NICE calls for extra help for pregnant women living in difficult circumstances
Women living in areas of high deprivation in England are five times more likely to die during pregnancy or after childbirth than those living in more affluent areas. Their babies are also around twice as likely to be stillborn or to die shortly after birth.
New NICE guidance entitled ‘Pregnancy and complex social factors' is calling for the re-organisation of antenatal care services to ensure these women - and others facing difficult circumstances when pregnant - get the extra help they need.
This will include NHS staff working with social care providers, charities - and even the police - to ensure women and their babies are kept as safe and healthy as possible during pregnancy.
The recommendations, which have been developed by the National Institute for Health and Care Excellence (NICE) in collaboration with the Social Care Institute for Excellence (SCIE), are particularly aimed at helping:
- Young women aged under 20 - because their babies are at greatest risk of being stillborn or dying within the first six weeks of birth.
- Women who experience domestic abuse - because they are more likely to experience depression, chronic pain, a premature birth and miscarriage.
- Recent migrants, asylum seekers and others who may find it difficult to speak or read English - as they may not understand what services are available. (Babies born to black women are more than twice as likely to be stillborn than those born to white women.)
- Women who misuse substances - because their babies face an increased risk of ‘cot death'. Excessive alcohol consumption can also affect a child's mental, physical and behavioural development.
“Expectant mothers need support throughout their pregnancy, yet some groups of women do not access, or continue to maintain contact with, traditional antenatal care services, explains Dr Gillian Leng, NICE's Deputy Chief Executive.
They might feel scared, overwhelmed, judged, unable to communicate, or may be physically stopped from attending appointments, she adds. But if they don't receive the help they need, this can increase the risk of them dying from complications after childbirth.
NICE recommends that services should be reorganised to ensure they are as flexible as possible. This means that the NHS should work with relevant local agencies, including social care and voluntary services. It also means that NHS staff at all levels should make women feel welcome and not judged, whatever their problems.
SCIE Deputy Chief Executive, Amanda Edwards, points out: “Social care providers can play an important part in the design of maternity services, especially for women with complex social factors. A multi-agency approach is an absolute necessity to make sure their needs are fully met.”
NICE recommends that these women should be provided with a telephone number so that they can contact a healthcare professional outside normal working hours. In addition, those who misuse substances and those under 20 should be offered their own, named midwife.
In addition, information about pregnancy and antenatal services should be provided in a variety of formats, settings and languages, it says. This includes providing an interpreter, where necessary (someone who is not a member of the woman's family, her legal guardian or her partner).
The NHS could even consider setting up specialist antenatal services in different locations (for example, schools, colleges and GP surgeries) for young women under the age of 20, says NICE.
For other recently published NICE guidance on pregnancy, see Guidance in Focus:
- quitting smoking in pregnancy and following childbirth (17 August 2010) and
- weight management before, during and after pregnancy (20 July 2010).
This page was last updated: 27 September 2010