Health: A special kind of help for new mums: Ann Robinson looks at a Dublin programme in which experienced mothers encourage those who have just had their first child

WHEN Linda O'Toole's first son, Leigh, was born she was invited to join a programme that is unique in Western Europe.

Once a month, for the first year of Leigh's life, she was visited by another, more experienced mother: a 'formal friend' recruited by a project called the Dublin Community Mothers programme. 'She was a local woman whose name was Mona and she would stay for at least an hour each time,' Mrs O'Toole recalls. 'We would chat about Leigh's progress, discuss any worries I had and go through all the leaflets. We covered just about everything, from immunisations to sleeping problems.

'Mona also made my husband and I feel good about Leigh's achievements. She gave us a development card which we filled out before each visit - it made us realise how much he was progressing.' It was thanks to Mona that Mrs O'Toole decided to breast-feed Leigh and introduced him to picture books. 'No one in my family had ever breast-fed and I wouldn't have thought to read to Leigh until he was older,' she says. 'But Mona encouraged me to think about things for myself, not necessarily follow old traditions.'

The Dublin Community Mothers programme was launched 10 years ago by the Bristol Early Child Development Unit, with the aim of using experienced mothers to give encouragement and support to first-time parents. Similar schemes using qualified health visitors had been tried successfully in Britain, but in Ireland inadequate resources made this impossible.

The Bristol unit decided to see if an effective substitute could be found. 'I became more and more convinced that experienced mothers would be the ideal people to visit first-time parents in their own homes,' says Dr Walter Barker, the unit's director.

Brenda Molloy, assistant director of the Dublin programme, remembers how difficult it was to find suitable community mothers when the programme started. 'We hadn't a clue. I wandered the streets wondering where we were to find these mothers. And at first we got it all wrong, choosing granny types instead of women who'd recently had children themselves,' she says.

'We didn't want 'do-gooders' who might be too dominant. They had to be ordinary, low-profile mothers who could respect confidentiality, and be reliable.'

Potential community mothers are identified by local public health nurses - the Irish equivalent of health visitors. After four weeks of training, a mother may support between five and 15 first-time parents, visiting once a month for the first year. Dr Barker stresses that the mothers are not there to advise in the traditional sense but to 'empower' parents and give them the confidence to make their own decisions.

Some public health nurses were wary of the scheme at first, fearing that new mothers might be given the wrong advice. But, Dr Barker says, the community mother is there to guide parents to the correct source of help if it is needed. 'We would never want the community mothers to overstep their brief and give medical advice. After all, if a community mother tried to reassure a mother whose child had a fever, and that child developed meningitis, she'd never be able to face her community again.' Each community mother also works with the guidance of a family development nurse.

A controlled trial of the programme was reported in the British Medical Journal in May. Two hundred and sixty-two first-time mothers, living in a deprived area of Dublin, were recruited; one group was allocated a year of monthly visits from a community mother, together with the standard visits by the public health nurse at birth and six weeks, and thereafter if requested. A second group of mothers received only the standard visits.

Of the 232 who completed the study, the 127 mothers and babies who had a community mother visit them fared measuarably better than the 105 mothers who only had standard care.

At the end of a year, babies on the community mothers programme were more likely to be fully immunised and were more appropriately fed for their age. They were read to more often, recognised more nursery rhymes and played more stimulating games than the babies who were not visited regularly. Their mothers were also likely to eat a more balanced diet and felt less tired, went outdoors more and reported feeling more positive than their counterparts who were not visited.

The results show, says the report, that a programme to promote parenting skills can be delivered effectively by non-professionals. The idea has been taken up by British health authorities: in Tilbury, Essex; Nottingham; and south-east Kent, community mothers are visiting families that are under particular stress.

Community mothers' work is voluntary - expenses and fares are paid. So are they just a cheap way to undermine the professionals? Margaret Buttigeig, director of the Health Visitors Association, thinks not: 'There were anxieties initially, but they have been allayed. The community mothers really do work alongside the health visitors or public health nurses, supplementing their skills rather than undermining them. We actually learnt a great deal from the programme.'

(Photograph omitted)