the early years.[1]  “Parents (both mothers and fathers) or carers are fundamental to creating a nurturing environment, particularly in the early years.”[2]  Babies need early and ongoing contact with their mothers and fathers.[3]  The vision of the NSF is confident parents, able to bring up their children in a way that promotes positive health, development and emotional well-being.[4]  Parents must be enabled to care for their child after the birth.[5]

A key to meeting the baby’s needs, therefore, is a partnership between professionals and parents, starting before the birth.[6]  Parents are to be actively involved in decisions about the child’s health and well-being[7] and be properly informed of the results of all screenings.[8]  Parents are to be given increased information, power and choice over the support and treatment they receive.[9]  Maternity services must include effective family support, focussed on those with high needs.[10]   Care of the child requires an assessment of the needs of the child’s family as well as of the child itself.[11]  Early identification of risk factors in the child’s environment is required.[12]

A new model of maternity care: women focussed, family centred

Maternity services, therefore, are simultaneously about meeting the needs of women who are giving birth, about preparing both parents for the transition to parenthood and about assessing the family environment in which the baby is going to be cared for: “women focussed and family centred”. [13]  Midwifery and obstetric services will be based on “providing good clinical and psychological outcomes for the woman and baby, while putting equal emphasis on helping new parents prepare for parenthood”.[14] 

Parents means mothers and fathers

The word “parents” is defined as shorthand for “mothers, fathers, carers and other adults with responsibility for caring for a child”.[15]  Standard 11 on maternity services includes women’s partners and families.[16]

The NSF emphasises the need to for the word “parent” to include both mothers and fathers.  “The National Service Framework supports a cultural shift in all service provision, to include fathers in all aspects of a child’s well-being.  See www.fatherhoodinstitute.org.”[17]

The importance of involving fathers around the birth

“The role fathers in parenting their children is frequently overlooked.  Their contribution to their child’s development and well-being is important.  Good parenting by fathers can significantly promote their child’s development….Good parenting by fathers is associated with better mental health in children, higher quality of later relationships, less criminality, better school attendance and behaviour, and better examination results.”[18]  Children who have fathers living in the same household receive on average a third of their parenting from their fathers.  Fathers’ sharing in the wider responsibilities of parenthood is of vital importance.[19]

“Involvement of prospective and new fathers in a child’s life is extremely important for maximising the life-long well-being and outcomes of the child (regardless of whether the father is resident or not).  Pregnancy and birth are the first major opportunities to engage fathers in appropriate care and upbringing of their children.”[20]

Partners, fathers, family and peers may provide significant influence and support for women using maternity services.[21]  Maternity services should seek to engage fathers[22], as well as community maternity services through Sure Starts and Children’s Centres.[23]

Parenting education and family support services, including preparation for the birth and around the time of the birth, should routinely include fathers.[24]

Actions for maternity services: the birth

Maternity care providers and PCTs should ensure that birth environments are welcoming to fathers and other birthing partners.[25]

Actions for maternity services: information for parents

The NSF contains many provisions for information to be given to parents, as the basis for partnership between professionals and parents.[26]  The information must be consistent and responsive to their needs, non-directive and sensitive to development, cultural, social and language differences.[27]  Information includes the Birth to Five guide for all parents.[28]  Standard 1 specifies a Child Health Promotion Programme that outlines a timetable for information to parents ante-natally and post-natally.[29] 

Subjects on which information is to be given to parents are the following:

• Services and the choices available to parents.[30]
• Preparation for the birth.[31]
• The transition to parenthood and parenting education.[32]
• The legal concept of “parental responsibility.[33]
• Healthy pregnancy, including the need for folic acid and pre-pregnancy rubella immunisation.[34]
• Smoking cessation and a smoke-free atmosphere.[35]
• Minimising alcohol consumption and the use of recreational drugs.[36]
• Breastfeeding, bottlefeeding where breastfeeding is not possible, weaning.[37]
• Immunisations.[38]
• Emotional and psychological changes around the birth and information on mental health problems, including post natal depression.[39]
• Reducing risks of sudden infant death, accident prevention, first aid, and life-saving skills for babies.[40]
• The importance of parents’ relationship with the baby, especially communicating with babies from birth.  How to nurture babies.[41]
• Healthy lifestyles, diet.[42]
• Local community support groups and national voluntary agencies and websites.[43]

Actions for maternity services: targeting information and support

Certain groups of parents want more information than they currently get: first-time parents, fathers, young parents, those who are in disadvantaged or minority ethnic groups.[44]  PCTs and Local Authorities should provide targeted provision of information and support to fathers as well as mothers.[45]

Information needs to be backed up by active support where there are particular needs.

• For parents who find it hard to access services and professionals.[46]
• For high risk groups – support to enhance sensitivity to the baby and improve attachment.[47]
• Parents wishing to stop smoking or who are drug users.[48]
• Parents who have mental health problems.[49]
• For parents with a family history of a genetic disorder and those concerned about familial disease or disabilities.[50]
• For parents undergoing relationship problems.[51]
• For parents experiencing a problem with the unborn baby.[52]
• For parents with an ill baby.[53]
• For parents experiencing bereavement.[54]
• When a parent is coming out of prison.[55]

Teenage parents need tailor-made maternity services.[56]  A positive relationship between young parents is a key predictor of the father’s involvement with his child in the early years.  Maternity services can support this relationship.[57]

Sure Starts provide community based ante-natal advice and support to all pregnant women and their families in the 20% most disadvantaged wards.[58]  In future, improved take-up of maternity services can be achieved by co-locating them in Children’s Centres.[59]

Actions for maternity services: planning services with parents

Parents should be involved in planning their care and services.[60]  During planning and delivery, services need to be seen through the eyes of the family.[61]

Core skills

Core skills for all those working with children include effective communication and engagement with parents.  In addition, skills are required in assessing parents’ capacities to respond to children’s needs.[62]  Health professionals need skills in engaging with teenage mothers and fathers.[63]  Midwives and health visitors working for PCTs and Local Authorities should have staff who are trained in the importance of supporting fathers and have the skills for engaging with fathers as well as mothers.[64]  Training to deliver these standards will need to be addressed centrally through national workforce planning.[65]

Footnotes

1 Standard 1, 2.1, p.23
2 Standard 1, 4.4, p.44
3 Standard 11, 10.1, p.36
4 Standard 2, p.65
5 Standard 11, 9.1, p.31
6 The Child Health Promotion Programme, which starts before the birth, is delivered “in partnership with parents to help them make health choices for their children and family”.  [Standard 1, p.31]  Planning of care is carried out in partnership with families.  [Standard 1, 3.25, p.38]
7 Standard 3, p.88
8 Standard 1, p.53
9 Setting the Scene, p.9
10 Standard 11, p.7
11 A programme of assessment is outlined in the Child Health Promotion Programme, starting ante-natally and running through to a review two to three years after the birth.  [Standard 1, fig.1, pp.26-29]  The NSF promotes physical health, mental health and emotional well-being by encouraging whole families to develop healthy lifestyles.  [Setting the Scene, p.9]
12 Standard 1, 2.2, p.23
13 Standard 11, p.43
14 Standard 11, p.4
15 Setting the Scene, p.18; Standard 2, p.65
16 Standard 11, 1.3, p.3
17 Standard 2.2, 3,7, p.70
18 Standard 2, 3.6, p.69
19 Standard 2, 2.4, p.67
20 Standard 11, 5.6, p.11
21 Standard 11, 3.4, p.8
22 Standard 11, p.8
23 Standard 11, p.14
24 Standard 2, p.74
25 Standard 11, p.29
26 Standard 3, p.88
27 Standard 2, p.65, Standard 3, p.93; Standard 11, 7.3, p.18
28 Standard 1, p.43
29 Standard 1, fig.1, pp.26-29
30 Standard 3, 5.1, p.93
31 Standard 2, p.74; Standard 11, 7.4, p.18
32 Standard 2, pp.71,75; Standard 11, 7,4, p.18; Standard 11, p.34
33 Standard 2, p.72
34 Standard 2, p.71; Standard 11, Box 2, p.17
35 Standard 1, fig.1, pp.26-29; Standard 2, p.71; Standard 11, pp.16,17
36 Standard 11, Box 2, p.17
37 Standard 1, fig.1, pp.26-29; Standard 2, p.71; Standard 11, Box 4, p.32
38 Standard 1, p.35
39 Standard 1, fig.1, pp.26-29; Standard 11, p.22
40 Standard 1, p.50; Standard 2, p.71; Standard 11, Box 4, p.32
41 Standard 2, pp.71,75; Standard 11, Box 4, p.32
42 Standard 2, p.71; Standard 11, Box 4, p.32
43 Standard 11, pp.19,34
44 Standard 2, p.65 and p.74; Standard 11, 7.3, p.18
45 Standard 2, p.70
46 Standard 2, p.65
47 Standard 2, p.74; Standard 1, Box 2, p.46
48 Standard 11, p.5; Standard 11, 7.2, p.18; Standard 11, Box 4, p.32
49 Standard 11, p.5; Standard 11, 7.2, p.18; Standard 11, Box 4, p.32
50 Standard 11, 6.3, pp.15,16
51 Standard 2, p.71; Standard 11, Box 4, p.32
52 Standard 11, 7.18 and box, p.26
53 Standard 11, p.37
54 Standard1, 10.7, p.39; Standard 2, p.71; Standard 11, Box 4, p.32
55 Standard 2, p.81
56 Standard 2, p.82
57 Standard 11, 5.7, p.11
58 Standard 11, Box 1, p.12
59 Standard 11, p.14
60 Setting the Scene, p.9; Standard 3, 3.4, p.90; Standard 2, p.84; Standard 11, 3.3, p.7; Standard 11, p.8
61 Standard 3, 3.1, p.90
62 Standard 3, p.115; Standard 11, 12.2, p.42
63 Standard 11, 5.7, p.11; Standard 11, p.13
64 Standard 2, p.70
65 Setting the Scene, p.17