Nannies and Postnatal Care
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The market in post-natal support is booming, in recognition of the fact that many parents are sent home from hospital much sooner than used to be the case. However, sometimes the choice can be bewildering and it is hard to know what type of help, if any, you will need. Here is a brief overview.
Traditionally called a “Monthly Nurse” by our parents’ generation, because that is how long they would stay, the role of a maternity nurse has developed over the last few decades. Our mothers had the luxury of staying in hospital for 10 days after the birth of their baby. By this stage, many would have given up breastfeeding on the advice of the hospital staff, whose main aim was to maintain order in the hospital. Regular bottle feeding ensured this, so a monthly nurse simply had to continue the four hourly regime already instigated in the hospital. Nowadays, you won’t stay in hospital for more than a few days and you will be encouraged to breastfeed on demand. So when you come home, the main skill you will want your maternity nurse to have will be an awareness of breastfeeding and the issues surrounding it.
However, the relationship will have begun months before this point. You will have interviewed your maternity nurse probably within the first few months of pregnancy and need to use this time to get to know her personally as well as professionally. A good agency will have sent you sufficient background information for you to tick some obvious boxes regarding her experience and qualifications; they should also have performed their own checks on her references, confirmed the veracity of her certificates and taken a copy of her Enhanced CRB disclosure. Your job is to decide whether you could live with this woman 24 hours a day for a month or so. And more importantly, could your husband?
Once you have confirmed with the agency and the maternity nurse that you would like to book her, you will be required to give a start date. This is one of the tricky grey areas of hiring a maternity nurse; if your baby arrives after her booked start date, you will have to pay her 50% of her fees. This is maddening for you as the client. It is also frustrating for the maternity nurse, who feels guilty at taking money for nothing, but she also has bills to pay. So book your maternity nurse no earlier than your due date, possibly a week after it; most maternity nurses will allow themselves a couple of weeks’ recovery time between jobs, so if your baby comes early she will nevertheless be able to start.
Do call her during your pregnancy – use her as a sounding board for those baby purchases you may feel are unnecessary, or to discuss your progress. Thus, when she arrives in your home, she won’t be a complete stranger. Her duties can be fairly simply explained: she is there to help you settle into motherhood. This will include breastfeeding, teaching you to bath and “top and tail” your tiny baby, ensuring you have a proper diet and plenty of sleep, undertaking your baby’s laundry and keeping the nursery tidy. Most maternity nurses are vocationally driven which means they realise that if you are stressing about the family’s laundry, they will deal with it for you – however, this is outside the normal remit of maternity nursing. And a really good maternity nurse is worth her weight in gold: you will be asking her back for the birth of your subsequent children, she will remain in touch over the years and will no doubt be a welcome presence at your daughters’ weddings!
Less intrusive than a maternity nurse because she only comes at night, your Night Nanny’s main aims will be to ensure you get some good sleep overnight and to encourage your baby gradually to develop good sleeping habits too. Generally, a Night Nanny comes for several nights a week from the birth of your baby until such time as he is sleeping through the night (by 6 months at the latest). But she can also come on an occasional basis to see you through a bad teething time, bout of colic or just until you have recovered from a tiring birth. A good Night Nanny will have sound knowledge of breastfeeding skills, but will also instigate strong sleep associations so your baby begins to understand the difference between day and night. She will work with your baby’s natural development and maximise his Circadian cycle (the body’s internal clock which children use to tell them it’s lunchtime, even if they can’t tell the time!) so that he learns how to sleep for gradually longer periods of time, until he can sleep through the night.
As with a maternity nurse, good Night Nannies can be sourced through a variety of agencies, some of which are dedicated to this particular type of post-natal care. They ought to be trained in a relevant area of babycare and many will have undertaken additional courses such as Breastfeeding Counselling, Post-Natal Depression or Sleep Training in order to enhance their understanding of the issues surrounding care of a newborn and his mother. You should interview your Night Nanny and make sure you feel at ease with her, and, once you have booked her you should try to stay in telephone contact in order to develop the relationship.
Unlike a maternity nurse, you do not have to book a specific start date – most Night Nannies will be flexible on this so you only pay for the nights you use. You can book as many or as few nights a week as you think you will need and you can stop using a Night Nanny once your baby is sleeping through the night or you feel able to continue the overnight routine the Night Nanny has instilled. It is generally accepted that babies can start sleeping through the night once they have been weaned at about 6 months, but babies who have had the benefit of a Night Nanny will often sleep from 10pm to 7am (and sometimes even 7pm to 7am) sooner than this, simply because they have had someone focus on their night-time routine.
Night Nannies have additional abilities to offer too; if your baby doesn’t get the hang of sleeping properly and you are struggling with disrupted nights, a Night Nanny can teach him (provided he is over 6 months and otherwise healthy) to sleep through the night within 10 days. Since sleep deprivation is a recognised factor in post-natal depression, this service is extremely useful to know about.
The word 'doula' means 'handmaiden' or 'servant' in Ancient Greek and is someone rather like a best friend to help you through your labour and the first few weeks of being a mother. Doulas divide themselves into two groups: birth doulas who are trained to mediate between the midwife and the mother during labour; and post-natal doulas who will come to support you for 4-6 hours a day for several weeks after the birth of your baby. The two distinct types undergo different training and it is important to specify which type you need.
A birth doula will have spent time with you before the birth and may have helped you write your birthing plan. She might even have come to ante-natal classes with you. She will be on call and will stay with you throughout your labour, which can be particularly comforting if your husband or partner is traveling and if your time in labour spans two separate shifts and therefore a different midwife. It is important to understand that a birth doula does not have medical training and cannot do the job of a midwife, however she will understand the options being presented to you and will know you well enough to be able to help you make informed decisions.
A post-natal doula will 'mother the mother' in the crucial few weeks immediately after the birth of your baby. She will also show you how to look after your new baby, teaching you the skills that our mothers were taught during their 10 day stay in hospital. She will explain the changes your body continues to go through in the first week post-natally; help with shopping; cooking; household cleaning; school runs; and even walk the dog if need be. Essentially, she is there to support and help you to be the best mother you can be.
This is a fairly specialized area of post-natal care and one which you might use if your baby struggles with disrupted sleep; is not sleeping through the night at about 6 months; or if your toddler is disturbing the rest of the family by coming to sleep in their bed or manifests any other form of inappropriate sleep behaviour. A Sleep Consultant is someone who will probably have experience encompassing nannying, maternity nursing and night nannying, and she will have developed her skills in these areas to be able to teach babies to sleep through the night. She may have attended a Sleep Training course. She will understand the physiology of sleep in newborns, babies and toddlers and ought to be widely-read and up-to-date on the latest research. The term “sleep training” covers a variety of methods and is understood by many to mean leaving your baby to cry for progressively longer periods of time until he falls asleep by himself. Many mothers, quite rightly, don’t feel happy with this because it goes against their nurturing instinct. Fortunately there are other means of achieving the same end, which involve hands-on care, consistency, confidence and lots of patience – something sleep-deprived mothers are very short on.
As with any other form of care for your child, you should interview your Sleep Consultant first. The interview will be a meeting between you, your husband, your baby and the Sleep Consultant. She should ask you in detail about your baby or child’s sleep history and current routine, what works for him and what doesn’t and you should get to know her, to understand her approach and by the end of the interview you and your husband should feel absolutely comfortable about what you are doing.
Again, you should telephone her references: speaking to past clients ought to provide you with additional reassurance not only about the Sleep Consultant but also that you are doing the right thing for your baby. Depending upon the extent of the situation, a Sleep Consultant will probably take no longer than a couple of weeks to resolve any sleep issues and, in many cases, significantly less. Your baby will be sleeping through the night, allowing his body and mind time to rest and develop. You will notice a significant difference in his behaviour and you will benefit yourself from sleeping properly for the first time in months.
There are many types of daycare available for your child, one of which is to hire a nanny who will come to your home and care for your child there. Once you have made the decision to hire a nanny then it is important that you choose the right person for your family. The safest and best way to do this is to use a reputable agency.
A good agency will have already carried out an initial interview with the nanny, asking many in depth childcare questions, and they will have followed up lots of references. Qualifications will have been checked too, including an Enhanced CRB disclosure and first aid certificate. They will also be able to advise you on employing a nanny whose particular skills and personality will suit your family, making the whole process much smoother and avoiding you interviewing people who just don’t suit your needs. It is, however, important to follow up references yourself – mothers are likely to tell you a lot more than they will write on a reference or even tell an agency.
A good nanny will have a childcare qualification and lots of experience working with children, not just necessarily in the family home. Naturally you would also expect the nanny to have a genuine interest in children and their development and making sure the child’s day is full of a variety of activities to suit all these needs. Qualifications and experience are very important, but it is also paramount that you go with your gut instinct; if something isn’t quite right then most likely the relationship won’t work, so keep on looking until you find the perfect nanny for you.