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Keeping mums happy

Dr Raj Persaud
Consultant Psychiatrist
Maudsley Hospital, London

Most nurses are women and this means something fundamental about them is often forgotten - they are often mothers. This means that they are probably wrestling with the issue of childcare. Many of the nurses I see in my clinics find themselves distracted from concentrating fully on their work due to worries over childcare. Women tend to feel guilty about leaving children in childcare, and it is vital that employers give adequate attention to the issue of helping working mothers in any way they can with childcare arrangements. This might mean being flexible over stop and start times at work, allowing a mother time to deliver and receive her children from whatever childcare arrangements pertain.
No mother is going to be happy at work if she is concerned about what is happening to her children while she is at work, and many women even give up successful careers because they find the whole childcare issue too stressful.
There's been a revolution in the childcare industry in Britain - in the last decade private nursery places have quadrupled. In 1981 only 24% of women returned to work within a year of childbirth - in 2001 it was 67%. Childcare has become a boom industry.
There is some evidence from US research that middle-class children get more preschool childcare outside the home because these mothers can afford it and go back to work sooner than their working-class counterparts. It seems that even at the very start of their school careers middle-class children are better prepared for the early school environment than working class children are, and this seems to partly arise out of their greater exposure to childcare outside the family home.
It would seem that children who have childcare outside the home are more socially skilled and advanced in certain cognitive areas. So maybe preschool childcare is actually good for your child?
However, what is often glossed over with this research is the issue of the quality of the childcare. You need a large number of adults to take care of a small number of children, and the adults have to remain in the setting long term so that the children develop healthy relationships with them. Poor-quality childcare with a small number of harassed, poorly skilled and stressed adults is not good for your child.
Good quality or not, there is also good evidence that children in childcare outside the home are more stressed - as indicated by stress hormone measures - compared with children at home. It is not necessarily a bad thing to stress children, but certainly this finding means that childcare has to be very carefully and thoughtfully constructed to assist rather than harm children.
One key issue is whether the early childhood experience could be formative in our children's later lives, and whether the quality of this early experience could be degraded by too much childcare and too little actual parenting. Another issue is whether parents are gradually becoming deskilled as they spend less time with their children?
Psychiatric research over the years has established that one of the most important things for children is continuity of care - it doesn't matter that much who exactly looks after them as long as they are warm, stimulating, attentive and, above all else, a constant reliable presence. High staff turnover in cheap childcare facilities is a real threat to providing a positive childcare experience.
Because mothers often feel guilty about even turning up for work and leaving their children in the care of someone else, they tend not to be assertive when it comes to asking for more help with childcare arrangements - even from colleagues. I firmly believe childcare needs to be placed more centre stage in the relationship between employer and staff in any female-dominated industry like the NHS. Nurses should therefore campaign actively for more assistance - physical, financial and psychological - with childcare and should not be afraid of raising the issue if it is interfering with their ability to follow their profession.