Download A new public health model for midwives and MSWs has been

Midwives / Spring 2016
Public health
M
IDWIFERY 2020
outlined several key
messages around
the public health
(PH) role of the
midwife. Their ‘unique contribution
to public health is that they work
with women… throughout pregnancy,
birth… and into the first weeks of
family life’, hence, they have a vital
role to play in ‘improving health
and social wellbeing for all women’
(Chief Nursing Officers of England,
Northern Ireland, Scotland and
Wales, 2010: 26). In many instances,
midwives’ input and involvement
in meeting the PH agenda is not
acknowledged. Five high-level
priorities were outlined by Public
Health England (PHE) in 2013, none
of which referred to the midwife:
‘Supporting families to give children
and young people the best start in
life, through working with health
visiting and school nursing, family
nurse partnerships and the troubled
families programme’ (PHE, 2013: 3).
Midwives are normally the lead
professionals at the start of life and
thus should be acknowledged as
playing a crucial role in ensuring that
women and their families benefit
from essential PH messages from the
outset. However, the document does
advocate for the development of a
new PH model for midwives.
In response and in recognition
of Action Area 1 of the NHS
England Compassion in practice:
implementation plans that advocate
developing a new heath role for
midwives, the RCM submitted a
proposal to the Department of Health
(DH) in England to undertake a study
exploring midwives’ and MSWs’
knowledge of, and involvement in,
the PH agenda.
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rcm.org.uk/midwives
public
health
A new public health model for midwives
and MSWs has been launched by the
RCM. Elizabeth Gomez explains more.
Women are telling
us that they don’t
know which
information is
correct or safe when
surfing the net
As a first step, the RCM
commissioned Cardiff University
to undertake the initial qualitative
phase of the DH-funded study.
Midwives, MSWs and students were
recruited through the RCM Facebook
page and the membership database.
Data were gathered via eight closed
online focus groups and themed into
the following categories:
1.Scope of midwives’ PH role
2.Training and support for PH role
3.Barriers and facilitators
4.Specific client groups
5.The role of the specialist
referral services.
It wasn’t possible to recruit service
users (SUs) to this study and as this
was considered essential to ensure
credibility and equity to the project,
the RCM subsequently undertook
a closed Facebook forum for SUs.
A total of 14 SUs participated in the
discussion, representing different
trusts across England, adding to the
richness of the data already collated.
DISSEMINATING THE MODEL
HoMs across England were invited to express an
interest in hosting launch events. Initially, 58 trusts
responded, and dissemination began in December
2015 and will continue into the summer of 2016,
as more trusts, universities and independent
midwifery services express interest. For more
information, email [email protected]
FURTHER INFORMATION
To access supporting material, including the
model, associated reports and a webinar
providing a more detailed look at the project
to date, visit rcm.org.uk/publichealth
SUPPORT – INFORMATION – CARE
Stepping up to
WOMEN AND FAMILIES – STEPPING UP TO PUBLIC HEALTH
Preparation for
pregnancy, birth
and beyond
Information about,
and/or referral to
third sector support
in the community
Women requiring care outside
of the midwifery team, while still
remaining under the care of
their midwife
Woman with
additional risk
factors
Some woman will
fall into both of
these specialist
categories
Women with
complex social
factors
ALL WOMEN AND PARTNERS
The first appointment with a midwife maximises the opportunity for a woman-centred
discussion. With guidance, women are supported to tailor a unique package of information
and support. This will be appropriate to their existing knowledge, recognise
individual needs and be responsive to changing circumstances.
Choice will be facilitated by offering options for accessing evidence-based information.
Preconception advice, support and care
Findings from both studies
informed the development of the
online audit/questionnaire, which
was rolled out to RCM members.
Although the focus was on members
across England, the views of others,
including health visitors, across
all four countries were taken into
consideration. Overall 2242 responses
were received, which yielded a large
quantity of additional significant
data. Seven themes were generated:
● Time constraints
● Timing – optimum time for
delivery of information to women
and their families
● Communication – relaying
sensitive information and asking
difficult questions
● Continuity of carer – ensuring
consistent, individualised care
● Education – training needs for
midwives, MSWs and students
● Method of conveying information
● Importance of specialist services.
Following analysis and theming
of the qualitative and quantitative
data, a think tank involving key
stakeholders was convened to validate
the findings. The group considered
methods for interpretation and
development of a model. Findings
from all studies and events were used
to create a robust and useable model
for maternity services in England,
titled ‘Stepping up to public health’.
Two models have been generated
– one for women and families, and the
other for midwives and MSWs. They
are closely aligned to demonstrate
how practitioners can work together
to achieve the recommendations and
ensure a seamless journey for women
and families.
Innovative components of the
model include:
● Giving a ‘menu’ of PH topics
to women prior to their initial
appointment with the midwife,
so that the women/family can tailor
advice sought to their individual
needs. The woman will subsequently
sign to say what information has
been covered at each appointment.
Rationale: Women expressed
concern that although their notes
indicated that certain topics had
been addressed, they didn’t recall
being given the information.
● Providing a repository of PH
information on the RCM website
for women and families to access.
Rationale: Women are telling us that
they don’t know which information
is correct or safe when surfing the
net; and that they don’t think that
leaflets are the best way of conveying
PH messages.
There is a plethora of excellent
evidence-based information
available, however, it isn’t always
easy to find. Providing one website
with links to reputable sources,
such as NHS Choices, RCOG,
SANDS and NICE, will ensure
that consistent, reliable advice
is accessible for women.
● i-learn modules for midwives
and MSWs
Rationale: Midwives and MSWs
identified a lack of training around
some PH topics, resulting in them
feeling ill-equipped to broach certain
essential topics.
More recommendations are
proposed. Look out for the next issue
of Midwives, which will take a more
comprehensive look at individual
elements of the model. Elizabeth Gomez, RCM professional
advisor – public health, and senior
lecturer, University of Central Lancashire
rcm.org.uk/midwives
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