We are good as mother and father, not as a wife and husband

We all know people who make us feel better about ourselves and more optimistic about life. Conversely there are others we encounter who leave us stressed and reaching for our comfort of choice – a cigarette, chocolate, alcohol, porn . . .

Relationships matter – not just romantic coupling to a significant other but all sorts of human connections from the cradle to the grave, with none more vital than the infant-parent bond. But is the extent of their effect on health being recognised?

Research shows that good relationships help protect against both chronic disease and mental illness, while poor relationships significantly increase the risk of both.

Do we ever stop to think how toxic a soured relationship between just two people can be?  Take a woman who has yet another row with her manager at work: she comes home and ends up arguing, again, with her husband, who shouts at their teenage daughter, who takes it out on a peer on social media who, in another household altogether, is so upset she is bitchy to her mother, who blames the father for never intervening, who storms off to the pub . . . It could be the proverbial “last straw” for one, or all.

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There needs to be a focus on relationships now in the same way that there has been a spotlight on mental health in recent years, says Dr Maeve Hurley, chief executive of the charity Ag Eisteacht. It is campaigning for professionals across the health, education, youth and social sectors to take a relational approach to their work.

“How we shape services at the moment doesn’t take account of the importance of relationships – so we tend to look at the individual.”

She stresses the importance of promoting people’s capacity to form, nurture and sustain healthy relationships across the lifespan, to try to prevent those relationships falling into difficulties. But, if they do break down, supporting people to move forward with their lives.

There is such a bank of evidence that relationships are key to every aspect of our well-being

In the same way that the HSE adopted an “every contact counts” programme, in which patients are routinely asked about the main lifestyle risk factors for chronic disease, such as smoking, alcohol and substance use, diet and exercise, she wants services to make every contact count for relationships too.

“There is such a bank of evidence that relationships are key to every aspect of our well-being, we need to train practitioners to incorporate that in their routine work,” she says. Ag Eisteacht has launched a new programme called Able (Adopt, Build, Listen, Empower) to do just that.

“When people are struggling, they will turn to somebody they trust and that is often a front-line worker,” says Hurley. That worker’s gut reaction may be “argh, I don’t have time for this, I am terrified of what I am going to hear, I don’t want to open up a can of worms . . .” but Able aims to equip them to manage such quandaries.

A former GP in Cork, she was motivated to set up Ag Eisteacht in 2001 after years of “sitting with people and realising there is a lot more going on than this person in front of me”. But she felt she had neither the language nor the process to start enquiring “how are things with your partner now that you have moved home . . . had a new baby . . . got a new job”. Yet it is during such transitions that relationships often suffer.

Listening

It’s a simple concept, she agrees, but there is a lot of frustration that the health system has become so focused on measuring outcomes that there is no box to tick for listening and helping a person with a relationship.

“We need the relational approach to be an outcome,” says Hurley. Health practitioners want to spend time listening “but they are in such a pressure cooker, that they think ‘we don’t have time for that’. But we say, ‘actually you can give somebody five minutes, 10 minutes, you don’t have to spend an hour’.”

The professional may have an agenda – I have to weigh this baby, I need to talk to this patient about blood pressure control – but there are times when that should be put to one side, she suggests.

It’s all about how the opportunity is presented. Instead of, for example, a hurried public health nurse in a clinic saying, “I only have five minute for this, sorry”, rather she can explain “I have five minutes, would you like to use that time to talk about what’s going on at home?”

The invitation is there – but the boundaries are clear too. “If people don’t want to go there, they won’t, but you are indicating that you are interested.”

However, when people take up the opportunity and feel listened to, they can quickly become much clearer about what’s really going on for them. In her experience, people usually know what they need to do, so if they are asked the appropriate question, such as how could things be better, they begin to visualise and start to become more hopeful and empowered.

Conflict is a necessary part of relationships, she explains, but that can be constructive or destructive, depending on how we deal with it.

Helping the professionals

Paula Rudkins, services manager with Enable Ireland in Kilkenny, says that undergoing the three-day, accredited Able training course earlier this year gave her and her colleagues a chance to pick apart how their work affects families and how the families can affect them.

Members of their multidisciplinary team were used to talking and listening to parents, she says, but found it difficult to stop and start the process and to help families move on. “It gave the staff the confidence and the tools to do that.”

Take the scenario where there might be a physiotherapist wanting families to do exercises with a child, an occupational therapist asking them to do a programme and the speech and language therapist having work for them to do too.

“The family is sitting there saying ‘Oh my God, our lives are upside down and you want us to do all this’,” says Rudkins. But if the team works well together, they can support the family and prioritise.

“It means the physio has a dual role: she is looking at the child from a physical point of view but is also listening and is aware of what the problems and pressures are in the family. She is tempering what she does or doesn’t do, and what she does or doesn’t suggest, based on her colleagues’ and the family’s interactions.”

What came out of the training, she adds, was that it was okay to take 10 minutes to listen and not do all the therapy that they are there to do. As one physio remarked, “I can go on and on about the stretches a mother is supposed to do but, if she is not in a place to hear me, I am wasting my time.”

Hurley recounts the case of a worker in one children’s disability network who reported how, after Able training, she had picked up on a mother’s anxiety and asked her how she was.  That woman, who had been attending disabilities services for years with her child, said nobody had ever asked her how she was.

“The impact of that, being able to say ‘this is how it is for me’ and get it off her chest and get in touch in how it was for her, allowed them to do a wonderful piece of therapeutic work.”

Case Study: ‘Why did nobody tell me life was going to be like this after having a baby?’

When Deepthi Popuri (25) and Shashi Mamillapalli (32) had their first child, Lakshana, last September, they had no idea of the impact it would have on them as individuals or as a couple.

Married four years ago, they were prepared in the sense of having bought a cot, clothes, nappies, but looking back Deepthi says “we were totally unaware of how to take care of a newborn baby”.

But they knew it was going to be hard? “No, no, no,” she replies, “I wasn’t aware of anything. For the first couple of months it was rolling in my mind, ‘why did nobody tell me life was going to be like this after having a baby?’.”

“Life changed completely,” continues Deepthi, who is candid about how she struggled with “accepting the truth that I have a baby now”.

Asked if it was love at first sight with Lakshana, she says: “I wasn’t having any feeling actually, to be frank. I remember seeing her and I wasn’t falling in love or I wasn’t hating her – it was like ‘okay, she’s my baby’, it was a neutral thing.”

But she did worry about how she was going to care for her. Having moved to Ireland just two years ago, the couple from Andhra Pradesh in southern India have no extended family and few friends with a baby around them in Cork city.

Both their mothers came over from India for the first three months to help. But it was a long time since the grannies had had their own babies and this was the first grandchild.

“They used to say ‘I remember when you were a baby . . . it wasn’t like this’,” laughs Deepthi, who was at a loss to understand her daughter’s different cries for the first couple of months.  But gradually she felt a deep maternal attachment develop.

She found joining a local Cuidiú group on Facebook a huge help, as there is always somebody there to answer questions. However she hasn't made it to any branch meet-ups in person yet but vows she will very soon. Does she feel isolated?

“Not really – I don’t have time to think am I isolated or not,” she says.

Shashi, a software professional, took two weeks’ paternity leave at the time of the birth. But the reality of coping with a demanding baby didn’t really hit him until after the grannies returned home.

He does think it would be helpful if fathers in Ireland got more paternity leave but not necessarily a continuous block – perhaps a further two or three weeks at, say, six months, he suggests. Developing the father-daughter bond took time but now the moment he walks in the door after work, Lakshana wants only him.

We are good as mother and father, not as good as a wife and husband as we were before

Both Deepthi and Shashi acknowledge that she is the centre of their life now and they talk about little else. “On a scale of 10, I would say nine times,” says Shashi.

“We miss out as a husband and a wife,” says Deepthi. “We are good as mother and father, not as good as a wife and husband as we were before.”

They never go out as a couple without her. Now they plan “either three should go or three should stay”, is how Deepthi puts it.

But they are happy, she stresses, both enjoying their daughter and regarding this as a passing phase. “When she is two or three years, we can get back the time.”

There is probably no other stage in life that tests relationships more than when starting a family. "Having a baby is like throwing a hand-grenade into a marriage," the late film director Nora Ephron famously once said.

It is also a time when at least one parent, usually the mother, has numerous contacts with the health services. That is why Ag Eisteacht is advocating that professionals use this chance to be mindful and supportive of what might be going on between a couple.

Research shows that 75 per cent of relationships experience a precipitous drop in satisfaction within the first year of a birth of a baby, points out Dr Maeve Hurley, chief executive of Ag Eisteacht.  Men's satisfaction with the relationship across the transition to parenthood has been noted as a significant influence on a couple's long-term stability.

The risk of breakdown is reduced if both partners have a realistic perspective of how relationships develop and change over time, she explains. A lot hinges on the capacity to understand what it is like for each other.

For front-line workers, such as public health nurses, to share the information that relationship angst is normal and to encourage new parents to think about what’s going on from their partner’s perspective could be an important step in bolstering that new family unit.

“If the Mum is feeling dissatisfied in the relationship, she tends to concentrate more on the baby,” says Hurley. “If the Dad is being criticised, for not being able to change a nappy or putting the dark clothes in with the whites or whatever, he will distance himself from the child.”

For more information on the parent-to-parent voluntary support group Cuidiú, see cuidiu.com

Relationships Matter report: key points

“The groundwork for all relationships is laid in early infancy,” writes Dr Sinéad Hanafin in a new report commissioned by Ag Eisteacht.

Positive attachment between infants and adults have a significant impact "not only throughout childhood but also into adulthood", she explains in the study Relationships Matter, which draws on Irish data across the life cycle. That is why supporting young families is such an important investment in their future.

The relationship between a child’s parents, or perhaps between a lone parent and a grandparent, forms the centrepiece of how children learn about relationships, says Ag Eisteacht chief executive Dr Maeve Hurley.

“That interaction the child is experiencing will shape the child’s expectations of relationships – obviously it’s not fixed but it does give a template. And that’s where our resilience stems from.”

Here are a few of the stand-out figures garnered by Hanafin, who is managing director of Research Matters and a former head of research at the Department of Health and Children:

• 43,596 referrals about child abuse and neglect were made to Tusla in 2015.
• 83 per cent of children report being able to count on their mother.
• 76 per cent of children say they can count on their father.
• One in five parents reports high levels of conflict with their child.
• One in four infants in lone parent families has no contact with father.
• 90 per cent of children report having three or more friends.
• One in four children reports of being bullied in school.
• 50 per cent + Of 211 women murdered over a 20-year period, more than half were killed by a male partner or ex-partner.
• 6 per cent of men experience severe domestic violence.
• €2.2 billion a year is what domestic violence is estimated to cost the State.
• 118,178 people identified as being separated in Census 2016.
• 7 per cent of workers have experienced workplace bullying.
• 2,592 referrals were made to the HSE elder abuse service in 2014.
• Resources: For more information, see ageisteacht.com and for more information on the parent-to-parent voluntary support group Cuidiú, see cuidiu.com

[ swayman@irishtimes.com ]