A multisite audit to assess how women with complex social factors access and engage with maternity services. (September 2017)

• Record Type: Journal Article
• Authors: Rayment-Jones, Hannah; Butler, Eleanor; Miller, Chelsie; Nay, Christine; O'Dowd, Jennifer
• Is Part Of: Midwifery. Volume 52(2017)
• Page Start: 71
• Page End: 77
• Publication Date: 2017-09
• Subjects: BMI Body Mass Index, weight in kilograms divided by height in meters squared -- Booking The appointment where the woman enters the maternity care pathway, characterised by information giving and detailed history-taking to help the woman choose the most appropriate antenatal care pathway (NICE, 2008) -- Clinical Governance the framework through which NHS organisations are accountable for continuously improving the safety and quality of services they provide -- Common Mental Health Depression, generalised anxiety disorder, panic disorder, obsessive-compulsive disorder, post traumatic stress disorder and social anxiety disorder -- Complex social factors Women who are substance misusers, Recent migrants, refugees, asylum seekers and Women with little or no English, Young women aged under 20 Women experiencing domestic abuse (NICE, 2010) -- Domestic violence / abuse An incident of threatening behaviour, violence or abuse (psychological, physical, sexual, financial or emotional) between adults who are or have been intimate partners or family members, regardless of gender or sexuality. It can also include forced marriage, female genital mutilation and 'honour violence'(NICE, 2010) -- Drug or alcohol dependency Regular use of recreational drugs, misuse of over-the-counter medications, misuse of prescription medications, misuse of alcohol or misuse of volatile substances (such as solvents or inhalants) to an extent where physical dependence or harm is a risk (to the woman and/or her unborn baby) (NICE, 2010) -- High obstetric risk Women with pregnancy related problems or pre-existing conditions, who require an obstetrician as a lead professional -- IMD Index of multiple deprivation: a composite measure based on income, employment, health and disability, education, skills and training, barriers to housing and other services, crime, living environment -- Induction of labour The artificial initiation of labour (NICE, 2008) -- Low birth weight Birth weight of a liveborn infant of less than 2500 g (5 pounds 8 ounces) regardless of gestational age (World Health Organisation (WHO) 2016) -- Maternal death / mortality Death of a women while pregnant or within 42 days of the end of the pregnancy from any cause related to or aggravated by the pregnancy or its management, but not from accidental or incidental causes (Knight et al., 2015) -- MBRRACE-UK Mothers and Babies: Reducing Risk through Audits and Confidential Enquiries across the UK (Knight et al., 2015) -- Multiparous A live born baby (born at 20+0 weeks gestational age or later, or with a birthweight of 400 g or more) who died before 28 completed days after birth (Draper et al., 2015) -- NICE National Institute for Health and Care Excellence (N/A), Primiparous, A woman who has never given birth to a live infant (NICE, 2015) -- Perinatal death / mortality A stillbirth or early neonatal death (Draper et al., 2015) -- Pre-term labour/birth Delivery before 37 weeks gestation (WHO, 2016) -- Severe mental health Severe and incapacitating depression, psychosis, schizophrenia, bipolar disorder, schizoaffective disorder and postpartum psychosis.; Midwifery -- Periodicals; Midwifery -- Periodicals; Sages-femmes -- Périodiques; Midwifery; Periodicals; Electronic journals; 618.2005
• DOI: 10.1016/j.midw.2017.06.004
• Languages: English
• ISSNs: 0266-6138

Abstract

Abstract: Objective: to audit women with socially complex lives' documented access to and engagement with antenatal care provided by three inner city, UK maternity services in relation to birth and neonatal outcomes, and referral processes. Background: women living socially complex lives, including young mothers, recently arrived immigrants, non-English speaking, and those experiencing domestic violence, poor mental health, drug and alcohol abuse, and poverty experience high rates of morbidity, mortality and poor birth outcomes. This is associated with late access to and poor engagement with antenatal care. Method: data was collected from three separate NHS trusts data management systems for a total of 182 women living socially complex lives, between January and December 2015. Data was presented by individual trust and compared to standards derived from NICE guidelines, local trust policy and national statistic using Excel and SPSS Version 22. Tests of correlation were carried out to minimise risks of confounding factors in characteristic differences. Findings: non-English speaking women were much less likely to have accessed care within the recommended timeframes, with over 70% of the sample not booked for maternity care by 12 weeks gestation. On average 89% primiparous women across all samples had less than the recommended number of antenatal appointments. No sample met the audit criteria in terms of number of antenatal appointments attended. Data held on the perinatal data management systems for a number of outcomes and processes was largely incomplete and appeared unreliable. Conclusion: this data forms a baseline against which to assess the impact of future service developments aimed at improving access and engagement with services for women living with complex social factors. The audit identified issues with the completeness and reliability of data on the perinatal data management system. Highlights: Inequalities in birth outcomes and experiences of maternity care disproportionately affect women living socially complex lives. Pregnancies to women living in areas with the highest levels of poverty in the UK are over 50% more likely to end in stillbirth or neonatal death, and carry increased risk of premature birth, low birth weight, and maternal death. TThere is a gap in knowledge around how women access and engage with their maternity service, multi‐disciplinary healthcare professionals, and what impact this might have on their pregnancy outcomes and experiences. Audit provides insight into the reality of women's access, engagement, and referral processes compared to national guidance for women living socially complex lives.