11Perspective – NCT’s journal on preparing parents for birth and early parenthood • Issue 26 March 2015

Evidence made easy

Protecting the couple relationship after birthBecoming parents can put a strain on a couple’s relationship, risking a negative impact on both the adults and their baby. Here, we aim to increase understanding of the issues so that NCT practitioners can think about the preparation and support they can provide.

Q How does having a baby affect couples?

A Although a minority of couples report an improvement in their relationship on becoming a parent, 1,2 the transition to parenthood is widely recognised as a time of relationship stress.3 A baby puts new demands on parents’ time, so nurturing a relationship can seem less important. Couples, however solid their relationship, may find they argue more and that being warm and affectionate is more difficult. They may be dealing with overwhelming tiredness which impacts on their mood.3

Women may have physical changes and/or pain to cope with, poor body image and low interest in sex.4 Almost half the first-time fathers in an NCT study describe feeling closer to their partner but nearly a quarter described increased conflict.3 Who does what in the home has been identified as a major stressor for new parents.5 A lack of time both for oneself and each other has been identified as a cause for relationship unhappiness, with half of new fathers citing this as having a negative impact on their relationship.3

Any existing problems are likely to be exacerbated. There is evidence that poor communication or conflict during pregnancy predicts a greater decline in the quality of the couple relationship after the birth.6 Mental health problems are both a cause and consequence of relationship distress. However, Relate says that the top four strains for couples arise from money worries, work-life balance, infidelity and poor communication.7

Q Why is the quality of the couple relationship so important?

A Happy, fulfilling relationships are important for emotional well-being, resilience and positive sense of self, and they protect against depression.7 During the first 1,000 days, couples who have a good-quality relationship are better placed to deal with the challenges of new parenthood and interact with their child with sensitivity and warmth.2 According to the Tavistock Centre for Couple Relationships (TCCR), positive relationships have measurable emotional, cognitive and physical

benefits for children. Poor parental relationship quality and conflict lead to increased stress within the family, and parents are less able to be sensitive to the needs of their baby. The TCCR suggests that supporting couple relationships during the transition to parenthood will provide far-reaching benefits.8

Q How is the transition to parenthood different for women and their partners?

A There is an extensive literature on this subject, which merits further reading (see ‘Supporting women in the transition to motherhood: a research overview’ on p16). For example, Stern argued that the birth of a baby alters a woman’s mind-set. She may become overwhelmed by a sense of responsibility for her baby but feel her partner’s life is unchanged, and may turn towards other women, particularly her mother, which can cause her partner to feel rejected.9 Gaunt carried out a detailed study in Israel to explore whether and how women ‘manage’ their partner’s involvement with their young child and argued that the mother’s beliefs and behaviours can be significant in determining the couple’s arrangements for work and child care.10

A review of men’s psychological transition to fatherhood, drawing on 32 research articles, has shown that men have to do a lot of psychological work during their partner’s pregnancy to adjust to changes, and this can be stressful. The postnatal period is highly challenging, involving juggling new relationship and emotional demands with persisting societal and economic pressures.11 If fathers of young children become depressed they tend to manifest different symptoms and behaviour from women, such as increasing alcohol intake, showing aggression and taking risks (for example, having an affair).12

Points for reflection• Consider how well you prepare

and support women and men for the impact of a baby on their relationship. Actively consider men’s needs, as they consistently report feeling excluded from maternity services and postnatal care.11 Examine your own practice and language.

• Consider the needs and sensitivities of lone parents. Emotional well-being is influenced by good-quality relationships all round. How can you encourage lone parents to build and maintain strong, supportive relationships, or separated parents to work together to build a nurturing relationship with their child?

• Be mindful that intimate partner violence (physical, sexual, emotional, economic) is common, but often not disclosed. Avoid making assumptions about relationships.

12 Perspective – NCT’s journal on preparing parents for birth and early parenthood • Issue 26 March 2015

Evidence made easy

References1. Kluwer ES. From partnership to parenthood: a

review of marital change across the transition to parenthood. J Fam Theory Rev. 2010;2(2):105-25.

2. The Relationships Alliance. Key evidence messages on relationship quality. 2013. Available from: www.oneplusone.org.uk/wp-content/uploads/2013/10/Key-Evidence-Relationship-Quality-October-2013.pdf.

3. Easter A. Fathers find more ‘family time’ means less ‘couple time’: how relationships change for new parents. Perspective 2014;(24):15-6.

4. MacArthur C, Winter HR, Bick DE, et al. Effects of redesigned community postnatal care on women’s health four months after birth: a cluster randomised controlled trial. Lancet 2002;359(9304):378-85.

5. Brotherson SE. From partners to parents: couples and the transition to parenthood. Int J Childbirth Educ 2007;22(2):7-12.

6. Doss BD, Rhoades GK, Stanley SM, et al. The effect of the transition to parenthood on relationship quality: an eight-year prospective study. J Pers Soc Psychol 2009;96(3):601-19.

7. Sherwood C, Kneale D, and Bloomfield B. The way we are now: the state of the UK’s relationships. Doncaster: Relate; Relationships Scotland; 2014. Available from: www.relate.org.uk/policy-campaigns/publications/way-we-are-now-state-uks-relationships-2014

8. Tavistock Centre for Couple Relationships. What do couple relationships have to do with infant mental

health and secure attachment? A policy briefing paper [2012]. Available from: www.bit.ly/1wpw0uZ

9. Stern DN, Bruschweiler-Stern N. The birth of a mother: how motherhood changes you forever. London: Bloomsbury; 1998.

10. Gaunt R. Maternal gatekeeping: antecedents and consequences. J Fam Issues 2008;29(3):373-95.

11. Genesoni L, Tallandini MA. Men’s psychological transition to fatherhood: an analysis of the literature, 1989-2008. Birth 2009;36(4):305-18.

12. Condon JT, Boyce P, Corkindale CJ. The first-time fathers study: a prospective study of the mental health and well-being of men during the transition to parenthood. Aust NZ J Psychiatry. 2004;38(1-2):56-64.

Tips for good practice • Exploring relationships within a group

setting may be difficult for some couples who may believe that their own relationship will be unchanged after the birth and are unwilling to engage with potential difficulties ahead. Using expressions such as ‘from partners to parents’ may open minds to there being a fundamental shift in their relationship.

• Postnatal leaders often work with mothers only, so it is also useful for

the group to consider issues from the partner’s point of view. This means practitioners need to be well informed about the transition to both motherhood and fatherhood and be constantly mindful of challenges to the couple relationship.

• You could ask parents to look at clips on the Couple Connection website (www.thecoupleconnection.net) and discuss them the following week. Have information about sources of further

support at your fingertips. Relate offers counselling services for every type of relationship, including LGBT couples (www.relate.org.uk), while Gingerbread offers support to lone parents (www.gingerbread.org.uk).

• It may be helpful to remind parents that wider NCT services, including the branch, the website and the helpline can support the couple relationship, and that couples can enjoy NCT social events together.

Exploring relationship changes with parents• Exploring how couples can show

each other affection will help protect their relationship, even when there is conflict. One Plus One describes the model of the Vicious/Virtuous circle, which can be very powerful; small changes in behaviour can make a big difference to the couple experience.

• Parents can be prepared for difficulties regarding ‘who does what’ by identifying and discussing their expectations before the birth and being prepared to revisit roles and responsibilities when the reality of parenthood hits.

• Brotherson suggests practical approaches to help make a healthy transition from partners to parents, including sharing personal experiences, having regular couple ‘check-ups’, negotiating topics, lining up support early in pregnancy, talking with trusted friends, family or professionals, and expressing appreciation for each other and the child.5

In depth For more information, look at:

• Relate and Relationships Scotland

(2014) The way we are now (www.bit.

ly/RelateWayweare);

• Brotherson S (2007) From partners

to parents IJCE 22 (2) 7-12 (NCT

tutors can access a copy on request

from information@ nct.org.uk);

• The Relationship Alliance – online

evidence-based briefings covering

all aspects of relationships (www.

bit.ly/RelationshipsAlliance)

and Key evidence messages on relationship quality (www.bit.ly/

UnderstandingRelationshipQual);

• The Fatherhood Institute (www.

fatherhoodinstitute.org).

It is also useful to consult relevant

research overviews in previous

issues of Perspective (www.bit.ly/

NCTresearchoverviews) and resources

on the Pregnancy and Maternity

Information Directory (www.bit.ly/

NCTInfoDirectory).

Q How can new parents nurture their relationship effectively?

A Honesty, commitment and communication are the key ingredients for a good relationship, enabling new roles and responsibilities to be negotiated, and new ways found to meet each other’s needs and adjust to changes in sexual intimacy.7

The Relationships Alliance uses the ‘VSA model’ (Vulnerability-Stress-Adaptation) to raise awareness about relationship quality.2 Relationship quality depends on three inter-related factors:

• Vulnerabilities, such as partners’ individual traits and experiences

• Stressful events, including becoming parents for the first time

• Adaptive processes, such as the ability to communicate effectively by listening and resolving difficulties constructively

Individuals at risk in one area are very often at risk in another. For instance, parents who do not communicate effectively are more at risk of stress. This model can provide a useful framework for working with new parents, to help them gain insights and improve their adaptive processes such as more effective communication and conflict resolution skills.