Framing the judginess of Plunket

It turns out that plenty of new mothers aren’t exactly forthcoming with Plunket nurses.

Pressured new mums not always honest

For people from outside New Zealand, Plunket is an in-home baby and new parent support service. When you have a new baby, and after you have left your midwife’s care, or hospital care, you sign on with a child and baby health support service. Someone from that service will visit you at home while your baby is tiny, to give you advice and assistance with everything from bathing the baby, to feeding it, to managing older siblings. Once your baby is a little older, you will visit the support provider’s rooms. The support provider will carry out a series of “well child” checks (height, weight, developmental milestones, general health). Plunket is the oldest of these services in New Zealand, and for a long time, it was the only provider of such services. It is much lauded, with good reason.

But… it’s very judgey, even when it’s not meant to be. You will breastfeed your child for six months. You will worry if your child is not lifting her head at 3 months. You will never let the baby sleep with you. All the rules for looking after small babies and children, laid down in black and white.

Here’s the problem. Even when Plunket nurses try not to be judgey, they are. You can be made to feel very small for having strayed from the guidelines in any way. And those guidelines turn out to be not very flexible at all. When my younger daughters were about 18 months old, I took them in for a regular checkup. They were doing well, but then I was asked how much milk they drank each day. About 400 to 500mls, I said. Neither of them were fond of milk.

I got the look. “You really should get them to drink more milk. They should be drinking about 600mls a day.”

My older daughter was with us, so the Plunket nurse took the opportunity to check up on her too. She was about four at the time. “And how much milk is Miss Four drinking each day.”

About 800 to 1000mls. She really liked milk. “Too much. She should only be drinking 600mls a day.”

So it turned out that the “guideline” was in fact a rigid rule, and any straying from that was not to be discussed in the context of the whole child, and what else she was eating and drinking.

I am a highly educated, middle class, white woman, and I felt intimidated, and judged. And really, even if I was doing all the “right” things, it would be hard not to feel judged. Health service visitors come into your home and assess what you are doing with your children. It’s very intrusive, even when it’s very helpful. My Plunket nurse was also a source of some great advice, especially with respect to managing twins. Even so, at times I found the advice, well, judgemental.

But for all that, take a look at the story about new mums not necessarily being honest with Plunket. It’s all framed as being a problem with the mothers.

Lying to Plunket nurses has become commonplace among first-time mums as they shy away from confrontation and questions about their baby’s milestones.

Let’s turn it around, and think about the source of the problems. How about…

Pressure from Plunket nurses is so great that young mothers feel they have to conceal things.

Then this becomes a story about how the support structures around new parents aren’t working, and a story about the need for better training of Plunket nurses and other health care workers. Simple stuff, like how to frame a conversation. For example, here’s a bad conversation.

Mum: I’ve started my five month old on solids.
Nurse: Really, she shouldn’t have solids until she’s six months old.

And here’s a simple way to talk about exactly the same issue.

Mum: I’ve started my five month old on solids.
Nurse: Okay. What was your thinking around that?
Mum: She seemed to be very hungry, and she’s a big baby for her age. It’s only a little amount of rice cereal, in the evenings.
Nurse: Yes, I understand that. Just take it gently, and try to keep it down to just a little bit for the next month or so.

Framing. It makes a difference.

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4 comments on “Framing the judginess of Plunket

  1. Gae says:

    And when I was a new mum back in the ‘olden days’ (the 60’s for goodness sake!) all the nurses at the Baby Health Centre were VERY close to retirement. Probably some of them were ex-Service nurses, and they really do not GET flexibility.
    Our son was a big lump (4.5 kg born) and whacked it on accordingly, our daughter was a dainty 3.6 kg, and although happy, obviously healthy, and VERY active, she was a dainty ‘gainer’. They were so fussed that she NEVER attained her weekly weight gain ‘targets’ that if she had been the first born, they would have destroyed my confidence. It was an absolute hoot to compare the two weight gain graphs. Erich started out just above the shaded area (indicating the average range), then tracked consistently 1 – 1.5 cm above the shaded area. Anne tracked roughly the same distance BELOW the shaded area. Did they want me to stuff her like a Strasburg goose?

  2. M-H says:

    I have to tell you my Plunket Nurse story – I have several, but this is the best. When Mat was four (late 1970s) he went along for his pre-school check. One of the tests was to show him some shapes, and he was to name them. Square was fine; circle, triangle… the last one was a diamond. He glanced it and said “Trapezium”. “That’s not right.” She marked her book. I intervened: “Sorry, Nurse, but his dad is a Maths teacher, and we cut the toast into different shapes every morning. Technically, that really is a trapezium.” I didn’t point out that he could also have recognised a hexagon, octagon and probably more if required. And I don’t believe she changed the ‘wrong’ mark in her book either.

    Plunket does a great job, but in truth it’s very limited by its rigidity. But then, so is a lot of healthcare now. Don’t you dare be a bit slow recovering from surgery!

  3. rayinnz says:

    Interesting, I remember my wife (who being a Taranaki girl is quite self assertive ) making special efforts in the 70s before the nurse came to make sure everything would meet the nurse’s approval
    I would like to think that the Plunket has loosened up a little, babies can thrive on formula even if breast milk is more natural and gives some advantages etc

    The reason I have always been a strong supporter of Plunket is that they get to see almost all children at the early intervention age when real changes can improve the child’s later outcomes. Up 27 visits in the can take place to offer this help

    We are just at the point of setting up a project locally that will encourage the parents of children who are at risk of not being up to speed when they start school being encouraged to improve their children’s outcomes. It is tricky stuff to do as the parents have to see the problem before we can offer assistance
    It is being done through the schools (which already have breakfast clubs) but hopefully in a non threatening manner
    Plunket are heavily involved as they get to see those that might fall into this category long before the kids arrive at school not having the skills to learn

  4. Sarah says:

    I have very recent experience with Plunket and I agree that their advice is mostly very rigid and often delivered in a scare-mongering manner. I do not appreciate being lectured about how my baby won’t sleep through the night because I breastfeed him to sleep. Actually, it’s normal for babies not to sleep through the night, and it’s normal for them to sometimes sleep even worse than they normally do when they are going through a developmental spurt (like learning to crawl). What I needed was someone to listen to me and encourage me, not tell me what I was doing “wrong”. My partner’s parents, a doctor and nurse, are just the same, always looking for problems and “advising” – I think it is very difficult for health professionals not to do this.

    What was great was attending a couple of their group classes (I think they are called Pipi groups), which I went to solely to try to meet other new mothers. Now I have a couple of friends to share ideas and experience with, and frustrations, and it’s much better.

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