The NICE guideline 'Antenatal care for uncomplicated pregnancies' (NICE clinical guideline 62) outlines the care that women should be offered during pregnancy. However, pregnant women with complex social factors may have additional needs. This guideline sets out what healthcare professionals as individuals, and antenatal services as a whole, can do to address these needs and improve pregnancy outcomes in this group of women.
The guideline has been developed in collaboration with the Social Care Institute for Excellence. It is for professional groups who are routinely involved in the care of pregnant women, including midwives, GPs and primary care professionals who may encounter pregnant women with complex social factors in the course of their professional duties. It is also for those who are responsible for commissioning and planning healthcare and social services. In addition, the guideline will be of relevance to professionals working in social services and education/childcare settings, for example school nurses, substance misuse service workers, reception centre workers and domestic abuse support workers.
The guideline applies to all pregnant women with complex social factors and contains a number of recommendations on standards of care for this population as a whole. However, four groups of women were identified as exemplars:
women who misuse substances (alcohol and/or drugs)
women who are recent migrants, asylum seekers or refugees, or who have difficulty reading or speaking English
young women aged under 20
women who experience domestic abuse.
Because there are differences in the barriers to care and particular needs of these four groups, specific recommendations have been made for each group.
The guideline describes how access to care can be improved, how contact with antenatal carers can be maintained, the additional support and consultations that are required and the additional information that should be offered to pregnant women with complex social factors.
Specific issues that are addressed in the guideline include:
the most appropriate healthcare setting for antenatal care provision
practice models for overcoming barriers and facilitating access, including access to interpreting services and all necessary care
ways of communicating information to women so that they can make appropriate choices
optimisation of resources.
In addition to the recommendations in this guideline, the principles of woman-centred care and informed decision making outlined in 'Antenatal care' (NICE clinical guideline 62), specifically recommendations on the provision of antenatal information and individualised care, are of particular relevance to women with complex social factors.