As a trained Occupational Therapist and a mummy, one of my primary interests is in relation to the topic of parenting as an occupation.
When Occupational Therapists talk of “occupations” we are referring to all ‘practical and purposeful activities that allow people to live independently and have a sense of identity…[including]…essential day-to-day tasks such as self-care, work, or leisure’ (RCOT, 2019). Not only do occupations give ‘meaning to life’, they also ‘organise behaviour’ (Polatajko, 1992). However, despite occupations being so important, and central to our identity and what makes us who we are, parenting as an occupation is rarely discussed.
There is a lot of focus upon parenting when it comes to parenting children with additional needs or where the mother is experiencing perinatal mental health difficulties, supporting her in developing skills and tools to perform her role as a mother. Of course, this work is essential, however, we also need to consider the parenting experience more generically in relation to populations and individuals...We need to explore parents’ perceptions of and their experiences as a parent and of parenting, the meaning given to, values and intentionality of parenting. Parents are very infrequently consulted upon this and when they are, consultations are often limited to their attitudes around child rearing (Llewelyn, G. 1994).
Parenting as an occupation is significant due to the parents overall influence on childhood development (Acharaya, V. 2014). However, this support is given once a crisis has been reached or where the child has been assessed as requiring support, rather than Occupational Therapy being available to all parents irrespective of a diagnosis. Occupational therapy services offer reactive rather than proactive support to parents and where support is given, the father’s needs are frequently overlooked. Jennifer Creek’s ‘Occupational Therapy and Mental Health’ (2008), dedicates particular sections within the book to the ‘mothering role’, however this is in relation to the mother having specific perinatal mental health needs. There is no such section relating to fathers or fatherhood, and there is no section dedicated to parents or parenthood. This is not to pick apart the book, because quite frankly it is a seminal piece of work and extremely valuable and relevant, however, it does illustrate that where of the UK Occupational Therapy elite is not mentioning parenthood and parenting more generally within her work, that there are indeed mountains to climb regarding this much needed support.
Occupational Therapists are skilled at supporting with life transitions, with focus regularly given to childhood and adolescent transitions, with transitions experienced throughout adulthood given little weight. As becoming a parent is one of the biggest occupational transitions that anyone will make within their lifetime, I feel that it is incredibly important that Occupational Therapy begins to recognise this and use the skills that Occupational Therapists are equipped with to support all parents, regardless of gender or parental role.
Many new parents experience complex feelings of loss and grief regarding numerous losses, they are leaving their previous life behind and moving into another. Some parents lose the sense of being part of a couple and may be struggling with their new role, with some parents feeling incapable (PANDA, 2017). Of course, these are just some of the difficulties a parent may experience and so often, parents are left alone to navigate through the early stages of parenthood themselves, with various conflicting information and advice given to them, with family or friend relationships also regularly changing too.
Literature and training support that therapists are able to work at an upstream level, tackling the root causes of ill health, diminishing those causes and reducing health disparities (Public Health England, 2015), however when we look to the current support given to parents, it is clear that there is a gaping hole within the healthcare system where upstream support needs to be. By providing this support, the child’s current as well as future mental health would be protected, as well as the parent’s mental health.
On a personal note, at the beginning of January 2018 when I returned home from having my daughter (she had been born on 28/12/17, but I had been required to remain in hospital for over a week to receive ongoing care and support following an emergency C-section and my resulting complications) I was shocked at the lack of support. I was both physically and emotionally struggling. I had no clue about babies despite having attended numerous antenatal classes and NCT, none of these things prepared me for what becoming a mother and a parent would actually be. Everything was a blur in the early days. Our house is small and our bathroom is upstairs and our bathroom downstairs. I struggled with carrying my daughter up and down the stairs, fearing I would drop her; I had no clue how to bathe my daughter properly or change a nappy - though this was soon worked out; I struggled with how to manage my daughter safely when I needed to go to the bathroom. I was unable to lift and carry her easily and even when I was able to take on more strenuous activity following some healing after surgery, I was still struggling with a number of my ADL's (Activities of Daily Living) as a parent - just managing the logistics of everything. I really could have done with an Occupational Therapist and possibly Physiotherapist visiting my home, assessing me on the stairs with my daughter, supporting me with the best way to lift and carry her, to advise me upon how to shower and bathe when I was caring for my daughter by myself; to educate me around my interactions with my daughter and the daily tasks I now had responsibility for. I remember, thinking back to having quite a serious car crash in 2012 where I received support from physiotherapy and occupational therapy in the hospital and then would have (had I not been out of the catchment area due to moving in temporarily with my gran whilst I healed) received support from Occupational Therapists and Physiotherapists to support me with mobilising and to complete holistic checks in relation to my injury and recovery. I cannot see how recovering from abdominal surgery does not warrant such support following a C-section - but I also cannot see why such support, particularly from Occupational Therapy is not granted to all parents, certainly within the hospital environment before leaving, and then I would argue for a short period within the home.
Many parents may access antenatal support both through the NHS and private companies, however, once baby has arrived, many of us are left stumped, unsure of what to do and unsure of who we are, it is likely we experience some occupational alienation, as well as experiencing feelings of joy and grief. Mothers, fathers... all parents regardless of gender or role, require and deserve this support.
In addition to what I've written, studies and anecdotal evidence shows that we now have extra stresses, strains and pressures upon us as parents as we navigate our way through the pandemic with our children. Many parents with slightly older children are experiencing 'Prolonged screen time, disruption to daily routine, frequent arguments, lack of exercise, and stress of exams...[all of which] have been contributing factors to our mental health and wellbeing...' (University of Oxford, 2021).
Maternal mental health services are 'struggling with increased demand' with mothers experiencing increased 'anxiety about giving birth during lockdown without partners present, , fears of losing jobs, heightened levels of domestic violence, bereavement, worries about catching Covid-19, and concern about new infants catching the disease...' (Simpson, F. 2021).
However, we are currently seeing advocates acting in ways to promote change within policy for fathers and birth partners, March 2021 saw introduction of a good practice guide for 'Involving and supporting partners and other family members in specialist perinatal mental health services', published by Kings College London and other organisations of note. Additionally, information is presently being gathered to inform the development of the governments 'Women's Health Strategy'. All of these things are positive and are needed, however, there needs to be more done and going back to the key point of this post, we require existing healthcare services to work upstream to prevent perinatal mental health difficulties for mothers and fathers, or to ensure that parents are educated and able to easily access the support that they need when such difficulties arise.
I experienced severe Perinatal OCD and it was undiagnosed, I fell through the net and it continued to affect me, to a lesser degree, up to my daughters turning 2. I have now had over a year without any symptoms, or where I have almost had a faint shadow pass by in relation to what I experienced but nothing anywhere near the nightmare I was living day to day for those first precious years. I know that had I had support at home during the early days, that the difficulties I was experiencing would likely not have escalated to the point that they did. Support with simple things such as educating expectant parents about the transition that they will experience and doing some ground work with parents around their expectations and roles would be a huge thing with little effort required, then providing support around ADLs (Activities of Daily Living) when learning to navigate parenthood with a baby would also be amazing and offer parents so much support. Occupational Therapist are equipped to support parents with so many of the issues that arise which may seem small from the outside, but to a new parent, they can be mountains to climb.
One of the main reasons that I set up Birthscapes was to provide holistic support and care to expectant and new parents, with a particular focus upon parental transitions and the tools that parents need for this journey. I am constantly seeking further training to expand Birthscapes services and offer parents a fully comprehensive service, providing continual support, which is something that is lacking, certainly within the UK healthcare system.