'One Born Every Minute' is some of the most compulsive TV I have seen in a long time. I became addicted one rainy Sunday, when I persuaded myself that it was research for one of our maternity related health projects. Other hardcore aficionados generally tend to be pregnant women who want to prepare themselves for what lies ahead. Women are able to see what a busy Labour Ward looks and sounds like; and, begin to appreciate all the different things that can happen during labour. It does strike me as slightly odd that women have to rely on a Channel 4 reality TV programme for information about what to expect.
The M(ums)-Power project that we are working on is about using information smartly to empower women throughout their pregnancy so that they are as healthy and prepared as possible for labour and parenthood.
Pregnancy brings women who might otherwise have very little contact with the NHS into regular contact with health professionals. Current antenatal care provision does not make these interactions easy for mums-to-be. Antenatal services predominantly reflect the convenience and priorities of healthcare professionals rather than the needs and preferences of pregnant women. M(ums)-Power, a project we are currently working on with UCL Partners aims to ensure that antenatal care is design by and for women.
Pregnant women have regular appointments with health professionals, to ensure that she and her baby are healthy. These women are not ‘patients’ and they are not ‘ill’. Their pregnancy and their antenatal care form only one part of complex, busy lives. As such, antenatal care should reflect this; and, be convenient and easy to access. Information should be shared between women and the relevant midwife or doctor to enable joint-decision making.
Increased accessibility reduces inequalities in antenatal and maternity care and an ‘information revolution’ would allow women, individually and collectively, to re-shape antenatal care for the better.
The Care Quality Commission’s (CQC) Maternity services 2010 survey noted that women are “generally positive about the services they receive”. I think this statement is telling – it highlights a level of passivity on the part of women in maternity services. They are generally done to. The survey also notes that there is much room for improvement. For example, “17% of women reported that infant feeding was not discussed with them during their pregnancy”, which makes the neonatal period very stressful.
More seriously, in England women from the most deprived communities are five times more likely to die in pregnancy than the least deprived women; and, their babies have poorer health outcomes. For other groups such as pregnant teenagers and women from ethnic minorities’ maternity services are not sensitive enough to their specific needs. Women from more affluent backgrounds have the networks and social capital to ensure that they access antenatal information from other sources, for example by attending the National Childbirth Trust’s antenatal classes. These disparities in antenatal care are unacceptable.
Over the next year we will be working with UCL Partners on a culture change programme, M(ums)-Power, to address these challenges. M(ums)-Power will improve mothers’ experience, optimise the number and timing of antenatal visits, and improve pregnancy outcomes for women in the North East London, North Central London and Essex (NECLES) HIEC region.
The project, part of the Health Foundation’s Closing the Gap work, will be working with mums-to-be to improve their current relationship with health professionals. Innovation Unit will be working to facilitate this culture change — taking key leaders from the NHS through this process, helping them to understand and reflect on the process so that they can support others to make changes. In parallel, the project will work with large numbers of women and health professionals to coproduce tools and approaches to radically change how maternity services are delivered.
These changes will be supported by the coproduction of a patient relationship management system (PRM) – basically some really smart IT software that will allow both women and their healthcare providers to manage antenatal care in partnership. Women will be able to contact their midwife, access their records and find information about maternity services in their local area. Maternity professionals will be able to share information with women to enable joint-decision making. Crucially the PRM will be coproduced with women, ensuring it is convenient to use, and fit in with their lives and their use of technology. We will be working with mums-to-be and Mumsnet to coproduce this PRM, ensuring that the technical requirements truly reflect women’s needs.
This project is potentially important for maternity services and pregnant women nationally. For hospitals, maternity services are one of the few pathways that will be a guaranteed income stream over the coming years — it is politically unpalatable to close them and women won’t stop having babies for the sake of the budget deficit! This coupled with a barrage of negative press about maternity services means that hospitals will be willing to engage with a project that will ensure good news for them, and their new mothers and babies.