Memorandum by Southampton University Hospitals
NHS Trust (MA6)
1. INTRODUCTION
Southampton University Hospitals Trust cares
for almost 5,000 women giving birth per year. The Princess Anne
provides care targeted at women's needs and aims to provide this
in the most appropriate setting. For those who require specialist
interventions we provide a regional service for foetal, maternal,
and neonatal medicine, and neonatal surgery. In addition to this,
for women with uncomplicated pregnancies we are developing new
models of care. This aims to increase the normal birth rate, increase
the number of women being delivered by a professional they have
met antenatally and move care away from hospital into the community.
Within the Princess Anne, there is an integrated midwifery led
birthing unit undertaking 400 births per year. There are also
three stand-alone midwifery led birth centres away from the main
hospital currently undertaking 300 births per year.
2. PROVISION
OF APPROPRIATE
CARE FOR
WOMEN LIVING
IN POVERTY
We have addressed the issue of poverty as part
of the maternity services strategy by focussing on the needs of
women and families in areas of socio-economic deprivation. The
aim is to provide effective services that are accessible and promote
uptake. Midwifery group practices have been established in areas
of particular need and work in partnership with Sure Start projects.
The midwives are locality based with a practice base in the community
providing an easy point of access and provision of antenatal and
postnatal groups. Working in partnership with Sure Start promotes
interagency working with regard to housing; benefits, domestic
abuse, mental health; smoking cessation and cultural and lifestyle
issues. Midwives provide continuity of carer from birth to six
weeks postnatally. Their knowledge of local services and ability
to build close relationships with the women and their families
makes them ideally placed to address many of the issues highlighted.
The midwives ability to work with different professionals, agencies
and voluntary groups enables them to co-ordinate the varied medical,
economic, social and cultural factors that contribute to the experience
of health.
The Group of midwives have now been working
together for two and half years and currently have a normal birth
rate of 80%, 20% of which occur at home. The incidence of intra
uterine growth restriction is now 1%. Breastfeeding is initiated
in 60% of the women and at six weeks 40% continue to breastfeed.
This system of care attached to Sure Start projects is now reflected
in two other areas in the city.
3. PROVISION
OF CARE
FOR THOSE
FROM MINORITY
ETHNIC GROUPS,
AND THOSE
WHO DO
NOT SPEAK
ENGLISH AS
THEIR FIRST
LANGUAGE.
Within Southampton there is a very culturally
diverse population with no less than 40 different spoken languages.
This presents a number of complexities when delivering a midwifery
service.
In order to promote clearer channels of communication
midwives access translation and interpreting services. However,
this is not always possible and Southampton is developing a visual
"communication tool" alongside consultation with the
women and the midwives to enhance better understanding. We are
also exploring ways of teaching women and their partner's key
English words used in labour, and midwives key phrases in the
three most predominantly spoken languages.
In Southampton a team of case loading midwives
operate within the culturally diverse communities. This ensures
they work with a locality focus and become recognised by the communities.
This way of working helps to overcome a number of issues. The
midwives provide continuity and individual care and by doing so
are welcomed into families. This helps understanding of issues
within the family regarding women's privacy, her role within the
family unit, the hierarchal influence within the family and the
impact these may have. They are able to prioritise health needs
and aim to influence a number of health issues such as diet, postnatal
depression, and breastfeeding.
The midwives have organised a breastfeeding
support group and actively encourage women to attend and support
each other. They are commencing a bumps and babies session coinciding
with an antenatal clinic. This allows women to share experiences
and also creates an opportunity for socialising, which can be
considered as "safe" by the Asian families.
Women with refugee or asylum status are often
without family or friends. Southampton has made links with Al-Nisa
(a voluntary group supporting Muslim women) and local Community
workers to provide a hospital visiting service to these women
offering help and information.
4. PROVISION
OF APPROPRIATE
CARE FOR
WOMEN WHO
ARE HOMELESS
The maternity service has a midwife who links
with the homeless health centre in the city centre. The midwife
can be called to see any woman when she attends the centre. Unfortunately
these women tend to transient and are rarely seen on two consecutive
occasions. National hand held notes would help to ensure the woman
can have a record of the care she has received for the service
in which she chooses to give birth.
May 2003
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