Posted on: 13 August 2020
Harrow Health Visitor Yvonne Nolan reflects:
The transition to parenthood has in no doubt been altered to an extent that only future history will expose the successes and failures of this time. No person embarking on parenthood planned for a pandemic with its enforced isolation, cancelled appointments and reduced human interaction, culminating in the overwhelming responsibility of raising a new human being in a world that appeared closed for business.
COVID-19 has been a steep learning curve for the Health Visitor also. We were expected to instantly adapt and work innovatively to meet the needs of clients that in the main were and are in a state of unprecedented heightened anxiety, notwithstanding we as individuals are perhaps in the same state! Even the most resilient, robust and pragmatic amongst us have been stretched and tested to perhaps limits we didn’t know we had.
As a Health Visitor that had been shielded, due to an underlying condition, I had initially felt that I would be of little help and my guilt was compounded by the Thursday NHS appreciation clap; perceiving it to be only relevant to the frontline heroes. However, as a Duty Health Visitor I have completely changed my outlook on what being on the ‘frontline’ in the fight against COVID-19 means, and the service and contribution I am personally offering on the virtual frontline. I realise I had totally misjudged the value of my telephone consultations, I have had so many wonderful, challenging, enriching and personally fulfilling contacts with Mothers, and Fathers, on the telephone. ‘Anonymous intimacy’ has in some instances most definitely increased the level of detail shared and has enhanced my ability to identify and support parents with many issues, most notably low mood, exacerbated by COVID-19.
I now question should telephone listening visits be routinely offered as a universal contact? Whilst I am in no way suggesting this is a preferred option over face to face contacts, there is in my opinion a valuable role for telephone and virtual contacts to play in the delivery of a 21st century health visiting service. It is reported people form an opinion of another person within 1/10th of a second of meeting (Willis & Todorov, 2006). The anonymous intimacy of the telephone, during this time, prevented mutually incorrect assumptions being made based on appearance, age or body language.
From my conversations as a Health Visitor there is a clear suggestion mothers and fathers feel ‘robbed’ of idealised moments that may to some seem superficial, for others however these heralded the ending of one era and the starting of what is arguably supposed to be one of the happiest moments in anyone's lifetime. Suddenly gone were the baby showers, the maternity leave socialising plans, ‘wetting the baby’s head’ and ‘showing off’ the newborn with colleagues, acquaintances, friends and family. Suddenly all but essential face to face contacts were immediately ceased however time does not stand still, nor can it be paused to be experienced at a later date in the way it had been originally envisaged. Pregnancy and shared treasured moments with a newborn were ‘lost’ for some. A new mother bravely shared her feelings of disappointment and anger with me, she stated “I didn’t get the congratulations from work that I wanted and needed...this isn’t how it's supposed to be”
My observations suggest we will see a rise in feelings of guilt, inadequacy and disempowerment. These feelings are comparable to those experienced when grieving. The Health Visitor is the professional best placed to assess and observe the impact of parental mental health on infant mental health and prevent the next health crisis of our time. Currently the cost of perinatal mental health is reported to be 8.1 billion pounds per year with an estimated 1 in 10 women developing a mental health issue in pregnancy or the first year; this could be a woefully low estimation if action is not taken (Maternal Health Alliance, 2020). If we as Health Visitors are not supported to intervene early, prevent ill health and promote wellbeing the health inequalities for the next generation could be wider than in any one's living memory.
I am at a loss to comprehend what would have happened to the parents that I had spoken to had they not been able to access the support of the Health Visiting service. We are possibly one of the only remaining services that does not require a referral into or a threshold or criteria to be met to access our support and wealth of knowledge. We are frequently overlooked by the media as the less ‘glamorous’ counterparts of the Midwifery service which demonstrates the complete lack of understanding of the specialist role of the Health Visitor. We do not have waiting lists; we attempt to ‘make every contact count’ with a plan of action agreed with the parent from the very first contact.
COVID-19 has highlighted the accuracy of Maslow's hierarchy of need (1943). The old adage “your health is your wealth” has never been more true. I am optimistic for the future. I will step up as the voice of the child to protect the next generation, however, it must now be recognised emotional care cannot always be immediately quantified, and there must be a longitudinal approach.
References
Maslow, A., (1943). A Theory of Human Motivation. Psychological Review , 50(4),
pp.370-396.
Maternal Mental Health Alliance (2020) Counting the Costs Available at: (Accessed on 14th June 2020).
Willis, J.and Todorov, A.,(2006) First Impressions: Making Up Your Mind After a
100-Ms Exposure to a Face . Available
at: https://journals.sagepub.com/doi/abs/10.1111/j.1467-9280.2006.01750.x
(Accessed on the 14th June 2020).