Memorandum by Queen Charlottes and Chelsea
Hospital (MA 12)
The One to One midwifery scheme, implemented
at Queen Charlottes and Chelsea Hospital in 1993, addresses many
of the issues regarding inequality of access for pregnant women
from disadvantaged groups. Advocacy is one of the cornerstones
of this service.
One to One midwives take responsibility for
co-ordinating midwifery care starting with the antenatal booking
at home until discharge in the community following completion
of the postnatal care. The majority of antenatal care takes place
in the women's home where the midwife is best placed to understand
family and extended family relationships.
Organising midwifery care in this way addresses
other issues such as poor attendance which may be due to lack
of understanding of the importance of antenatal care and unwillingness
or inability to access the traditional antenatal care provided
in the hospital or GP surgery. If the midwife is unable to contact
a mother and has reason for concern, appropriate agencies can
be informed at an early stage.
Because of the high level of continuity of carer
the midwife is usually able to build up a trustful relationship
with the mother. This in turn facilitates disclosure of problems
such as domestic violence and discussion of sensitive cultural
issues such as female genital mutilation. It has also been shown
to increase maternal confidence and satisfaction.
Some of the One to One midwives specialise in
providing care to a particular client group. The "Young Mums"
group consists of six midwives who caseload young women aged less
then 19 years at the time of conception. This is a client group
that benefits from peer support and the midwives organise antenatal
and postnatal support groups, teenage parent information sessions
and baby massage with good attendance rates. Advocacy is an important
component and much of the midwives' time is spent liasing with
health visitors, social services, housing departments and the
schools integration project.
Although teenage pregnancy is not specified
in terms of reference almost every teenage mother fits into at
least one of the identified groups. In particular many of them
are from the nearby travellers site and because the "Young
Mums" group have built up a good relationship with this community
they are now providing One to One care for all the local travellers.
They visit the site regularly to provide antenatal care. This
promotes early antenatal booking and addresses the issue of poor
attendance.
Involvement in local Sure Start Programmes has
also provided opportunities to access disadvantaged groups. As
the Somali population make up the largest minority ethnic group
in one particular Sure Start area the programme has welcomed a
proposal for a midwife to work within the local Somali community.
The midwife will provide antenatal information sessions in individual
homes or group sessions in the homes of women identified as community
leaders.
Queen Charlottes and Chelsea Hospital are also
fortunate to have an Ambulatory Care Centre for the babies and
children of local families. This is a "drop in" outpatient
service where babies and children can be referred by GPs, midwives,
health visitors or school nurses. Parents can also self refer
their children. The welcoming atmosphere, cheerful environment
and ease of access has encouraged parents to bring their children
for treatment where before they may have been reluctant to overcome
the difficulties of negotiating their way through the system or
may have had to travel some distance to access this care. As part
of the local maternity hospital the Ambulatory Care Centre provides
a seamless service for new parents.
May 2003
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