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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. 68 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 69