Agenda item

This report provides an update on Medway’s approach to supporting healthy pregnancy. It details some of the initiatives, targets and outcomes being delivered locally and sets out some of the key undertakings in the next 12 months.

Discussion:

Members considered a report which provided an update on Medway’s approach to supporting healthy pregnancy. It details some of the initiatives, targets and outcomes being delivered locally and sets out some of the key undertakings in the next 12 months.

The following issues were discussed:

·       Team Connect – a point was made that the numbers of vulnerable people  engaging with Team Connect seemed low given the relatively high birth rate in Medway. What more could be done to engage with this group was questioned. Members were advised that Team Connect focussed on vulnerable families and cases were increasing generally. The Team decided whether further support was needed and, in general, outcomes for women with vulnerabilities were good. The Team worked closely with Children’s Services and other partners.  

·       BAME women – noting that BAME women were more likely to experience problems during pregnancy and birth, what efforts had been made to offer support was queried and also whether this had made an impact. The Head of Midwifery reported that BAME women often had other comorbidities and there were pathways in place to support them during pregnancy and after. During the pandemic this group had been a priority for continued face to face appointments.

·       Pre-natal care – whether more work could be done on this was questioned and Members were advised that regular screening took place to identify babies at risk and ensure an appropriate birth plan was in place. There were several methods by which health and wellbeing key messages were communicated in addition to the Bump Birth and Beyond Website, including pre-conception counselling, advice delivered through GP appointments and conversations between parents and health visitors about planning for the next baby. 

·       Smoking and vaping – in response to a question about to what extent the dangers of this in pregnancy were known, Members were advised that nicotine replacement therapy was offered first to help pregnant woman to stop smoking. The national guidance on vaping was that it was not risk free but was less risky than smoking. The smoking at delivery target tended to fluctuate, which was why the 16% target had not been reduced.

In response to a query whether permission was required to carry out carbon monoxide monitoring and whether this could mean smoking rates were higher than thought, Members were advised that this took place at 32 weeks and was offered to everyone, with a good take up of over 80% and a high level of referrals to the smoking cessation team.

An undertaking was given to examine whether it would be possible to provide a breakdown of the age ranges of those classed as smoking at delivery.

·       Caesarean sections – with regard to the  statement that that the proportion of caesarean sections in Kent and Medway between 2017/18 -2019/20 had been statistically higher than the England average required further exploration, Members were advised that this rate had risen in the last 10 years. In Medway the number of first-time mothers in this group was a concern as this would influence future birth planning. There was a need to understand what was behind the numbers to provide assurance on clinical decision making and leadership. The national team had advised that the caesarean rates should not be used as a performance indicator. Still birth rates were lower than the national average at Medway and Hypoxic-ischemic encephalopathy had decreased. The aim was for all caesarean sections to be due to good clinical decision making and with a positive outcome. A new rota was now in place so obstetricians were on duty on the labour ward with the capacity to attend on site when called overnight. There was also a daily audit of all emergency caesarean sections that had taken place in the previous 24 hours to provide assurance and learning.

·       Overnight stays for partners – in response to a query about this being under review and whether partners could stay when the expectant mother was in established labour, it was clarified that partners could remain during the day. While in the labour ward birth partners were supported to remain without any time limits. Overnight stays were not supported unless on compassionate grounds or due to vulnerabilities.

·       Foetal Alcohol Spectrum Disorder (FASD)  - it was reported that the ability to diagnose FASD was difficult and it was not possible to give the figures for  Medway, although the national figure was 3%. All paediatricians in Kent and Medway had been trained on FASD. In the case of complex needs referrals were made. More partners would be trained but it could be a few years before any outcomes were seen given the complexity of this issue.

·       HUGS Group (Helping You Grow Stronger) – further information on the drop-in sessions for mothers who had completed the HUGS group sessions  would be provided to Members following the launch in the summer of 2022.

·       Recruitment and retention – Members were advised the Trust supported  students at Canterbury and Greenwich universities. There was now only one cohort of students graduating each year. Although there was a small number of staff leaving due to the pandemic and retirement very few left the profession. A media campaign was about to be launched to publicise a recruitment plan. The Trust hoped to attract international midwifes. The Head of Midwifery comment the team were very committed but it was a stressful time at present.

Decision:

The Committee noted the offer families have to support them to have a healthy pregnancy and asked that an article on the support available be included in Medway Matters.