Public Health Prevention
In 2018, both North East LMS boards, with the North East Association of Directors of Public Health, agreed seven ‘must-do’ priorities to improve population health within maternity services.
7 “Must Do” Work Priorities
- Reduction in tobacco dependency in pregnancy
- Increase vaccination uptake in pregnancy
- Improve perinatal mental health
- Reduction in alcohol consumption in pregnancy
- Increase in breastfeeding initiation and at 6-8 weeks
- Improved Maternal Healthy Weight
- Increase in making every contact count
Key progress September 2018 – March 2020
Led by the LMS Prevention Lead and working closely with many women and organisations, including; Public Health England, NHS England and Improvement, Clinical Commissioning Groups, Clinical Networks, local Public Health teams, commissioned services, Health Visiting services, Neonatal Services and Voluntary, Community, Social Enterprise Sectors, best practice and resources are developed. These regional recommendations and support tools improve the consistency of services and support available to women across the North East and support Heads of Midwifery and maternity staff to embed priorities into clinical pathways through bespoke maternity plans in each trust.
A variety of audits and service scoping reports have been completed for the ‘must-do’ priorities, which have been mapped against NICE guidance and other evidence to establish a baseline and to inform a clear, specific work plan made in partnership with Maternity services and the regions other stakeholders.
1. Tobacco Dependency in Pregnancy
Following a regional audit, engagement event and key recommendations Integrated Care System(ICS) Leaders agreed to support and prioritise the reduction of tobacco dependency in pregnancy.
Bringing together key professionals and service user representatives a Tobacco Dependency in Pregnancy pathway and script has been developed that improves the language and mindset of supporting those women who are tobacco dependant. This pathway and tool has been launched in the regions Foundation Trusts and is supported by Specialist Stop Smoking Advisor and Very Brief Advice train-the-trainer courses. Further developments in the workstream have included improving data collection and the provision of treatment therapies. Highlighting the importance of the work, the ICS engaged NHS Trust Chief Executive Officers to embed the work in their organisation and prioritise the care of pregnant smokers as highly as the A&E waiting times.
Working closely with NHS England and Improvement, training standards, reporting methods and models of delivery have been reviewed. An Immunisation in Pregnancy Best Practice guide has been developed to support maternity units to increase the availability of immunisation whilst women are accessing maternity services.
3. Perinatal Mental Health
The Perinatal Mental Health (PMH) workstream has reviewed training needs and course availability with a strong recommendation for iHV Perinatal Infant Mental Health Champion train the trainer cascade model. 25 ‘Champions’ were trained in May 2018, a further 26 Champions were trained in February 2020 and another 25 to be trained in November 2020. The work has seen improvements in referrals and accessibility to local support through the work of bespoke plans. A review of maternity birth debrief services has been undertaken with key recommendations. The LMS has also supported the North East and North Cumbria PMH Clinical Network to undertake a service scope of listening visits provided by Health Visiting Services which has informed the commissioning of specific training to improve provision and consistency to women. Future work includes development of the North East and North Cumbria PMH pathway which will include improved support for women’s partners.
4. Alcohol in Pregnancy
An Alcohol in Pregnancy pathway, adapted AUDIT tool for pregnant women and training package for maternity has been developed to improve the identification of women who drink alcohol in pregnancy and offer timely, appropriate advice and support.
Following these key recommendations the LMS Breastfeeding Strategy and can be found here. Key recommendations includes UNICEF accreditation across all Maternity, Health Visiting, Neonatal Units and Early Years sectors which is underpinned by the strategy. Following on from the recommendations and strategy an Infant Feeding Touchpoints Pathway is in development; raising consistency and accessibility of information and support.
6. Maternal Healthy Weight
Physical activity training will be available for all maternity and health visiting staff in autumn 2020. Nationally recommended resources have been distributed to maternity services and a LMS training package is in development.
7. Making Every COntact count
A maternity specific train-the-trainer event was held in September 2019 and the e-learning package has been embedded into all maternity training plans.