‘O my Hostess … a Wild Thing from the Wild Woods is most beautifully playing with your Baby.’ ‘A blessing on that Wild Thing whoever he may be,’ said the Woman, straightening her back, ‘for I was a busy woman this morning and he has done me a service.’
Rudyard Kipling, Animal Stories, 1932.52
Childcare and postnatal depression are almost always associated with a discussion on attachment. Childcare is a heavily divisive issue, with some people feeling that parents should not place young children into centre-based care as it will negatively impact on attachment. Postnatal depression is also a divisive issue in terms of why it happens and how it is best handled. So here is an overview of the very latest research on both.
The assumption many people tend to make about childcare is that it’s ‘bad for mother–child attachment’. But this is an assumption that is not currently supported by the research. Even the journal that is the bastion of attachment research has recently published papers which reveal a very different picture.
The pattern of attachment between a parent and child is so powerful in a child’s development that attending or not-attending childcare pales into insignificance. A secure attachment is the most important thing.
To the question ‘Is childcare good or bad for my child?’ the answer is, ‘That’s not the question.’ The question remains, ‘What kind of attachment do I have with my child?’ And also, ‘What other kinds of attachments does my child have with other carers and loved ones?’ Another relevant question is, ‘What alternatives do I have?’
Often there are no alternatives. My belief is that ‘childcare’ is really ‘mother’s help’ or ‘cooperative care’, and should be called so. This is what we once called the women who helped out other women in their homes, and then, as it is now, women needed that particular help.
In a nutshell, the big finding from all the studies is that non-maternal care is not the significant factor in your child’s development. The biggest predictor of all child outcomes overall comes from home: how stressed parents are, how good the marital relationship is, and, above all, the attachment type that exists between the parents and their child. Time away at work does not necessarily equate to children missing out on that same amount of time with you. Research shows that many women give up other activities, such as household tasks and leisure, to spend more time with their children when not at work.53
This research told Mum and me that trying to improve outcomes for Aboriginal children at risk in the Murchison by providing them with high quality daycare was not going to be ‘the answer’. Although an enriched environment does help children, the best way to improve outcomes for children at risk is to improve the kind of relationship they have with their parents.
Rather than aiming to provide an ‘enriching environment and learning experiences’ alone, our goal for working with children at risk has changed. We now have a range of strategies that all aim at changing the emotional environment around parents and children so that their attachment patterns can change too. One of these strategies is to provide parents with a mentor who has their own head ‘straight’ regarding attachment, so that they can experience an intimate relationship with an adult who can help them become autonomous themselves. After that experience they will have the necessary ‘right brain growth’ to be able to create secure, organised relationships with their children. ‘Time out’ for these women to grow their right brains is also valuable, and to achieve this time out, we will be providing a top quality crèche for the children of participants.
Along the same lines, any women who need time alone to get enough fuel in their tanks to warmly and sensitively parent could also benefit from being able to access this kind of support. Once upon a time that help was provided by extended families, but extended families are now spreading across the globe, following opportunities rather than staying at home and supporting (or staying near) kin. If a woman doesn’t have that kind of support available from family and friends, high quality childcare is all that is available. Often it is all that is available for a woman who needs to work. It is the quality of relationships that your child experiences that makes the biggest difference to her outcomes, and this is the thing to remember in reading the rest of this section.
The best known researcher into childcare in America is Professor Jay Belsky. In looking at his research you need to be aware that he personally feels children should not spend long hours in non-maternal care. In the very early days of the childcare debate he was a co-author on a report on how time away from parents in centre-based care impacts on a child’s wellbeing in the short and longer term — and the message from this report was ‘we don’t know yet’. Unfortunately, this inconclusive position was ‘spun’ by the pro-childcare lobby. They announced that his work proved that there were no harmful consequences to children from daycare. Professor Belsky was infuriated by this disingenuous tailoring of his work and promptly waded into the public debate, not just in the United States but in other countries also.
In 2007 Belsky and others released a report from a well-designed, long study of 1300 American children from birth to 12 years on the impact of childcare. This report looks not just at specific effects from childcare (for example, maths skills) but also at when those effects appear — at two, at eight, at 12 — and whether or not they disappear over time or grow stronger. In addition to the finding that family life is a far better predictor of outcomes than childcare, they also found that, at younger ages, better quality care, including time with grandparents, predicted better language abilities than did poor quality care. However a ‘sleeper effect’ of subsequent poorer language abilities in children who had non-maternal care between three months and four and a half years of age was also found down the track. In other words, children in non-maternal care performed better initially than children who stayed at home, but they were later overtaken by these same children at around 10 years of age. Why? Is it a one-off finding? They aren’t sure yet.
Secondly, the longer children had spent in centre-based care the greater the number of problem behaviours such as aggression, neediness and hostility were found at all ages. This related only to centre-based care. The interesting thing is that these effects were found in all children who’d spent time in centres, even those who were securely attached. The conclusion is that this is a very real and concerning issue for Americans, particularly when you add up the impact of all that increased aggression in schools.54
So how well do Belsky’s findings apply to the Australian setting? The general feeling of researchers here is ‘not that well’. The critical difference is that the care offered in Australia is of a much higher quality. Even in America, quality of care makes a significant difference.55 The leading researcher in Australia is Dr Linda Harrison, who is crunching the data in this area from Australia’s own (even bigger) child development study, Growing Up In Australia.
In her most recent paper on the subject she concludes that there isn’t much difference in the social and emotional development of children who receive non-parental care and the children who do not. Children who are in childcare tend to develop better social skills, as these are required in such a setting. They may also, however, have more behaviour problems and less empathic skills with longer hours in care. But these effects are very small, particularly when set against the much more powerful impact of family life and the individual nature of the child.56
So what makes the care in Australia of higher quality? Dr Harrison calls it simply ‘child-focus’. What does she mean, exactly? Smaller numbers of children in a group and carers who spend more time doing things with the children.
I would say that it is all about the relationship. The person caring for your child needs to be ‘autonomous’, to have the state of mind towards attachments that allows a secure, organised attachment to be formed. They need to have the energy and the time (and so a very low ratio of staff to children) and the commitment to your child individually for that to occur.
Dr Harrison does sound one warning related to childcare. In a 2000 paper she found that Australian children who’d moved between many different care settings had more behavioural problems. A meta-study (where the results from many different research papers are combined together to get the big picture) of American non-maternal care studies found this also. The conclusion that continuity of care is a big deal seems solid.57
Before we finish with Belsky, it’s interesting to know that he has recently published a paper on temperament. Along with a number of other researchers he has identified a group of children who are ‘temperamentally vulnerable’. These seem to be the same children who temperament theorists call ‘highly sensitive’ or ‘difficult’ or ‘high reactives’. They are the children who are slow to adapt to changes, quick to respond negatively, highly active and very sensitive to their environments. These children, he suggests, may be unusually susceptible to both positive and negative environments. More often than not they are boys, who are, in general, more sensitive to environments anyway.58
Belsky has not yet explicitly linked centre-based childcare with very poor outcomes for the highly sensitive group of children, but it’s a fair guess that he will. Certainly he is not alone in highlighting that temperament and gender may influence how childcare affects development.59, 60
A baby and mother are nested inside the circle of close family, which is nested within a wider family and social circle, which is nested within a society, which is nested within a nation, which is nested within the world. The first circle is usually the one that impacts most on the pattern of attachment developed by a baby. There is the mother’s attachment pattern, but there are other factors too, which both change and are changed by that pattern. Postnatal depression is, unfortunately, known to increase the likelihood that the baby will have an insecure attachment. A depressed mother who is ‘autonomous’, however, is far more likely to be able to create a secure attachment in her baby despite her depression.61
Postnatal depression, like any other illness, is greatly alleviated by the kind of care the ill person receives. In this case, the more supportive her partner is of her decisions in caring for the baby, the better the quality of the relationship and the more help she is given with practical tasks, the shorter the duration of her postnatal depression.62, 63
Why is the partner’s support so very important? Is it because such support helps to prevent sleep deprivation? That seems a good explanation, given the link between sleep deprivation and postnatal depression.64 Or is it perhaps because such support gives a woman more time to be with her baby, learning to read her cues, with a consequent improvement in her own faith in herself as a mother?40
Or is it because such support decreases stress, resulting in more oxytocin release, changing her right brain faster and making her feel happier and emotionally warmer? When women are stressed in late pregnancy, those brain-transforming oxytocin surges are absent: and the absence of increasing oxytocin predicts a decreased sense of connection to baby, which is very distressing to most mothers.65
Of course, each answer is valid. Common sense tells us that a new mother needs good support from those closest to her for every one of these reasons.
What makes parenting so hard is that it requires you to either call out of yourself forgotten aspects (for example, living at the very slow pace of the toddler) or grow in yourself whole new capacities, and your baby is always one step ahead, changing the dance as you change yourself. And while every parent really wants to throw themselves totally into the dance — passionately, absorbedly and consistently — sometimes it can be difficult. You know you should dance but between you and the dance floor lie anxiety or depression or fatigue. Sometimes you know you should be dancing, but no-one has told your baby! In each case ‘knowing you should’ becomes a burden to lie alongside everything else. You’ll notice the word ‘parents’ is used here, rather than ‘mother’. This is not mere political correctness but because, as we are increasingly recognising, fathers get postnatal depression too.
What postnatal illness seems to impair, above all else, is your ability to become obsessed to the right degree with your baby. What is the right degree? It is far more excessive than you can imagine before you actually have the baby. You are passionately preoccupied with the baby, almost to the exclusion of all else.
It is actually normal to have some horrid intrusive thoughts of what might go wrong with the baby. Revolting as some of these thoughts are, you do need to accept them as warnings that help keep your baby safe. They usually fade when the baby is about six months old.
Fighting the thoughts is exhausting, and usually causes them to throng in even greater numbers. What has worked well for me is saying simply, ‘I’m listening, I’ll be careful’, and ‘befriending’ the anxiety and wrapping it in the same care with which you wrap your baby. However, if you really can’t cope, even with the knowledge that most women actually have these thoughts, and they have grown too many for you to enjoy your baby, go to see your GP. If you are actually having difficulty thinking about the baby and you don’t want to be holding the baby much of the time, go and see the doctor. Don’t let anything get in the way of this time with your baby.
It is also normal to have difficulty being interested in anything else but the baby. If you have become boring company you will probably be a better parent for it. An obsessed mother, and an only marginally less obsessed father, is the right emotional environment for a baby.66
Try not to castigate yourself for any sense of insecurity. If you are feeling unsure of your ability to provide the kind of emotional environment you’d want for your children, you are hardly alone. In fact, in Australia parents are experiencing a growing lack of confidence in our ability to provide the emotional and financial family environment we would like for our children. In 2008 the Australian Institute of Family Studies reported that the dropping fertility rate in Australia is nothing to do with a ‘lack of wanting to’ have children. Poignantly, many Australians would like to have more children than they do. The choice not to have a child, or to have fewer children than they really want, appears to be one some Australians feel forced to take. Parents, write the authors of this report, ‘require access to community resources, including family-friendly workplaces and the confidence that they have a strong, continuing commitment from the community. It is of the utmost importance that parents do not feel alone in raising the next generation of citizens.’67
Children down the centuries and across cultures have been raised in cooperative family groups, usually with parents at the heart of their care, but we seem to have forgotten this and expect mums and dads to do and be it all. So parenthood often leaves us feeling alone: mothers at home with children by themselves, fathers of young babies marginalised in the workplace when they decide to put the hours in at home rather than with their mates, new parents distanced from their own parents by a very different world in which to parent. This aloneness straightaway puts us at risk of depression.
The latest research from beyondblue, Australia’s national depression initiative, indicates that parents (and their partners and their friends and their families) still don’t necessarily know when they are depressed. Fatigue and anxiety are equally insidious. How many of a certain kind of thought is too many? What is the difference between very tired is too tired? If you feel that fatigue, anxiety or distressing or depressing thoughts are limiting the degree to which you are enjoying your baby, then go and see your GP.
The other thought that struck me on reading the recommendations from beyondblue was their insistence that it is all family members who are affected. Is it useful any more to talk of a mother having ‘postnatal depression’? Is it perhaps more helpful to see it as a whole family illness requiring a whole family approach to healing? (Or a whole society illness requiring a whole society approach to healing?)
I could have listed out risk factors and warning signs, but I’ve chosen not to. Why? The research is very clear about the fact that such lists cannot be used to diagnose or eliminate postnatal depression. You will often see the Edinburgh Depression Scale reproduced on brochures or in magazines, but now beyondblue is saying quite explicitly that the Edinburgh Depression Scale should not be used by itself. Reading through such a scale and thinking ‘that’s not me, really’ is dangerous. Again, if you are not enjoying your baby — or only enjoying your baby occasionally, see your GP.
I also wonder if such scales contribute to ‘stigmatising’ people who do get depressed by encouraging ‘us’ and ‘them’ thinking. The truth is, anyone can get postnatal depression. Anyone can become anxious. Anyone can get too tired and from there slide into postnatal depression or anxiety.64 It is in recognition of this that beyondblue is rolling out a new strategy for postnatal depression that includes ‘universal application of a routine psychosocial assessment strategy as a population health initiative’.68
Let’s follow the lead of this most informed group. Let’s support every mother and every father and every baby and every family as if they have, or could easily develop, postnatal depression. This, of course, is what some cultures have always done. In Islamic cultures, all cooking is done for the new mother. She is brought high-protein snacks by friends and family. She is encouraged to rest and sleep as much as possible for the first 40 days after the birth of her child.69 The time is designed to be as pleasant as possible for everyone, with lots of the warm fuzzy feelings that promote right brain growth. Mind you, Islamic women still get depressed, but usually for reasons other than fatigue. So insufficient sleep and rest are not the whole of the problem. Nonetheless, these rituals allow the new mother to be ‘mothered’ herself for a period of time after the birth, and may help with the transition to the mothering role, as well as protect against fatigue.70
If you are a father or a grandparent or a general support person to a new mother you might be thinking, ‘I don’t have much time, so what is the one best thing I could do to support attachment between this mother and child?’ One study showed that the support most appreciated by women cross-culturally is practical support. Women put a higher value on being helped out in caring for the children rather than on help with the housework. All of these women said that an unequal division of childcare was more distressing than an unequal division in the housework.71 By offering your time to help with caring for children, you are actually valuing the role of mother and appreciating how very hard it is. You are also offering her time for personal growth — right brain growth — which she can then pass on to her baby.
In the next part of the book you will see just how contagious strong right brain growth is, and what makes it happen. This is part of the research that utterly transformed my idea of who and what we human beings are.