Podcast transcript
Giving birth during a pandemic: what parents experienced and how we’re helping
Introduction:
Welcome to NSPCC Learning, a series of podcasts that cover a range of child protection issues to inform, create debate, and tell you all about the work we do to keep children safe. At the heart of every podcast is the child's voice, and how what they tell us, informs the work we do.
Ali:
Hi and welcome to the latest NSPCC Learning podcast. This is one of two podcasts focusing on how the NSPCC and our external partners have delivered services during the pandemic. The episode you're about to listen to looks at how our Baby Steps service has been run since the lockdown began in March. Baby Steps is a very established face-to-face service that's been designed to help people prepare for becoming parents, not just for the birth itself.
I had a chat with Julia Mayes, who is the NSPCC's Development and Implementation Manager for Baby Steps, and Meredith Russ, who runs the service in one of our nine external sites. We talked about how Baby Steps has been adapted and delivered since March, what's worked well and the benefits and what the challenges have been. We also speak about what lessons have been learnt along the way and how these changes have impacted both families and practitioners.
Can we talk about how we approached working with each site about adapting and adjusting the service in the early stages of lockdown?
Julia:
So when lockdown was first announced, we had no idea what the impact was going to be on Baby Steps in each of the sites. And we knew we needed to allow organisations some time to start activating their local business continuity plans. But then once we felt like people had a little bit of time to do that, we set up an initial call to bring teams together, which we sort of asked, would this be something that's useful? And everyone was really keen to find out what was going on in the other areas. So we set that up to sort of take stock of what people's plans were and identify opportunities for collaboration and support and the kind of coordinating role that we might be able to play in that.
And at the beginning, there were only a small number of sites who had made the decision to move to online delivery of the groups. And others were just sort of developing emails they were sending out to families and following those up with one-to-one phone calls. So we were wanting to try and identify what were the kinds of resources that we could develop across the whole Baby Steps community that would support people to work in these emerging ways.
The approach was really for teams to just do whatever was going to be feasible within the given constraints in their local areas and the needs of families which were varied hugely across sites. And the key thing was as best as possible to continue delivering the key messages that form the Baby Steps programme and to support parents during this really challenging time, within the ethos of Baby Steps.
Ali:
Meredith, if we can come to you from an external provider's point of view, how was it for you and your colleagues during this time? Did you feel supported by the NSPCC? How did that work?
Meredith:
Yeah, I think we really did feel supported. It was great to have that opportunity to share and collaborate with the other providers across the country. But in the early days, it was a case of running to catch up really and figuring out what we were going to do, how we were going to do it. But I think the NSPCC's coordinating role felt quite nicely 'light touch' which I think at that point we needed. We didn't need sort of very directive “you've got to do it like this” because there were all sorts of figuring out which platform to use, how we were going to condense that and do it online. So it was supportive but just to the right level really for us.
Ali:
Great. So can we talk a little bit about how Baby Steps itself as a service has been adapted? Meredith maybe we can come to you again first. What adaptations did you guys make?
Meredith:
Initially it was a case of we've still got these families that need supporting. We've got a number of groups that we'd started pre-lockdown which we were either half way through or we were in the break where they were having their babies. So we continued supporting them, particularly the families who were in the break for their babies to be born. We really were able to fill a gap there for offering them support which maternity services weren't at that point able to. We focused on that, offering the support on a one-to-one basis. Then we developed our programme and adapted it to be delivered in a shorter time because we had a kind of pause where we weren't delivering anything at all because we were trying to figure out how to do it and finding the right platforms and things. So we condensed it down to a full week of antenatal classes rather than the six which we usually have. And each session was really kind of tailored and focusing on the Baby Steps ethos particularly. We weren't able to do all of the activities we normally would, but we really focused on that supportive ethos and thinking about engaging with the babies and connecting with the babies when they were born.
And then as time went on and we learnt more and became more confident about working online, we were able to take stock of where we'd got to and think, okay well actually, we do feel more confident now. We can develop this further. We can get back to the six weeks of antenatal sessions and the three weeks of post-natal sessions and learning really collaboratively with other providers of Baby Steps across the country through the shared learning for managers and facilitators that they set up. And that meant that we could bring more of the content back into the programme. And we were able to utilise things like the YouTube channel early on. So the YouTube channel was great because it kind of gave us the 'go to' resource for videos and ways to get that content over to the families early on when we were very condensed. But as time has gone on, we've used it less because we kind of developed our own resources and own ways of sharing things remotely, so, electronic links to videos and that kind of thing.
Ali:
Great thanks Meredith. Julia, so Meredith has just mentioned the YouTube channel, could you give us an overview about what that was?
Julia:
We had some teams who just didn't have the organisational infrastructure in place to move to an online delivery of groups. They either didn't have the platforms available to use or they just didn't have the skills and experience of delivering services virtually.
In the initial phases of the adaptation, there were some teams that were just having to make use of emailing out content and following that up with phone calls. So one of the ideas that we came up with was to create a private YouTube channel, put some of the videos that we use in the Baby Steps group delivery on that channel and also create some new films that show some of the role play type activities the facilitators do in Baby Step groups. So we identified what we thought the key videos would be and shared those out across the teams. And people did the sort of selfie style homemade videos of those activities. And then we collated all of those and put these on the YouTube channel. So it just really gave something to add a bit to these emails that we were sending out to families in areas where they weren't able to deliver the groups on a virtual platform.
Ali:
Sure. Bring it to life. And was that quite well received? How did that go down?
Julia:
Yeah, I think so. As Meredith said, it was filling that gap in the initial phase. I think we’re now at this point where most teams are now delivering the programme on a virtual platform. So there's sort of less use for those kind of resources. But at that time, in a lot of areas we had nothing to go with.
The other thing we did was set up a shared resource bank as teams were rapidly developing new content to enable them to deliver Baby Steps online or through the emails they were sending out. There was lots of good material that was being developed. So we wanted somewhere that we could place that centrally so that people could make use of that, and access that and not have to reinvent the wheel. And there was some really good stuff I think that people were spurred into, for example, creating content that was translated into different languages. So I think we've got some really rich, useful resources that we'll be able to make use of going forward, even beyond this pandemic period.
Ali:
So what have been some of the benefits of moving the service to a more virtual way? What's come out of it that's been really positive?
Meredith:
Well, one of the things that we found is that we've probably been able to engage some of those really hard to reach families, which traditionally would have some barriers around transport or childcare of their other children, things that would hold them back from attending courses, even just anxiety around going into a group in a room and feeling inhibited about that. So because people can join from their kitchen, wherever they might be, even we've had families, women join from their hospital beds - so they've maybe gone in, nothing dramatic is happening but they don't want to miss the opportunity to come to the session. So they've actually joined from a sort of bay on a ward somewhere which is really great and shows how important it can be for families.
I'd say we've also noticed that real benefit in the building of relationships that we do with Baby Steps. The facilitators particularly it was evident with the families who had started the course, were on the break, they were really kind of left a bit high and dry because all home visits were stopped. I mean most areas it was really hard for families in those initial first few days after going home from hospital with their babies and people turned to the Baby Steps facilitators for breastfeeding advice. So I remember doing a few calls about how to breastfeed or they were about to have their baby and they were really worrying and panicking about it. I think the anxiety around lockdown came out in other ways related to their pregnancy. So it was great to be able to reassure people and fill some of those gaps that were inevitably there. And then as time's gone on, again, we've just been able to be that kind of nice, calm, anchor for them through the sort of storm of COVID. And I think that's really valuable.
One of the other benefits for us was the community that was really brought to the fore by the NSPCC input. We're used to meeting with other Baby Steps providers maybe once a year in London which is not easy to access for everybody. But we've met multiple times online. We've really got to know each other. We really shared a lot and collaborated and problem solved with the technology issues and how to adapt activities so that you can do them online. There's been some really great innovation that's come out of it and I'd love to keep that going if we can.
Ali:
Yeah, that sounds great. So Julia from the NSPCC's perspective, that's a really nice list of benefits Meredith has given us. So would you echo that? Is there anything else the NSPCC has thought that's really positive?
Julia:
Absolutely. We ran our first virtual community of practice event last month and we just got so many more people who are able to come along. And I just think it's accelerated people's acceptance of using these virtual platforms and that's brought us together. In addition to running these sort of biannual events, we now have monthly meetings on Zoom or Teams as well. So there's more regular real-time adaptation and sharing that can go on.
Ali:
I guess on the flip side, what have been some of the challenges over the past few months of operating in a more virtual environment?
Meredith:
Well I think connectivity is got to be top of the list really. So you know we're working from home, our home WiFi networks have never been so overloaded. Everybody down the street is all trying to work online and that can be a real challenge. And it's one thing if it's just a team meeting that you're trying to join and something crashes but when you're actually trying to deliver a course content, meet a group of other families who are all a bit anxious about joining as well and you really want it to go well. You've got a lot invested in it and it can be really stressful when it doesn't work. So I think it's the same for everybody, but it is still a challenge there.
We have had some people not being able to join us, who would benefit from the programme, because of connection issues and digital WiFi capabilities. But I would say in general, it's been a lot less than we might have anticipated so that's reassuring to know. I think most people do have some way, whether it's a smartphone or an iPad or whatever it might be, some way to connect in this way. And as the facilitators have become more confident in how to talk people through it and to begin with, they were very anxious about joining. Now that they are confident - they've done it a lot - they can really bring people with them and make them feel that it's going to be okay if they try and join with us.
Ali:
Great thanks Meredith. And Julia, I think Meredith touched on a little bit earlier on in the podcast about midwives and health visitors in the early stages of lockdown, they were redeployed. And so that obviously had an impact on families and those who just had a baby. Can we maybe touch on that as a challenge?
Julia:
So in the initial phases of the lockdown, there was lots of redeployment of midwives and health visitors. Some of the Baby Steps teams were disbanded altogether because staff were all deployed to the front line. And it also had an impact in some areas on the referrals coming into Baby Steps’ teams because many of the teams rely on maternity services to refer families into their Baby Steps service - so that sort of broke down.
Ali:
And how did that impact you Meredith as an external site delivering this? How was that an impact for you?
Meredith:
We have unfortunately seen a drop in referrals in most areas, although it isn't all areas, so it's difficult to know whether it's to do with how the changes have been managed in certain Trusts versus others, or whether it's a combination of factors. As in there are difficulties for midwives referring, but also perhaps difficulties in families buying into wanting to attend something virtually. I think that may be becoming a factor as we get that sort of Zoom fatigue of just “does it have to be online? I just want to do something face-to-face”.
Ali:
Of course.
Meredith:
A combination of things there. But I think as time has gone on and we've worked hard to explain what we're offering and how accessible it is, I think we will see those referrals coming back up again in certain areas.
Julia:
But I think in some other areas there was an increase in referrals and an increase in the needs that families were bringing. I mean, having a new baby is hard at the best of the time, but having a new baby in a pandemic where all of your usual support has fallen away is even harder. So we had some teams who were having to start to triage families into more intensive and lighter touch versions of Baby Steps or just spend a lot more time working more intensively with families.
Ali:
Are there any more challenges that we encountered?
Julia:
Yeah so I think access and digital exclusion was a big one and Baby Steps really was developed in light of this evidence that there is about those families that don't engage in traditional antenatal education and that the families who would benefit most from additional support at this time are the ones that tend to be excluded from services. And so there was just a real concern that in some areas where digital exclusion was a really big challenge, that this was just further compounding the vulnerability of these families.
Meredith:
Yes, some of the challenges we've had around delivering virtually are, it is hard to keep a group of people engaged on a screen, much more difficult than if you're meeting face-to-face. So we've really worked hard at developing new ways of working and new ways of delivering activities.
And I think also another challenge for us was the evaluation of the programme which traditionally was done with paper forms of all the questionnaires that we use and the different points. Three times throughout the programme, we would in the face-to-face world give out these paper forms and get them filled out and handed back to us personally. Obviously we weren't able to do that so we kind of scrambled to catch up and developed and brought in an electronic evaluation system which is great. I think it's a challenge but one of those benefits is that actually the innovations that we've made with technology have really made great in-roads and made things more accessible and actually provided big, positive impacts on our service. And those are things that we can keep going for the future too.
Ali:
Can we maybe touch on some of the ways in which you did work to engage the families that were more reluctant to engage remotely?
Meredith:
Yes so we have been more flexible and we've offered one-to-one support for a few families who were either reluctant to join in a group or really reluctant to have their camera turned on for example. So really, I think in a group situation, it's really important that everyone's camera is on because it's kind of fair then to all members of the group there and they will feel happy to share and take part in the session. If people are really unkeen to do that, then we have offered one-to-one. And we've also done that for those families where English isn't their first language, they might need an interpreter. That's a lot more difficult to do in a group. So we've offered more one-to-one than we otherwise would have.
Julia:
A really important part of Baby Steps is having the baby in the room and when you're delivering over a format that's just a head and shoulders and you can't see bumps and then it's much harder to see babies once babies have arrived. It's just finding ways to keep that alive throughout the delivery of the group. Facilitators reported this as a challenge.
Meredith:
One of my facilitators said that they've tried doing a sort of jokey “oh show us your bump!” so everybody stands up and shows their bump. And I think if people are willing, it's quite a fun way to do it. So we are trying these different ways to keep families engaged and feel connected and Julia's right about how we just aren't able to see people in the same way.
Another thing that has been a restriction is that usually talk and listen time which is a really crucial part of Baby Steps at the end of every session. This moment where you can really teach communication skills and develop people's active listening skills and things like that, so they do it in pairs and in a group in a room but we can't on Microsoft Teams which is the platform we're using in our area. You can't very easily put people into pairs in breakout rooms. It's supposed to be a development coming soon but that's been quite a restriction.
And I think another thing which we're missing is the video-enhanced, reflective practice, so looking at the minute body language and interaction with the baby, which we would go into a lot of detail with them at their postnatal home visit, sadly we don't really do that in the same way.
But we're developing ways that we can still give feedback. We're seeing families on screens with their babies at their postnatal home visit. And because the mother and father are able to see themselves on the screen which you don't normally do when you're just sitting in a room, we can draw their attention, “look at how you're holding your baby” or “I love the way... have you noticed how you're doing this?”, and we can draw their attention to lovely little things that they're doing which is that really strengths-based approach of promoting their self-esteem as parents. So there are ways aroundb but it's frustrating as well.
Ali:
What have we learnt over the past few months and how are we putting that into practice? Or have we put some of that already into practice?
Julia:
I think the importance of face-to-face has really come through as a strong message. And whilst there's been some real benefits from the virtual delivery and it definitely has a place going forward, I think it's really highlighted just how important face-to-face is for doing this kind of work.
Meredith:
Absolutely. It's so hard to make those connections for the participants of Baby Steps. A big part of why they're there is to build their own support network with other friends that they might make on the group, with the children's centre or other workers that they can come into contact with by going into a building. And understanding “oh these are groups and they're really friendly so actually I do feel more confident to go along to that” or whatever it might be. And we've developed ways of trying to overcome that.
So, for example, starting our WhatsApp groups for the families on a course earlier than we otherwise would have. So usually we do at the end of the antenatal sessions, now we're doing it right at the start. They're getting the opportunity to connect with each other right from the beginning. But yes as Julia says, face-to-face is so important and I think we're really plugging away at the hospital trusts and the children's centres and making sure that they know that. And that we don't want anyone thinking, “well this is a lot cheaper and easier than it was when we had to hire a room and we had to make sure that there are tea and coffee available. It's easier to do”. It is in some ways easier but we're missing a huge amount there.
And I think particularly from a safeguarding point of view, so much is missed when you can't actually see people and their body language and how they're interacting with others or not. So to get back face-to-face is just a big kind of priority for us.
Ali:
Great and what about the facilitators themselves? What have we learnt about the way that they've been delivering the programme? Can we talk a little bit about that?
Meredith:
Well I'm a lead for the facilitators in Wiltshire and I have to say hats off to them. They have adapted and developed the new content and ways of working so brilliantly. But I've really needed to support them more. So usually we wouldn't have met as a Wiltshire team all that often, maybe three or four times a year. We started doing weekly online team meetings which had really offered a place for them to just let off steam about how this doesn't work or that is annoying, also of course share resources, share ways of delivering content online which they're really developing all the time. So we're all going through this and I think it's just really important that not only are we there for the families, but we're there for each other as facilitators. They're supporting really vulnerable people going through a very challenging time but they're also struggling sometimes too, so having time and space for them has been really important.
Julia:
I just wanted to echo what Meredith's saying. It's been a real reminder about the importance of looking after our practitioners because they are the intervention. If we're not looking after the practitioners, it's really a lot to expect them to be able to look after families.
But I guess just linking back to our earlier discussion about the way that we as NSPCC can play this national coordination and support role, there's been some big learning for us about using these platforms, how we might make our community events more accessible and how we might take those forward, post-pandemic, I think is definitely something we would want to be doing.
Ali:
Julia, Meredith, thank you for joining me to talk about Baby Steps. It's been really interesting to hear how you've run it. And thank you also to the practitioners that have been facilitating this and working really hard and to the families that have taken part. It all sounds brilliant. So thank you both very much.
Julia and Meredith:
Thank you.
(Outro)
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