Supporting Postnatal Women into Motherhood

A Guide to Therapeutic Groupwork for Health Professionals

Lynn Bertram

• Publisher: Taylor & Francis
• Year: 2018
• eBook ISBN: 9781315345789
• Edition: 1
• Topic: Medicine
• Subtopic: Health Care Delivery

New mothers are often unprepared for the emotional impact of having a baby. Feelings of isolation and anxiety which often emerge in the early months can trigger postnatal depression. Health professionals can support women with therapeutic groupwork to help them overcome these feelings and adjust to the many changes which inevitably occur at this time.

This book describes setting up and managing a discussion group for new mothers to provide support and introduce women to others at the same life stage in a safe environment. It shows how facilitating this structured activity can be positive and empowering for all concerned. It is practical and stimulating reading for everyone involved professionally with postnatal women.

PART B

The six-week programme

This section of the book outlines a programme for a six-session group and includes a case study of a typical group of women who might attend. Although the characters’ personal circumstances, thoughts and feelings are representative of women at this life stage, they are not based on specific individuals.

The supporting notes provide background information and highlight issues women themselves have repeatedly raised. The notes provide evidence about the universal themes that women grapple with in the early postnatal period.

Overview of the six-week programme

The programme is designed as a whole package and maximum benefit will be gained by attendance at every session. The focus is on the mother and how she is feeling, giving women a chance to listen to each other and, even more importantly, to be heard. Each session lasts one and a half hours.

Course content

Introductory sessions
Week 1	Expectations and reality	During the first two sessions the women begin to get to know each other and get used to this style of group. Confidence grows and trust builds as feelings are explored. Topics are fairly ‘safe’.
Week 2	Roles of motherhood
The real focus of the work
Week 3	Changes in relationships	As the sense of safety increases, more personal topics can be addressed. Issues from the past may emerge. Support within the group for each other becomes more apparent.
Week 4	Parenting styles
Week 5	Managing feelings
Consolidation and ending
Week 6	Building self-esteem	Sense of group identity has emerged and confidence has grown among group members. Celebration of ending and arrangements made to continue to meet beyond the group.

Chapter layout

Each of the six chapters in this part is laid out in the same way.

Outline Plan

An outline plan, which provides a framework for the group process, is included for each session. There are suggestions for a series of prompt questions, on topics relevant to this life stage, that can be put to the group to provoke thought and discussion.

The appendices at the end of the book contain the prompt questions and handouts for each session. There is not always time to fully discuss all the issues and the appendices can act as reminders of what was discussed as well as providing further areas for consideration. They can also be sent out if anyone misses a week to keep absentees updated on the group’s progress.

Group case study

To bring the material alive, a group case study is included to illustrate what can actually happen within a group setting and demonstrate the very real issues explored. As the weeks progress, we observe how individuals respond to the course content, and also how life events continue to occur and impact on the women’s emotional world.

It is a dynamic setting: the babies grow and change week by week, and the mothers learn new skills as they adapt to these changes and get to know their babies. As trust develops, relationships between participants develop, thus facilitating more sharing and exploration of thoughts and feelings.

The facilitator’s preparations and reflections

The facilitator plays a key role in managing the group, and each session she records how she is feeling and thinking as she awaits the group’s arrival, and her reflections log her responses at the end of the session group.

At times, she notes more personal feelings about the group process. While it is not appropriate for her to share this material with the group, she needs to recognise her feelings so that she can process them to ensure they do not get in the way of the groupwork.

Supporting notes

These notes give some further information about the issues that may arise at each session and highlight the most common themes and issues. The group case study illustrates how some of these themes might impact on the lives of individual women.

Organisation of each session

Each session lasts for one and a half hours. After this time the babies can become more fractious, and it is probably long enough for the woman to juggle the baby’s needs and her involvement in the discussion. The groups offer a mixture of structured and unstructured time to ensure any immediate issues can be brought to the group and addressed, as well as ensuring the subject matter of the day is explored.

Check-in

From week two, a ‘check-in’ round, where everyone has the chance to say how they are feeling that day, is suggested. As well as being an ice-breaker, it provides a space for everyone in the group to contribute. Significant events or worries can be voiced and shared. As trust builds, the check-in may take progressively longer. While it is valuable to off-load, a balance needs to be maintained to ensure sufficient time is allotted to the main topic of the day.

Equipment

A whiteboard or flipchart (and suitable pens) for brainstorming sessions is useful, although it is important that the facilitator does not slip into ‘teacher’ mode.

Baby mats for the babies to lie on during the sessions and a box of baby supplies would be a welcome addition – spare nappies, baby wipes, nappy sacks, (although soiled nappies must always be removed from the room). Most women come laden with all necessary baby paraphernalia so only emergency supplies are required.

The focus of the session

Each session has a specific area to explore and discuss. The issues are all relevant to the new mother and often provoke lively discussion and debate. Initially, the facilitator may need to ‘nudge’ the discussion along but, as confidence grows within the group and the women interact more freely with each other, the facilitators input will reduce.

Summary and feedback

Allow about 10 minutes towards the end to summarise the main points raised. There may be some issues or questions that the group may wish to take away for further thought or discussion, and perhaps share with their partners. Any issues raised but not sufficiently addressed could also be highlighted.

It is also valuable, especially in the early sessions, to gain some feedback about the content and style of the group, to ensure their needs are being met and make adjustments accordingly.

Preparation for the next session

It is always useful to remind the group of next week’s topic to enable them to give it some thought beforehand or perhaps to discuss it with their partners. A handout with an outline of the next topic would be a good reminder, but ensure it does not come across as ‘homework’, which may induce anxieties about past learning experiences and therefore be counterproductive.

CHAPTER 5

Session 1: Expectations and reality

The session

Aim

Facilitator introduces the group to the programme and creates an environment for open discussion. Group compares the expectations of motherhood to its reality.

Objectives

Introductions to each other and to the group ethos.

✦ To begin to build a safe environment for sharing.

✦ To find out what the group can offer.

✦ To discuss and focus on expectations and reality of motherhood.

Welcome and introductions

See pp. 53–5 for a full account of how to manage the initial part of the first session.

Main topic

Once all the practicalities have been completed, the group can focus on the main topic of the session. Expectations and reality is a non-threatening subject area for the introductory session, to which everyone can contribute. The following question provides an opportunity for everyone to reflect on their pregnancy and to consider how their thoughts, feelings and expectations may have changed over past months.

BRAINSTORM THE FOLLOWING QUESTION: Think back to your pregnancy. How did you imagine this time would be? What is it like in reality?

Although for some women the pregnancy may be a distant memory; for others it will still be very present in their minds. It may also be that feelings, thoughts and events that occurred during the pregnancy may have coloured how the mother reacted to the baby at birth, and may still be influencing her now. It is all too easy for this material to be ‘lost’ in the excitement and ‘busyness’ of the early days, and so many women welcome the opportunity to reflect on the nine months leading up to the baby’s arrival.

It is likely that birth stories will also emerge, and again this can be a cathartic experience to recount what happened to them.

Brainstorming the women’s responses very quickly provides lots of material for more in-depth discussion and can reveal some shared experiences, which helps the bonding process begin within the group. The responses in Box 5.1 are taken from material recorded from actual groups.

Expectations

Reality

Positive	Positive
I would be the perfect mother. I would be able to cope and would be organised and tidy. We would be the perfect family. Breast-feeding would be easy and natural and good for the baby. Mothering skills would be instinctive – I’ll know what to do. Fulfilling. Enjoyable. Wonderful. Smooth life change. St...

Table of contents

• Cover
• Half Title
• Title Page
• Copyright Page
• Dedication
• Table of Contents
• About the author
• Acknowledgements
• Introduction
• Part A: Background and preparations for a postnatal group
• Part B: The six-week programme
• Epilogue
• Appendices
• Index