Jill Nicholson (1968) Mother and baby homes: a survey of homes for unmarried mothers London: Allen & Unwin 0 04 362010 8
This research, sponsored by the National Council for the Unmarried Mother and her Child, was the first attempt at a comprehensive study of this type of home. Though it covers homes for adults as well as for young people, many of its findings are relevant to caring for children away from home. Carried out not long before the arrival of the contraceptive pill and just before the 1967 Abortion Act came into force in April 1968, it was unusual in including residents’ views - something still all too frequently missing from residential care research.
- Mother and baby homes were initially established by concerned lay people but are now largely provided by church bodies.
- They cater for around one in six of extra-marital pregnancies.
- Most residents had family contact and very few had been rejected because of the pregnancy.
- Unmarried mothers in the north received greater sympathy from the community than those in the south.
- The material conditions of most homes were poor though the food was usually adequate.
- Rules tended to be more restrictive in evangelical homes and in those where staff were overworked, but in practice there were fewer problems in homes with fewer rules, where the rules were broken less often.
- The matron was central to the assessment of the home and the quality of the residents’ experience.
- Residents were better off in homes for ten or fewer or for twenty or more; homes with 15-16 residents tended to split into two hostile groups.
- While many homes had difficulty filling posts, homes in the north had more flexible staffing arrangements than those in the south.
- While ante-natal and GP support was good, few homes provided relaxation classes and none preparation classes.
- Mother and baby units with maternity units were considered better for younger mothers because they avoided the stress of being among married women and possibly receiving unsympathetic comments in hospital maternity units.
- Staff generally took too much responsibility for the care of the babies.
- The religious aspects of the homes had relatively little impact beyond occasional irritations for most of the residents.
- Religious groups should not be criticised for providing mother and baby homes when other community groups were not providing any alternatives.
- Most matrons and social workers thought that social workers should hold casework responsibility but few social workers had enough time to carry out their responsibilities and fewer than one in six residents valued what they did.
- The residents were rarely afforded the opportunity to discuss their situations with anyone.
In Chapter 1 Introduction, she notes that mother and baby homes had historically been provided by religious bodies; 138 out of the 172 homes they were able to identify were provided by church bodies. They had initially been for penitent prostitutes, who generally had to part with their babies because their stay in the home had been seen as part of their penitence leading to their reform. This image still hung over mother and baby homes, even though now they normally only care for the mother for the weeks around confinement and the baby is expected to remain with the mother during this period.
They encountered views on illegitimacy from ‘it’s normal’ to individual sin. There was a lot of ambivalence, with mother and baby homes being criticised for doing too little by those who saw the problem as social or emotional and for doing too much by those who saw it as individual sin. Most had been set up by individual groups of lay people even though now 80% were run by church bodies using a wide range of titles.
Their functions can be seen as:
- helping to cope with extra-marital pregnancy
- providing adequate medical and physical care
- helping with ambiguous motherhood.
They cater for around 11-12,000 of the 70,000 extra-marital pregnancies a year, normally only for three months in the mother’s life.
In Chapter 2 Residential accommodation in England and Wales, she describes the three main types of mother and baby unit identified in the study:
- twelve hostels for pregnant girls which take girls from early pregnancy to near confinement when they are transferred to the second type of home;
- 154 homes providing accommodation around confinement, of which 32 had their own maternity unit; three were for girls at school and one for girls in care or on probation;
- four projects offering accommodation for mothers with children either hostel-style or in self-catering flats, usually for up to two years.
Twelve more projects of the third type had opened or were being planned since the study had been completed.
While the average size was thirteen beds, they varied from fewer than five to over thirty, those with their own maternity unit usually being larger. Twenty-four were being run by local authority health and welfare departments; most of the others were run by local bodies or dioceses with only the Salvation Army offering a national service. Two children’s departments had opened homes since the survey. Over half of the homes received local health authority block grants and around a quarter smaller grants as well as per capita fees.
In Chapter 3 The survey, she describes the twenty three homes, 60% in the north and 40% in the south, selected for detailed study during which matrons and residents were interviewed and the building toured. They also interviewed 51 church and local authority social workers.
The residents were interviewed in groups of four to eight and asked to complete a questionnaire at the end; over 80% of the questions were answered and only 10 out of the 250 interviewed were unable or unwilling to complete them. Also the most recent arrival and the next expected departure were interviewed individually using a combination of scheduled questions and informal discussion.
In Chapter 4 The use and scope of mother and baby homes, she discusses the use of mother and baby homes compared with other alternatives; it was generally the social worker who had decided that a mother and baby home was the best; only eight out of the two hundred and forty expectant mothers had made their own arrangements. She notes that unmarried mothers were only a small part of social workers’ caseloads and a high percentage of the mothers were interested in adoption.
Social workers gave lack of alternative services as the most common reason, fear of ostracism leading to family tensions as the second and accommodation difficulties, including homelessness, parental illness or lack of space at home, as the third. The residents gave adoption as the most common reason, getting away from neighbours, in part because of the impact on family or siblings, as the second and accommodation problems as the third; six had been turned out of home. Some residents also said that it would give them space to make decisions about the baby and nine that they had really been given no choice, whether by social workers or family.
The main constraint on the selection of a home was the willingness of the local health authority to fund out of area placements; other constraints could be admission criteria or where first contact had been made in the last three months of pregnancy. Nearly half the residents had had two or fewer interviews with the social worker before the choice of home had been made.
Only two homes in the study had no time limits; most limited the stay to the last six weeks of pregnancy and the first six weeks after the birth though some extended or varied this period. Only six homes allowed married women and only seven homes expectant mothers where it was not the first pregnancy; the others only admitted those in their first pregnancy or who had not been to a mother and baby home before. The Roman Catholic homes stipulated that either the mother or the putative father had to be Roman Catholic. There were two homes for girls under 17 and two that excluded girls under 17 but otherwise there were no age limits. Girls with disabilities, except epilepsy, were accepted as long as they could cope with hostel life. Four homes banned girls on probation or from approved school and one local health authority home only took local residents while two others gave priority to them.
Social workers tended to select homes according to the matrons’ views about which ‘backgrounds’ were suitable and local authority and Salvation Army homes were seen as the most open. Very few homes used admission criteria for positive reasons, mostly for negative reasons, sometimes linked to the earlier purpose of distinguishing the deserving and the undeserving poor.
In Chapter 5 The residents in the homes, she describes the very wide range of residents. Only six in the study had been married; two were widowed and four separated or divorced. For 92% it was their first pregnancy, though, because some were known to have concealed earlier pregnancies to satisfy admissions criteria, this was probably an overestimate. Most were British and they were younger overall than the population of unmarried mothers as a whole, though teenage mothers were not over-represented, refuting the belief that social workers encouraged teenage mothers to go into mother and baby homes.
Most were in employment and there was little evidence to support the idea that unmarried mothers took lower status jobs. 76% of putative fathers knew about the baby but only 26% had been in recent contact, more often with the younger girls. One in eight had been illegitimate themselves, twice the proportion in the population, and 68% were from intact homes. Only nine had concealed the pregnancy and nineteen had only told their mother. Two-thirds had seen their mothers since admission and half their fathers; only thirteen had had no contact. Most had been living with their parents when the child was conceived and, though a third had left home since, a sixth who had conceived away from home had moved back home.
Though matrons often cast doubt on residents’ favourable accounts of family life, three-quarters were planning to go home afterwards. One third were assured of a job, all but six with their previous employer. Interestingly, in the north disapproval was mixed with sympathy: neighbours and workmates would collect for the girl or knit for the baby but not in south.
In Chapter 6 The material standards, she describes the material state of the homes; most were adapted homes, often in need of substantial repair. Only three had satisfactory buildings. The halls were normally dismal; most had separate living rooms and dining rooms but the furniture was often drab and uncomfortable and some rooms were too small. Nine homes had modern kitchen equipment; one had a commercial laundry and three excellent laundry facilities but some had no washer or drier.
The nurseries were generally well furnished but one had no windows and only one had day and night nurseries; there was no privacy in the nursery to feed baby. Residents mostly shared bedrooms; only one home had curtains to go round beds. The standard of furniture was low; there was a shortage of cupboard space and only one home provided a lockable locker for residents.
Sanitary provision was inadequate with insufficient baths in five, insufficient lavatories in eleven and only seven homes providing wash hand basins in at least some bedrooms. Sometimes the handbasin, bath and lavatory were in same the room or any alternatives were some distance away; there was little privacy for washing.
Staff accommodation was generally poor, especially for assistant staff. Both staff and residents deplored the poor material conditions; the girls often saw it as punishment while the matrons had difficulty persuading management committees to improve things. Interestingly, the best and worst homes were both run by local health authorities.
Though ten homes were planning improvements, neither matrons nor committees had much experience of planning mother and baby homes.
In Chapter 7 The pattern of daily life, she describes how the pattern was generally set by baby’s feeding times with housework in the morning and the afternoons and evenings free, in some cases broken by a one hour siesta or with options for handicraft or relaxation classes; as the first feed could be at 5.30 and the last 11, it could be a long day. Sunday was the most boring day because ten homes banned Sunday visits, some only allowed residents to go to church, two banned cards, games, the record player and TV and one banned Sunday newspapers.
The food was generally good though in a small number of homes residents complained that the food was insufficient or inappropriate for expectant mothers. The residents usually helped to prepare meals and in half the homes prepared breakfast or the evening meal themselves; two homes allowed self-cooked evening meals. Three homes allowed drinks at any time and one allowed unlimited access to milk, of which residents in other homes were mostly likely to complain that they were not given enough. Only one home provided storage space for residents’ own snacks.
Residents were expected to do a wide variety of housework, mostly to keep them occupied; only one home used it as a tool for reform and three as skills training. In half the homes household tasks started before breakfast though in a third there was only about one hour’s work to do against a third where it was planned to last all morning. Residents mostly accepted the work even if they found it difficult, because they had the rest of the day to recover, but in eight homes there were complaints about it being too hard, long or unsuitable; there was also some frustration about spinning out work to fill the time and resentment at the strictness of some inspections. Housework partly saved on costs and was partly a hangover from the rescue homes days; three matrons disliked it and tried to find other jobs around the house. Interestingly, there were no classes related to motherhood and baby care.
Residents were mostly only allowed out during the day, not the evening; some matrons expected to know when residents were going out and some homes restricted activities but there were fewer complaints and less demand to go out in homes with fewer restrictions.
In Chapter 8 Rules, she summarises the rules. All homes allowed parents to visit except for one where fathers had to ask permission; other relatives, apart from young children because of fear of infection, were also allowed to visit. There was a wide range of rules about boyfriends, whether or not the putative father, with one third of homes banning all visits from boyfriends unless they were contemplating marriage. Though most residents did not want visits from the putative father or boyfriends, they did not see why homes should rule on these, particularly if they wanted to talk over the situation with the putative father. The matrons who allowed putative fathers to visit said it had a salutary effect on them.
Six homes allowed visits at any time but the rest set visiting hours, usually on Saturday and Sunday, while allowing residents to go out in the afternoons if their parents were unable to visit during visiting hours. In practice, those who allowed unlimited visiting did not encounter the problems used to justify limited visiting and residents who did not receive visits were often asked out by other residents’ families in homes that allowed unlimited visiting.
The censorship of letters was rare, mostly restricted to approved school girls. Only two homes had coin phones while four allowed residents to use the staff phone but this gave no privacy.
Smoking was forbidden in nurseries and bedrooms and sometimes in one of the living rooms or for periods around mealtimes; nine homes had restrictions and two banned it completely.
The residents generally accepted the rules but they were most often broken in the most restrictive homes; in the three homes with few rules they were rarely broken. In practice, rules were difficult to enforce, punishments generally being loss of privileges or group punishments which usually led to identification of the culprit. Some matrons tried to avoid confrontation with suggestions boxes or a ‘complaints day’ when issues were discussed. The evangelical homes and those where staff were overworked tended to have more and more restrictive rules.
In Chapter 9 Relationships in the homes, she notes that homes were normally judged by the quality of the matron and that many residents found the matron a mother figure. The matrons saw helping residents with their personal problems as part of the job and in a third of the homes there were real gains from this relationship. However, six matrons were disliked or feared, four were two-faced, two deliberately upset residents, one nagged, one went through residents’ possessions and two were always reminding residents of why they were there. In fact, some girls could not get on with the popular matrons and some found the unpopular ones kind and understanding. Three hard-pressed matrons were very impressed by positive responses from residents to their situations. Relationships with assistant staff were less significant for residents.
Before they came in, many residents feared being among ‘tarts’ or thought that they were the only person with the problem and were relieved to find that they were not alone, but most had difficulty settling in, with residents’ responses varying from ignoring them to interrogating them. Some residents never settled down, in four homes because of poor relationships with the matron. Most received support from the group though there might be difficulties from time to time.
Few matrons or staff had had any training; the residents tended to prefer younger married staff who knew about babies but not all of them were able to communicate. The most important factor was whether staff understood the world from which the residents came.
There were conflicting views on whether small homes promoted harmony or friction but residents were better off in homes for ten or fewer where they lived in a single group and in homes for over twenty where they had more choice of staff and friends. The least satisfactory size was 15-16 beds where there was a tendency to split into two hostile groups.
While the matrons saw having a wide age range as beneficial, the residents were more relaxed with a narrower age range. The main problem was that the residents were generally treated as ‘girls’, that is, as not able to accept responsibility.
While the matrons liked the idea of living as a family, only four homes achieved this according to the residents. In some, staff had different food and crockery.
In Chapter 10 Staffing, Jill Nicholson notes that the matron was the only resident staff member in five homes and the only full-time staff member in three. They generally:
- undertook the administration
- supervised the housekeeping and
- were responsible for the residents’ welfare.
Some matrons undertook external social work.
Only eight had been in post for less than three years and four had been in post for over ten years. They had at least one assistant and the well staffed homes tended to have staff with specific jobs. In the south the non-resident staff were domestics, gardeners or night attendants only; in the north they might also be nursing staff or assistants. Sixteen homes had a nurse and nine a moral welfare worker - three had both.
The local authority homes were the best staffed with the most qualified staff and at least two resident midwives. There were wide variations in staffing in the others. Nine matrons said they were understaffed and in half the homes there was no domestic help and in a third no cook or no gardener; only five had secretarial help. Nearly half had a vacancy at the time of the study visit and some had not been able to fill vacancies for years; many matrons had not had their full leave, one for fourteen years. One home closed for one month each year to allow staff leave.
Generally, management committees failed to:
- understand residential work
- think through the purposes of the homes.
Though some matrons refused to delegate, many simply did not have the time to do their jobs and they appreciated residents’ consideration in this area. She suggests that living-in needs to be re-considered because, with the shortage of single women, new arrangements may need to be considered such as greater use of sleeping-in or employing married couples as in family group homes; the homes in the north had moved in such directions whereas the homes in the south had not.
All except the Salvation Army and Roman Catholic homes had committees; eleven matrons found them good, but others found them out of touch or old-fashioned. Some homes used voluntary workers, for example, for classes; there were mixed views on whether they were a help or too much trouble.
In Chapter 11 Medical care, she notes that residents received routine supervision from a general practitioner but there was little use of dental or psychiatric services. There was routine use of ante-natal care but little use of relaxation classes. Residents tended to ask for them if they were not available but had mixed views where they were available because they sometimes had to attend alongside married women.
Many were ignorant or apprehensive about the process of birth because preparation classes were not readily available. There were no problems getting residents to hospital maternity units but sometimes they did not have enough staff to accompany them. Half the matrons allowed other residents to visit the hospital and six allowed visits if there were no family or friends visiting; one matron forbade visits. Five matrons tried to visit themselves and in two cases where distance was a problem committee members or friends of the matron visited.
There were complaints about hospitals where residents returned without breastfeeding having been established or because the hospital was short-staffed. The residents were generally satisfied with hospital care but their status had often been reinforced when husbands and families of other women visited. Though the mothers did not mention this, the matrons described various thoughtless remarks made to residents in hospital.
The homes with maternity units tended to be larger and less relaxed than the mother and baby homes but they avoided the painful aspects of being in hospital and also offered continuity of care. The matrons thought that these were better for the younger ones because of the stress of being in hospital.
In Chapter 12 The care of babies, she describes how all but two of the homes expected the mother to care for the baby whatever the plan; there was wide variation in the extent to which mothers had responsibility for the baby’s care.
Most homes preferred either breast or bottle-feeding and encouraged it; one third preferred breast, one third bottle and one third said it was the mother’s choice but only one matron was genuinely not bothered either way. The residents saw breast-feeding as encouraging love for the baby and most residents followed the line of the home except for those opposed to that line; most were encouraged to move to the bottle before they left the home. Only one home had an on-demand feeding policy; the others were time-based, some with flexibility, others not.
Mothers gave baby a daily bath in all but two homes where the staff bathed the babies. In nine homes babies slept in their mothers’ rooms, in twelve in the nursery - in six with night attendants, in three with mothers accompanying them, in three with no-one.
In less than half the homes were mothers allowed free access to their babies; mostly it was just at feeding times or sometimes if the baby was crying but others banned such contact. Seven matrons prohibited mothers from taking babies out in their prams, in two cases because they had been receiving gifts from admiring strangers in the park. Only a few allowed babies out with visitors. Two allowed mothers to go out if another resident, often an expectant mother, cared for their baby.
Thirteen homes had trained staff to advise on baby care but residents could be irritated if this came over as criticism; residents were also frustrated at the lack of time to play with their babies. Overall staff took too much responsibility.
In Chapter 13 Religion in the homes, she notes that all, except the local authority, were religious homes and daily prayers were said in all but two, in three twice a day and in one each service lasted over 30 minutes.
Residents were expected to go to church in most homes and an alternative recorded service was made available to those staying at home; in one home residents were free to choose and in one home they were banned from church, a rule that upset the residents. However, only six homes had set out their expectations in the admission forms and there was only one home where matron and residents agreed it was not an obligation.
All the homes had chaplains and six held discussion groups; some chaplains saw the residents individually and the residents generally valued them; however, there was little religious instruction.
Most matrons saw their work as part of a Christian task but thought it was pointless to force it on the residents. About a third thought the residents responded to it while in the home, though the social workers thought the Christian message only affected a tiny fraction. In most homes residents accepted things and only complained of it being pushed in a few homes.
She found no evidence that the religious emphasis materially affected the homes, though the residents valued the motivation it gave to staff and, as other parts of the community were not providing a similar service, it was inappropriate to criticise those that did.
In Chapter 14 Social work in the homes, she notes that the provision of social work had grown from ‘moral welfare work.’ Most social workers and half the matrons agreed that the social worker should hold casework responsibility; most of the matrons were not trained to do it but four matrons and one fifth of social workers thought matrons should have casework responsibility.
The matrons generally thought that social workers did not take enough interest while social workers thought that the matrons were not competent or interfered. Most social workers saw residents once or twice before and once or twice after confinement; there was little variation between the different types of social worker except that two local health authority social workers did not visit at all. Most social workers were dissatisfied with the level of care they could offer.
Only 15% of residents valued their social workers; most saw them as “nice, kind people who would help you if they could” (p. 134); they had little understanding of the social worker’s role and half had not seen their social worker since they were admitted; fewer than one in eight had seen a social worker three or more times.
Few residents understood the impact of giving up their babies and many were confused by the different rules of different adoption societies; they were all desperate to sort things out but had no-one to talk to. Since the number planning to keep the baby normally doubles after birth, they really needed the chance to talk about this during pregnancy and after birth when discussion is least likely to be offered. Though the matrons tended to stress the need for the mothers to make up their own minds, this did not mean that they should not talk it over with someone. Overall, the practical problems were dealt with but not the emotional ones; residents were rarely offered a relationship in which to work things out.
Some of the problems related to shortages of staff, some to lack of agreement on the roles of matrons and social workers and some to the need for social work to be recognised as part of the process being managed by the matrons.
In Chapter 15 Assessment and conclusions, she concludes that there was general agreement that mother and baby homes are necessary but confusion about their functions. They provided:
- accommodation for homeless mothers to be
- an alternative to other services
- the best method of treatment in certain cases.
Considered as accommodation, the best were superb but most were shabby and inadequate with lots of restrictions, intrusions on privacy and an erosion of responsibility. Considered as alternatives to other services, they provided support for residents, acceptance from staff and asylum, but they often lacked social work support, failed to assist in the management of ‘mothering’ and were limited by a fixed length of stay.
Overall, the uncertain purpose of homes dominated all others. They needed to look at the therapeutic aspects, focus on developing group cohesion, improve staffing and financing, be subject to proper registration and inspection - not least because homes found the existing inspection regime condoned poor standards, become integrated with other services and develop their social work input.
This study starts with a reminder that the churches were mostly opposed to social welfare provision outside the poor law in the eighteenth and early nineteenth centuries, the first home for penitent prostitutes being set up by merchants of the Russian Company following a proposal by the Bow Street magistrate, John Fielding, on ‘fresh start’ principles, with staff and trustees banned from asking about the woman’s past (Taylor, 1985). When the organisations which we now think of as church organisations were set up, they were almost entirely individual initiatives of lay people or, occasionally, clerics which only became formal church organisations at a later date (Heywood, 1978).
Unusually for residential care at the time, family contact was mostly supported, even if there was little direct family involvement, as the focus was on the unmarried mother making the decision, sometimes without the interference of family members. The matrons’ scepticism about family relationships may have reflected the prevailing view at the time that there was an inevitable generation gap, a view which was not to be challenged until the publication of Fogelman (1976) and Rutter et al. (1976) .
The success of the homes with fewer rules may have been related as much as anything else to the cognitive development of the residents who, in Wolins’ terms, were more likely to be at the ‘other-oriented’ than at the ‘nomocratic’ stage (1973). The failure of the staff to recognise that the mothers were more able to accept responsibility than they assumed may explain both the excessive use of rules and the assumption of too much responsibility for babycare, but it may also relate to the assumption that being an unmarried mother was a result of a ‘moral failure.’ The clause allowing unmarried mothers to be detained as ‘moral defectives’ had only recently been repealed by the 1959 Mental Health Act.
The study predates King et al. (1971) and Sinclair (1971) in identifying the centrality of the head of the unit to the quality of the residents’ experience but this conclusion is based on feedback rather than observation, as in King et al., and may have been discounted at the time because it involved women and girls rather than males.
The finding that size of home was significant, in that those for around fifteen or sixteen residents were least satisfactory, is consistent with the evidence that groups need to be more than four but less than fifteen and that girls are happier in smaller, less hierarchical groups than boys (Argyle, 1994). The finding that homes of twenty or more were better than those with around fifteen or sixteen residents may help to explain why the Curtis Report (Care of Children Committee, 1946), for no apparent reason, recognised the value of some homes of thirty residents while specifying a maximum of twelve residents for the majority.
The preference for resident staff in the south rather than the development of more flexible staffing arrangements may be an early sign of the housing problems that continue to plague the public services in London. This may be one area where changes to residential staff conditions were more beneficial to residential care providers and their staff outside London than to those in London, where lack of suitable accommodation for low paid residential staff inhibits recruitment.
Though Jill Nicholson ends with a plea for more therapeutic input, she does not provide any evidence that the residents needed anything more than better information and a friendly ear to listen to their problems and it is interesting to note that the chaplains who provided that appear to have been appreciated. Given the evidence from later studies that social work input, other than to support family input, has little impact on outcomes (Taylor and Alpert, 1973; Fanshel and Shinn, 1978), she may have been influenced by Polsky (1962) or taken this idea from Wills (1960) and the moves to make social work input more relevant to residential care which culminated in the Keyworker concept (Residential Care Association/British Association of Social Workers Study Group, 1976).
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