Pregnancy and complex social factors

Implementing NICE guidance

2010

NICE clinical guideline 110

What this presentation covers

Background

Scope

Key priorities for implementation

Costs and savings

Discussion

Find out more

Background

• Women with complex social factors are at higher risk of death during or after pregnancy than other women.

• They are less likely to access antenatal care or stay in regular contact with maternity services.

• Providing antenatal services in a more flexible way may encourage more women to attend and receive appropriate care and referrals.

Barriers to accessing care

Barriers may include:

•unfamiliarity with antenatal care services

•difficulty communicating with healthcare staff

•attitudes of healthcare staff

•practical problems attending antenatal appointments

•involvement of multiple agencies.

Scope

Antenatal care of all women with complex social factors.

Four exemplar populations.

Provides recommendations for service provision at a service/organisational level and at an individual healthcare provider level.

Key priorities for implementation

The areas identified as key priorities for implementation are:

• Service organisation - actions for commissioners and service organisers

• Information and support for women

• Care provision

Define populations locally by ensuring data collection for:

• the number of women presenting for antenatal care with any complex social factor

• the number of women within each complex social factor grouping identified locally.

All women with complex social factors

Ensure that specific data are recorded for each complex social factor grouping relating to:

• gestation at booking• attendance and non-attendance at scheduled

appointments• maternal and infant mortality or significant morbidity.

All women with complex social factors

All women with complex social factors

Involve women in service development:

• ensure that women are asked about their satisfaction with services

• ensure that this information is recorded, monitored, and used to guide service development.

Work with local agencies to:• co-locate services• develop inter agency care plans which include

information about opiate replacement therapy• offer women information about other services.

Provide training for healthcare professionals on the social and psychological needs of women who misuse substances.

Women who misuse substances

Women aged under 20

• Consider commissioning a specialist antenatal service for women aged under 20 using a flexible model of care tailored to local need

• This may include provision of education and care in peer group settings such as GP surgeries, children’s centres and schools

Develop a joint protocol with social care providers, the police and third sector agencies. This should include:

• clear referral pathways which set out how information and care will be provided

• latest government guidance• sources of support and safety information• plans for follow-up care • recording of contact information for both the woman

and others involved in her care.

Women who experience domestic abuse

• Provide information about pregnancy and antenatal services in a variety of:

– formats– settings – languages

Recent migrants, asylum seekers and refugees

At her first contact with any healthcare professional:• Discuss the need for antenatal care.• Offer a booking appointment in the first trimester if

she wishes to continue the pregnancy.• Offer referral to sexual health services if she is

considering termination of pregnancy.

During antenatal care:• Provide each woman with a one-to-one

consultation on at least one occasion.

All women with complex social factors: information and support

• Co-ordinate care and communicate sensitively.

• Consider initiating a multi-agency needs assessment.

• Discuss the woman’s fears in a non-judgmental manner, respecting her right to confidentiality.

• Explain why and when information may need to be shared with other agencies.

All women with complex social factors: care provision

Costs and savings

The guideline is unlikely to result in a significant change in resource use in the NHS. However, the following may result in additional costs or savings, depending on local circumstances:

• Offering a named midwife or doctor with specialised knowledge of, and experience in, the care of women who misuse substances.

• Antenatal care and education for women under 20.• Potential savings around the packaging of services

and improving pregnancy outcomes.

Discussion

• What local processes are in place to ensure that data are collected regarding women with complex social factors?

• What sources of information are available for women, and do they meet the needs of the population group for which they are intended?

• What processes are in place to support joint working?

Find out more

Visit www.nice.org.uk/guidance/CG110 for:

•the guideline •the quick reference guide•‘Understanding NICE guidance’•a costing statement•audit support•baseline assessment tool•a guide to resources•examples from practice