Title: Describe the positive and negative aspects of being in the NUCLEAR FAMILY. How can the midwife support the NUCLEAR FAMILY.
Undergraduate Degree Level Essay
The family unit is an entity which is defined by environment and culture as much as behaviour. Different civilisations and cultures will define “the family” in different ways. Economic considerations are often paramount in the transition from an extended family to the nuclear family and social commentators often refer to the difficulties in establishing a new household base (in areas of high rent or commercial property value) as being one of the major obstacles to the emergence of the nuclear family as the common features of society.
To quote Margaret Mead:
“Nobody has ever before asked the nuclear family to live all by itself in a box the way we do. With no relatives, no support, we’ve put it in an impossible situation”. It is not surprising perhaps that members of the nuclear family can find themselves in emotional and practical turmoil. (Mead M 1972)
Cultural factors may also be significant such as the Hindu “joint family” where a marriage will being two family groups together as one family unit. (Bengtson V L 2001)
The first task in this essay is to describe and define the nuclear family. It first appeared in the scientific literature just after the war and was used to describe the family structure of a mother, father and their children. A formal definition could be:
The nuclear family is a social group characterised by common residence, economic cooperation and reproduction. It contains adults of both sexes, at least two of whom maintain a socially approved sexual relationship, and one or more children, own or adopted, of the sexually cohabiting adults.
(Murdock, G P 1949).
In modern social literature it is also sometimes used in the context of stable single parent families or families where the parents are a “non-conjugal” couple. In this essay we shall consider the nuclear family to be in the original Murdock tradition.
In the context of the implications for midwifery, we should also consider the implications of a being nuclear family. The literature often describes its positive features as including being a haven which encourages intimacy, love and trust where individuals may escape the competition of dehumanising forces in modern society…… a place for escape from the rough and tumble industrialised world, and as a place where warmth, tenderness and understanding can be expected from a loving mother and protection from the world can be expected from the father. (Popenoe D 1997)
The family life was famously pilloried by Nancy Mitford in her autobiography:
“The great advantage of living in a large family is that early lesson of life’s essential unfairness.” (Acton H 1999)
Although this was clearly intended as a flippant comment, one can suggest that the concept of the family as a haven is still both admitted and encouraged by social scientists, but in modern UK society the mechanisms of social protection and support that are currently available to most somewhat reduces the role of the father as “protector” and some commentators now add the concept of facilitating the ideal of personal fulfilment (or family fulfilment) as being the major role of the family unit
The media would have us believe that society is decaying (The Guardian 2004)
and cite the suggestion that the move towards self sufficiency, personal gratification and the move away from the extended family unit is evidence of that degeneration. The transfer of responsibility for the elderly from the family to the state and, to a lesser extent, the responsibility for childcare being assumed by the state is often put forward as further evidence of that decline.
Such considerations are of peripheral importance to this essay and therefore will not be discussed further.
We can examine the factors which are relevant to the change in prevalence of the nuclear family however, and these are often cited as
- Increase in sole occupancy dwellings and smaller family sizes
- Average age of marriage being older
- Average number of children decreasing and first birth at later age
- The historical pattern of fertility. >From baby boom to baby bust (instability)
- The ageing population. The trend towards greater life expectancy.
- Rising divorce rates and people who will never marry.
(after Kidd K E et al. 2000)
Clearly many of these factors have a resonance in the field of midwifery and we shall discuss them further. We should note however, that despite comments being made about the move away from the nuclear family structure that in the UK it is still the most prevalent stable family structure accounting for in excess of 70% of all households.
If we consider briefly how the nuclear family developed, we can look back to the days of the industrial revolution when social scientists point to the move from the extended family unit to a mobility dictated by the absence of a welfare state and family members moving to live with others who were in employment. Such changes were seen as an influence to extend and modify the family unit as a whole. As the welfare state evolved, the economic pressures referred to above became less of a compelling factor and the nuclear family emerged. Some commentators use the term “dispersed extended family” due to the fact that a nuclear family is now able to keep in functional contact with other family members through the medium of telephone, fast easy travel and now email
(Shaw M et al. 2002) Other factors that have changed and that are relevant to our considerations here are the relationships between parents and their children. In the past it was comparatively common to find that parents had children for economic reasons and were typically very authoritarian. The advent of social prosperity and the social support mechanisms available to UK households now mean that the economic necessity for having children is no longer viable. Parent / child relationships are said to be more loving and warmer and children are typically allowed a longer period of childhood in modern day life. There is also a considerable body of evidence to show that children are dependent on their parents for much longer than they used to be.(Wilkinson R et al. 1998)
We should not suggest that this comparatively rosy assessment of the nuclear family is the only consequence of social evolution. We can point to evidence that the traditional order of life events – marriage, sex and children – is becoming progressively reordered. Marriage is progressively less likely to come first and progressively more likely not to happen at all. In the last three decades the levels of cohabitation has trebled and the number of babies born outside marriage has increased fivefold. In the same period the number of single parent families has increased by a factor of three. Other significant statistics are that over the last 30 years the divorce rate has doubled which currently has the effect of finding that 50% of children under the age of 16 have had to live through their parent’s divorce.
The midwife is often central to the portal of support systems to the newly pregnant mother and thereby to the family. The possibilities of interaction between the midwife and the family are virtually endless and the opportunities for support and guidance at a vulnerable time in life are legion. (Pennebaker J W et al. 2002). We shall therefore use a few examples by way of illustration.
One of the prime reasons cited for relationship breakdown is depression in one or both partners. This is a well recognised sequel of childbirth and the midwife can clearly play a major role in spotting the early signs, enlisting prompt intervention and offering support to the whole family unit in such circumstances. (Davidson L 2000)
One recent paper examined the role of the midwife in actually preventing (or minimising) the onset and severity of post natal depression with the simple expedient of holding “debriefing” sessions. (Small R et al. 2000). The aim was to allow the mother to verbalise her experiences and to gain support and empathy from the midwife. The paper was both long and involved but, in essence, it examined the practice of debriefing, which has been successfully employed in other fields of healthcare as a means of reducing the burden of psychological morbidity, in its application to the field of midwifery. The authors point to the fact that there has only been one other qualitative trial in this area in the field of reproductive medicine and that was after spontaneous abortion when it was found to have a marked beneficial effect. (Bland J M et al. 2000)
This particular paper emphasises the role that the midwife can play in providing support. The significance is that the debriefing process, as such, does not measurably reduce the incidence of maternal depression but that the support that was provided was found to reduce the psychological distress felt by the mothers. The downside of such an intervention is that it can be seen as causing introspection and medicalising of the patient’s symptomatology. Empathetic handling and a sympathetic approach would clearly be part of the midwife’s clinical acumen (Lavender T et al. 1998) and nearly all of the women who underwent the debriefing sessions said that they found then helpful.
In terms of bonding and fostering the loving relationships that were commented on earlier, one could postulate that the role of the midwife in the promotion of breastfeeding activities is fundamentally important. The literature does not show any good evidence base for this hypothesis, mainly because of the fact that it would be both hard to quantify and measure, but the trial from Graffy (J et al. 2004) does support the fact that positive help and advice from healthcare professionals in the immediate postnatal period helps to promote maternal bonding which, in turn is associated with and increase in bonding in later life (Hamlyn B et al. 2000).
Curiously enough the trial did not find that the intervention significantly increased the rate of breast feeding, which may be a reflection of the fact that the modern mother in the UK is bombarded with promotional messages about breast feeding from many different sources and the intervention of the midwife is not fundamentally critical to achieving this goal. The mothers interviewed afterwards who were successful in their attempts at breast feeding commented on the fact that they felt emotionally satisfied with a greater frequency than those who were not able to do so.
>From the point of view of our considerations here we should note that there were a significant number of women (26% in this trial) who positively refused any help or support from any of the healthcare professionals, and this group may well benefit from careful handling and empathetic intervention in the pregnancy when the midwife is the main healthcare professional in contact with the expectant mother.
The midwife has a number of constraints upon her professional involvement and, generally by virtue of time constraints she has little time to act as a councillor to the family’s problems. We should therefore consider the effect of the modern concept of the seamless interface of care and multidisciplinary team working. (Kvamme O J et al. 2001). If the midwife is working in the hospital setting and becomes aware of family difficulties she should consider it part of her professional remit to pass on her concerns and knowledge to other appropriate professionals in the healthcare team whether that is at the level of the primary healthcare team or to a specific councillor or other related agency. Clearly this is easier if the midwife is already working in the community setting (Haggerty J L et al. 2003) as both continuity and coordination are more easily controlled
The thrust of this essay is to suggest that a role of the midwife is to support the newborn child as it begins its presumptive relationship with its new family and this can sometimes best be achieved by supporting the family unit during and after the birth of the child. In this regard we could finish this examination of the nuclear family with a comment from Pearl S. Buck who criticized the current system on part of emotional security aspects. He said ” The lack of emotional security of our young people is due, I believe, to their isolation from the larger family unit. No two people – no mere father and mother – as I have often said, are enough to provide emotional security for a child. He needs to feel himself one in a world of kinfolk, persons of variety in age and temperament, and yet allied to himself by an indissoluble bond which he cannot break if he could, for nature has welded him into it before he was born. ” (ODQ 2004)
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