Children: And the nurse makes three: Margaret St John is about to have another baby. She investigates the option of hiring a maternity nurse

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The Independent Culture
FIVE DAYS after my son Charles was born by Caesarean section, we were ejected from a Washington DC hospital armed only with my paediatrician's phone number. There were no community midwives to check our progress. Doctors in the US do not make home visits.

Breastfeeding instructions at the hospital had consisted of a 10-minute lesson from a bored nurse. Charles and I battled on. I began to supplement breast-milk with a bottle early because he needed feeding every two hours and I was exhausted. We both dozed in and out of sleep on the rocking chair. He put on the required amount of weight but he grew used to being held and rocked. The result: he woke up two and three times a night until he was almost three years old.

Now living in Britain and pregnant again I want to avoid making the same mistakes. As I might have another Caesarean section I need to be more organised. Friends suggested that a maternity nurse - a professional who stays for up to a month caring for mother and baby - might be the answer. I began to make enquiries, with some trepidation, not knowing whether to expect Mary Poppins or Mrs Gamp. Anecdotal evidence leaves me undecided. Most people say that maternity nurses are 'worth their weight in gold' and that they 'keep you sane at a vulnerable moment'.

Others found the experience more traumatic than motherhood. One friend had to lock herself in her bedroom to escape an unbearably bossy and talkative maternity nurse. Another found her helper 'lazy and inflexible'. She protested, poignantly: 'She even put wet baby clothes to dry on my antique furniture.'

How do you hire a maternity nurse, anyway? What exactly do they do? Numerous nanny agencies handle them. Their duties include the complete care of the newborn baby, while mother recovers from childbirth and learns from the nurse rudiments of child-care. Maternity nurses can be an extraordinary fount of both medical and folk wisdom. When I was struggling with Charles a friend told me of a Mrs Merryweather, legendary in mother-and- baby circles in Washington, who guaranteed to have all babies sleeping through the night from midnight until 6am at the age of two weeks. She needed only two pieces of equipment, a rocking chair and a soft hairbrush, to stroke the baby's head.

Even the more conventional maternity nurses will attempt to establish a four-hourly sleeping and feeding routine. Crucially (for mum) the baby sleeps in the same room as the nurse during the night and is taken to the mother only for its feed. Some maternity nurses encourage expressing breast-milk in advance using a pump for the night feed or even a bottle of formula so the mother can rest.

Maternity nurses work, in effect, for 24 hours a day, six days a week. Because of the strenuous schedule, they are advised to take a week off before and after each job. They earn between pounds 200 to pounds 350 a week, depending on age, training and experience. They are responsible for their own tax and national insurance but families must pay agency fees of approximately pounds 50 a week plus VAT. In other words, the cost to the family is between pounds 250 and pounds 400 a week. If the baby arrives late, you still have to pay the maternity nurse for the days you booked. A cheaper option is the 'nights only' service offered by some agencies, which comes out at pounds 30 to pounds 50 a night, excluding agency fees.

You might have thought that the recession and the advent of paternity leave would have severely squeezed this rather Victorian profession. Not a bit of it. Maternity nurses are as much in demand as ever. Several agencies complained to me of a shortage of personnel. The good nurses get booked up early.

In fact, paternity leave is not really a factor. According to the CBI's Hours and Holiday survey, only 28 per cent of men in manufacturing companies are entitled to the average leave of two to three days. In service companies, 38 per cent of new fathers are entitled to between two and five days.

Liz Hindle-Fisher was delighted with both the maternity nurses she hired for her babies. 'I got so much rest and support that I felt quite well and both babies got into a good routine early. They had enormous amounts of knowledge. One immediately spotted the symptoms of mastitis. A combination of very hot compresses and frozen cabbage leaves, administered by the nurse, sorted it out.'

Louise Harris said: 'My nurse insisted that the baby always fed for 30 minutes even if he tried to fall asleep during that time. I had to tickle his feet to wake him. After a little while, he settled into four-hourly feeds.'

Lucy Talbot's nurse insisted she drank ginger beer to improve her milk supply. She also ordered that the baby's nappy was changed before he was fed. Lucy was not a satisfied client. 'Edward would be screaming for a feed but that was her routine. When I had my next baby, I made sure I had practical help in the house for cleaning, cooking, ironing and shopping and I concentrated on the baby. My advice would be to use your visiting midwife's knowledge and pay for an au pair.'

Interviews between expectant mothers and maternity nurses are vital. Honesty about what the mother expects is important, but when you have no idea of what motherhood will be like, it is difficult. Some maternity nurses appear more willing to prepare breakfast and lunch than others.

Problems also arise with older children. Of the few complaints received by staff at The Rocking Horse agency in Fulham, west London, they mostly concerned nurses annoyed by having been left in charge of older children while the mother 'popped out for an hour'.

Some mothers I spoke to regarded the whole business as a self-indulgence and a barrier during a vital period of bonding. Annette Cowley, a mother of three and an enthusiastic member of the National Childbirth Trust, said: 'I don't understand people who would want to have a maternity nurse. A lot of this knowledge can be picked up by going to the courses at your local hospital. They're just too snooty and proud to go.'

However, she admits that maternity nurses are, in a sense, a substitute for the kind of family support - from mothers, aunts, sisters - that seldom exists in our fragmented society. Cutbacks in the NHS often mean that new mothers are finding hospital staff are overworked and don't have the time to pass on their expert knowledge.

When Linda McGill recently gave birth to a daughter she stayed in hospital for three days but discovered the staff were too busy to help with feeding problems. 'I wish I had come home after six hours and paid for help even for a week,' she says.

Why should women go into such a demanding profession? Lynn Harris has been a maternity nurse for seven years. 'I'm my own boss and my boyfriend is also self-employed so it suits us. I'm looking for easy-going, relaxed families who want to spend time with their children. Because most women breastfeed, it's an intimate job so you are there as a friend to advise and reassure. The difficult part is the constant sleepless nights and getting used to somebody else's home. Space is very important for everybody. I sometimes eat with the parents but I'm just as happy at the end of the day to go to my room with a tray and watch TV.'

Lynn was so calm, relaxed and confident when I interviewed her that I almost hired her there and then. Instead, I was cheeky enough to ask for some infant-care tips instead. 'People tend sometimes to overhandle babies.

Babies get fussy when tired and might just need a quick cuddle before putting them down awake. Don't always try feeding or changing them again. Alternate lying them on both sides and on their backs. When baby is awake, pop them in a seat so they can look around but don't leave them there for long periods as it is not good for their backs. Bathtime should be a relaxing time for everyone. If baby is fussy, or you are too busy, just top and tail them (clean their faces and bottoms).'

Contrary to Mrs Merryweather's dictum, she advises against the use of a rocking chair. She says a baby should be trained to go to sleep in a cot on its own.

My conclusion? I am tempted by the nights- only option. But I suppose I'm one of the luckier mothers. My husband has two weeks' paternity leave and is already reasonably well trained as an amateur maternity nurse.-

(Photograph omitted)

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