Tuesday, 26 August 2014

Nurturing New Families

Another review of a book very kindly sent to me by Pinter & Martin. If I suddenly became money- and time-rich I'd buy their whole catalogue as a job-lot and shut myself away to read it start to finish, and you can see from my recent post how much I loved Dynamic Positions in Birth so I had high hopes for this one.

The book, by ex-midwife Naomi Kemeny, is about the work of postnatal doulas. It's aimed mainly, as far as I can tell, at those setting out to work as a doula, or perhaps considering doing doula training.  I wanted to read it because I hoped it would give me more insights into my work as a breastfeeding counsellor, and also because in one of my fantasy worlds I do work as a doula - probably not in any real world, as it brings in a lot less towards the bills than being an accountant does - but when I'm sitting around sighing about not having more babies, then I get into all sorts of wild imaginings about how I could stay involved in the world of wonderful pregnant mothers and thrilling births and enchanting newborns..ahhhh...babies babies babies.

I want to say I loved it, but I didn't. I liked it, and I could see why its exact target audience would enjoy it, but it just wasn't quite clear to me exactly what it was for. There's all sorts in there - practical tips about newborn care, ideas for things that new mothers might like to eat, information about breast and formula feeding, brief pieces on "baby blues" and postnatal depression...but somehow at points it reads like a bit of a brain dump, a sort of "remember to put a hat on a baby when it's outside, oh and cat nets are good over cots but they won't stop insects, and remember always to spend time checking what the new mother wants". Perhaps what I mean is that for me, it doesn't flow quite as well as I'd hoped - there are themed chapters but they do seem to go off topic.

Two other more fundamental things for me (since that first is really just a stylistic comment, and might serve to make it a more interesting and varied read, with a more human tone, than if it was very strictly segregated into topics) are the breastfeeding information and the implied attitude on attachment.
On attachment, there were just a few places where the author talked about taking the baby so the mother could rest, including a sample timetable of a day where the mother feeds her baby, then when he sleeps she leaves the baby with the doula for around three hours and goes for a sleep. In this, and other places, I wanted it to talk about supporting the mother in her mothering, not about removing the baby so the mother could have "me time" (tbf, she doesn't phrase it like this). Why can't the baby nap with the mother while the doula does the washing up? I see it as so crucial that a mother-baby dyad, particularly when nursing, remains together as much as humanly possible, so I prickled at any of the bits where it was suggested that the doula might do baby-tasks. I know I'm at the crunchy hippy end of things, and the book's meant to have a wider reach than that, but perhaps it could have had more balance by making it very clear that many mothers like to have a very intense relationship with their newborns and will enjoy being encouraged to keep them close as much as possible, which is also hugely beneficial to the breastfeeding relationship (in the example above, a 3 hour gap is pretty unlikely with an 8 day old baby!)
And so onto breastfeeding. There's nothing inaccurate as such in there, but the pictures aren't great, and I felt there was a slight impression of "here's everything you need to know about breastfeeding in a couple of pages". I'd have liked to see more emphasis on helping the mother to find appropriate breastfeeding support, and an acknowledgement that there are plenty of very rich resources out there.
Actually this comes back to my issue overall with the book. Breastfeeding, baby care, baby development, post-natal depression...they're all big, big subjects and to do them justice you need books dedicated to them. In my imagination people working as doulas will have a whole set of favoured reference books that address these topics, so I'm not sure quite what one overview will add - there's not enough detail on anything to replace a specialist book.
And this sort of explains my slight disappointment. I was hoping for more on the emotions of new motherhood, the real nuts and bolts of how to understand and provide the kind of emotional and practical support a mother might need, and although there are pieces about this (which were my favourite parts) there was, for me, too much clutter about things like which baby equipment you need and how to prepare a bottle.
Just one more thing - the odd piece that recommends reassuring the mother, for instance when her baby is very jerky. Reassurance is nice, and desirable, but I worry that there's a suggestion of being The Important Reassuring Expert. Unless the doula is medically trained (as midwives and health visitors are) I'm not sure she's well enough placed to reassure parents that the level of jerkiness they're seeing is normal rather than something alarming. Perhaps there should just have been a little bit more emphasis on encouraging mothers to seek qualified advice if they're concerned, rather than reassurance in areas where the person providing it isn't likely to be an expert. 
It would be useful for someone right at the beginning of looking into becoming a doula, perhaps someone whose own baby experience was some time ago so they would like a refresher on the basics before reading and learning more deeply. I'd love to see a follow up that looks more at the emotional side of things, with (slightly better attributed) quotes from mothers and practising doulas (there's an appendix of longer stories which were fascinating and gave a vivid picture) - the advanced course, if you like.

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