I recently published an article in Early Childhood Research Quarterly (the best early childhood education journal) showing the factors that can predict Head Start preschool teachers quitting their employment across the first half of the school year (click here to read the published article).
Study Design: Ten Head Start centers in one major Midwest city were recruited to participate (170 total preschool teachers). Head Start preschool teachers with two years or less of experience, were asked to complete a 16-item questionnaire, as well as a demographics questionnaire at the beginning of the school year (n = 65 participating preschool teachers).
In January, half-way through the school year, I learned from the Center Directors who had continued teaching and who had quit. I then compared the scores of those who stayed and those who quit for any differences.
Preschool teachers came from a variety of backgrounds, according to the demographic questionnaire–different races, ages, work experiences, education, etc. There were also some differences between lead and assistant preschool teachers (see full article). However, all but one of the participants were female.
Huge Turnover Rates:
48% of all Head Start teachers were newly hired (within the last two years)!
36% of newly hired teachers quit during the first half of the school year!
The preschool teachers’ salary was not a contributing factor to their quitting their job. In fact, on a one-to-seven scale, preschool teachers who stayed rated their salary as a 3.9, while those who quit rated theirs as a 3.7 (statistically identical)–and both are just above the middle (3.5 out of 7), suggesting that both stayers and quitters think their salary is adequate.
Five factors differed between those who stayed and those who quit:
Preschool teachers were more likely to quit if they:
did not want to stay teaching in the early childhood education (ECE) field
were not happy
had a bad relationship with their supervisor
did not like their work environment
had a lower education
In addition, the more factors that an individual teacher possessed the more likely they were to quit (e.g. if they did not want to stay in ECE AND were not happy AND did not like their supervisor AND did not like their work environment AND had a low education).
While those preschool teachers who kept teaching, either did not have any or had only one of these five risk factors.
Conclusion: Preschool teacher turnover affects child outcomes, the quality of the preschool program, the teachers who continue teaching, and those who feel they need to quit their job.
Interventions should use this information to tailor their programs, so that fewer preschool teachers quit their job; yielding positive outcomes for children, parents, the school, and the teachers.
We recently published a paper that looks at why mothers and fathers attend a parent support program–in this case, Triple P – Positive Parenting Program in the Scandinavian Journal of Public Health (Click here to read the published article).
Most research on this topic looks at parents in general, and some only on mothers. Fathers however come much less often to parent support programs compared to mothers–so we wondered why that might be?
The intervention: The program was offered free-of-charge to all parents in one community in Sweden. We then looked at the background factors of mothers and fathers who attended compared to those who did not attend to see if there were any differences.
Results: Turns out that mothers are much more likely to attend the program if they perceive their child as having behavior problems, while fathers were approaching significance of attending if they perceived their child as having emotional problems.
Future research should look further into various background factors to see how to increase rates of other minority groups, such as those who are not native to the country the program is held in or those parents with less education.
Since it is the goal of public health ventures, like parent support programs, to reach as much of the population as possible, direct and specific marketing methods should be employed, rather than marketing to parents–since parents, based on their gender, have different needs.
Future research can better target parents via marketing/advertising strategies that appeal to the parents’ needs. In other words, if you only market for improving children’s behavior problems, you can expect more mothers to come to the program than father, since they are more likely to perceive that as an issue.
In Sweden you have one ultrasound, typically around week 18 to 19 (see my previous post about that experience here). We were told that you only have more than one ultrasound if there are potential complications.
Yesterday we received news that our baby did not appear to be growing, although our midwife said that it was possible the baby had just shifted position; thus resulting in the uterus appearing like it wasn’t growing (read that story here). We were scared, I cried, Lisa comforted me, and off we went to see what the hell was going on.
Quick Background on Uppsala:
Thankfully, we live in a city with a hospital. Also, we live in Sweden–where health care for pregnancy is completely free. So we didn’t need to ask ourselves if it was worth the money to get the check up. We didn’t need to consider the expense of another ultrasound. We could totally focus on our family’s health.
That was more than enough to focus on.
Even though we had time to walk to the hospital (20 minutes), we were too anxious, and called a taxi to drive us there (5 minutes).
Once we arrived and checked-in, there were two main tests that would be performed: 1) check the baby’s heartbeat over a period of time and 2) get an ultrasound.
Lisa was in the bathroom when they called for us. I sauntered over to let them know.
“Hi, she’s currently in the bathroom,” I politely and semi-quietly said. “Oh wait, here she is.”
The midwife popped out of her chair, walked immediately passed me and greeted Lisa.
Checking the Heart Rate:
She then said, “come this way Lisa” and led the way to a private room complete with a bed and a heart rate machine. It had two circular sensors that would be strapped onto Lisa: one to monitor the baby’s heartbeat and the other to monitor the number of contractions. Lisa also had a joystick-like object, where she should press the top button with her thumb whenever she felt the baby move.
Lisa was all strapped in, and I sat on a chair next to her bed.
“Oh, I forgot to introduce myself,” the midwife said. We shook hands and quickly exchanged names (my name was never spoken again).
I miss my prenatal midwife! I thought.
“How long will the heartbeat be monitored for” I asked. After all, we had just heard the baby’s heartbeat at the prenatal clinic, where they said everything was fine.
“It’s different. It could take 10, 15, 20+ minutes. Just look for a check box to be on the machine, and then you’re done,” the midwife reluctantly replied.
“You said the number of contractions will be counted. Is there a number or range that’s good?”
I prodded her more to get more specifics. “So should we expect to see 5?”
“Yes, that’s possible. It’s also possible to have 0. Anything is possible.”
“So we could have 100,” I asked, looking for a limit to the number of contractions.
“No, not 100. That would be too high.”
No more was discussed on this or any other topic, since she decided to leave the room. The language that the midwife used was always non-helpful, even with multiple questions.
Lisa and I continued to talk, hold each other’s hands, and tried to relax. Meanwhile, I sent out texts to different parents letting them know what was happening–I always need a support network.
I buzzed for the midwife to come back after the “check-mark” was on the screen. She then informed us that the doctor would look at the output and then determine if an ultrasound was needed. She failed to ever mention how our output looked. I still have no clue if Lisa had any or several contractions while the baby’s heartbeat was monitored.
Thoughts on the Support the Midwife (Didn’t) Give:
It was clear that the midwife made no decisions and could provide few answers, as she placed the results on the doctor the way a guy places his results on his wife–“aw guys, I want to come play poker tonight, but I’ll have to check with my wife first.”
There was clearly no accountability to be had via the midwife. She was there to perform the tasks instructed and to not provide us with advice or support or results.
She could however explain what different machines do or what she’s currently doing–although these responses often left more questions than answers.
Nevertheless, we figured the baby’s heartbeat was good, since we had just had that test completed, and we knew how to interpret the results (this time, the baby’s heartbeat was often around 140-150 compared to the slower 130 heartbeat 30 minutes earlier).
The Second Ultrasound:
We were then taken to the ultrasound room.
“Lisa, please come this way,” the midwife said walking us down the hallway.
“I’m not going to measure the baby,” the midwife said after laying on a thick layer of jelly on Lisa’s belly. “Are you ready Lisa,” she asked.
She then studied the baby, mainly measuring the baby’s head, stomach, and femur. She was silent, clearly focused on her work. This ultrasound was a lot different than the first. The first time we felt a great joy in seeing our baby on the screen. This time, we felt overly anxious, concerned, and in constant wonder of what was being found as the midwife measured these areas.
Brief side note: The stomach was measured twice, from NW to SE and NE to SW, making an X pattern on the screen.
“Did you also check the umbilical cord?” Lisa asked.
The midwife then checked the flow (of blood or nutrients???–this was never explained, but the answer was simple–after hearing a few beeps and seeing wave-like formations show up on the screen, the midwife announced–“looks good.”
The midwife seemed to remeasure the head, stomach, and femur two or three times, and then called in a second midwife to assess her assessment (although leading questions were asked).
“I measured from here to here and I got a normal number. Do you see that?” she said to the second midwife.
We were then abruptly told that everything was normal. No pomp, no circumstance. It was just black-and-white with no explanation.
“How do you know?”
The midwife then when into a litany of how numbers are calculated based off of the mean size for a baby in the week you’re in (e.g. week 36) compared to the size our baby is.
After the ultrasound, we found out that our baby was -6 on their head size and -3 + -3 on their tummy = -12 overall. Of course these numbers meant nothing to me, so I inquired further.
I can’t remember how long the femur was except that whatever the average was for a 36 week baby, ours was one (cm, mm???) longer.
Turns out that there is a scale for the average head, stomach, and femur (for some reason the femur length isn’t calculated, but is still measured. This was never fully explained to me).
Great, the one part that’s above average isn’t calculated into the proper growth of our baby’s size, I thought.
Then they take how long our baby’s head and stomach are, and those numbers are subtracted from the average baby at our week.
You’re considered “normal” or “healthy” if you’re between +22 to -22.
Meeting the Doctor
We then met the doctor. She had only one agenda–to reassure us in as many different ways as she could that there was no problem. Again, without going into as many (apparently needless) medical details as possible.
“Do you know why you’re here?” she asked as an opening statement.
“To check on the growth or lack of growth of our baby,” Lisa quickly responded.
“Yes, that’s right. Well, this is as perfect as it gets. You’re great. You fall within the normal range. Everything is fine. You have nothing to worry about,” she said.
“You can go home and enjoy your New Years,” she continued.
Again–I had lots of questions, but clearly could see that those were not welcomed. In fact, at one point I even called her out saying “Yes, I get the point that you clearly have one job–to make us feel calm and safe, but…” and then I continued asking several questions of things to look out for or how to prepare ourselves should this arise again, and what to do at our next prenatal meeting.
Conclusion: The doctor could only guess like our original prenatal midwife–that the baby had just shifted position in the body, making the uterus appear as though it’s not growing.
I told her I was quite interested in what was happening with our baby, which is why I had so many questions.
Rather than finding it beneficial to have involved parents seeking answers from a professional, her response to me stating my interests was simple, but dumbfounding.
“Google it,” she said.
“Really? We come to the hospital seeking answers from a professional and your response it ‘Google it’?”
She then argued why Googling was a good method, but that people can’t interpret the results well.
Well no shit! That’s why we’re talking with you right now. We want to be informed parents and understand the potential situation our baby may or may not be going through. Plus it just doesn’t hurt to know more, in case this same thing happens again in the future with another child, I thought.
We left the hospital feeling glad that nothing was wrong with the baby (as far as they could tell). The first baby scare was over. For now.
But I also left the hospital with a pain in my stomach, knowing that I could have a midwife as inattentive, unsupportive, and unwelcoming as her when we give birth.
Fingers crossed that we have one like our prenatal midwife!
PS–Interesting side-note, the midwife said it wasn’t a problem to take pictures during the ultrasound, despite the first ultrasound midwife saying that we weren’t allowed to take pictures. Of course, no explanation was given on why it could or could not be ok to take pictures during the ultrasound.
PPS–This has so far been our fifth midwife, and we haven’t even given birth! Talk about a lack of continuity of care, as well as trying to develop trustful, stable relationships! Not ideal, Sweden!
Yesterday I had my first real parenting scare. I cried. Several times…
Side-note 1: I say “real” because twice now Lisa has felt quite dizzy, with a palpitating heart, forcing us to quit our dinner outings and take a taxi home–presumably due to low blood sugar (or so thinks the midwives who answer the phone at the hospital).
Side-note 2: We’re in week 36. At this point, several people have already gone through miscarriages, pre-term births, or know that they are awaiting various birthing complications. This has not been our case, so far. Despite the fact that we’re currently in the norm, we still feel quite lucky and thankful that no major problems have arisen.
Side-note 3: Our biggest pregnancy problem thus far has been acid that continuously disrupts Lisa’s sleep, often starting in the evening and continuing throughout the night. Even though she stays away from acidic foods, like apples and oranges, especially late at night, she still routinely gets acid, causing her to miss out on plenty of sleep, and subsequently myself as well. A prelude of things to come.
My schedule for the day: The day started out normal–I was to clean out my old desk, since I will start a new job in the new year. Then I should get a new haircut; a courtesy for the new job. Then I should meet Lisa at the prenatal clinic for our normal two-three week check-up. Then after-Christmas shopping should ensue 🙂
Routine Prenatal Visits: The visit to the midwife was standard and routine. Read my previous posts about these visits here and also here. Therefore, I have not continued documenting every visit (although currently, including the present visit, we have gone to the prenatal clinic post ultrasound 6 times, with two more times scheduled before the birth [since we had two visits pre-ultrasound, we will have a total of 10 visits to the prenatal clinic + 1 ultrasound)–every two weeks, we arrive, the midwife greets us, we swap slightly personal stories about the goings-on in our lives (aka small talk), we ask semi-anxious prenatal questions, and then proceed with checking the blood pressure, occasionally checking the iron levels via a finger prick, and measuring the size of the uterus (a subjective measuring, but still, fun to see the results charted out on a graph). Overall, it’s a fun time, because we like our midwife’s personality and get along well with her (aka–she laughs at my jokes 😉
In fact, the last four visits to the midwife have been so mundane, that I, a fatherhood researcher of child health care, have questioned if I even need to show up. I figure everything will be normal and if not, then my partner will inform me if anything is abnormal (e.g. iron levels are low; solution = take an iron pill more frequently). So, unless I have specific pregnancy questions, there’s little reason for me to attend–accept that most of our visits have, so far, corresponded with the prenatal parent education classes–and since those go over different information at each meeting, I may as well come 20 minutes earlier and still participate in the routine meetings with the midwife. Plus it’s fun!
Back to the prenatal parenting scare: Yesterday’s visit was not completely routine. Beyond the trivial routine measurements and tests, we were to also talk about how we wanted to give birth. The midwife would then notify the hospital of our requirements–epidurals, laughing gas, sterile water, etc. Do we want things in succession? Do we want a completely natural birth? Do we want a midwife who’s good in English? Yes, that last one is a definite yes! Do we have any special needs, especially dietary?
Lisa was already at the clinic when I called her from the elevator asking where she was. I hadn’t worn a hat, despite the Swedish winter in bitter December.
“Oh, I love your new haircut,” Lisa responded when she first saw me. “She does such a great job, and great job styling it. You need to buy whatever product she puts in your hair. You look so good!”
That felt amazing. I can’t wait to get another haircut! I have the best girlfriend, I thought.
We hadn’t really discussed this at home to any great extent. So we went into the prenatal visit saying “we don’t know, what we don’t know,” and sought out a few more answers–why get laughing gas over the epidural and vice versa? What are the pros and cons of both? And what point are you beyond the point of no return when it comes to getting these?
Prior to having the birthing discussion though, we decide we would go through the normal routine. Lisa’s blood pressure was perfect. Her finger was then pricked, and her iron count was 130; a very healthy iron level, just like every other visit.
Then she went to lay on the bed so that her uterus could be measured and the baby’s heart rate could be measured. Knowing Lisa loves video of the baby’s heart rate, I started video recording with my phone. While the last few times we had visited the baby’s heart rate was always around 150-160 (dropping below 150 and occasionally going above 160), this time the heart rate was around 130.
“A perfectly normal heart rate” the midwife responded.
I replied back, “ya, but normally it’s around 150-160, because [the midwife] is pressing so hard on Lisa’s belly, forcing the baby to stress out and move around; so maybe the resting heart rate is closer to 115 or 120?”
No one seemed to care about answering that question, including myself. It was just an automatic statement that blurted out, since we had always seen the baby’s heart rate rise (to 160-170) and then drop after thirty seconds to two minutes (to 140-160).
The uterus was then checked. I was so excited. Since the start of the pregnancy, the uterus has been about one standard deviation below the mean, but over the weeks, had been inching itself closer to the mean. I was hopeful that we would be directly on or even just above the mean line this time.
“There is no growth since the last time you were here,” the midwife said in a slightly urgent and bewildered tone.
She appeared confused and re-examined the size. Then she called in another midwife to confirm her findings.
The room wasn’t filled with jokes. The cheery feeling had left. Silence took it’s place, as Lisa and I wondered what all this meant. Especially having just seen a “perfectly normal heart rate.”
The second midwife came up with similar results. Lisa then reannounced that the baby had, starting a day or two earlier, started to move a lot less. This fact was stated at the beginning of the meeting but was quickly dismissed as “normal” and “anything can happen during pregnancy”. The sentence was not dismissed this time. This time, it was taken seriously.
“The baby not moving much, coupled with no uterus growth–I recommend you to go to the hospital and get another ultrasound,” the midwife strongly urged us.
Thoughts rushed through our heads. What does this mean? How bad is this? Will we give birth today via a C-section? Can something bad happen to our baby? Can we lose our baby!? I want answers, and I want them now!
She then immediately called the hospital to arrange our visit. We found out we could go as soon as our routine prenatal visit ended.
The new chart was created. We weren’t near the average growth anymore. We were on the second standard deviation line below the mean.
Joking time was over. I didn’t give a shit about my new haircut. I was, for perhaps the first time of my baby’s life, completely focused on whatever might be happening in Lisa’s belly.
Lisa and I didn’t speak to each other, but it was clear that we both just wanted the meeting to end at that moment. We wanted to know what was wrong with the baby’s growth. Answers were needed; were needed quickly; and we were quite done at this meeting.
“Do you want to talk about how to give birth,” the midwife inquired.
Lisa didn’t immediately talk. I spoke up.
“Honestly, I don’t really care. I don’t know if we should reschedule or if we should just decide quickly. Lisa, maybe you have some quick thoughts and then we can go to the hospital,” I said.
“I agree,” Lisa responded.
Even still, we continued on, and made some decisions, asked a few more questions related to the birth….and took a few more deep breadths. Lisa and I were clearly more worried than the midwife was about our situation, but even still, she made sure to know she cared.
“I’ll be off the rest of the week, but I may still check my email. In fact, I will try to check everything before I leave today to see how it went at the hospital. If anything comes up, please let me know. And feel free to email me the results and any questions you have,” she said while we were shaking hands goodbye.
As we walked down the stairs, scared and filled with questions, we easily decided we would take a taxi (5 minutes) rather than walk to the hospital (20 minutes). We wanted answers, and we wanted to make sure we did everything we could to be seen sooner.