Maternity Services

Maternity ServicesIntroduction

It is well understood that the foundations for health and well-being start in pregnancy.
From heart disease to obesity, educational achievement and economic status, the months before and, the years immediately after, birth are crucial to the life chances of the mother, her child and her family. The health and happiness of future generations can be enhanced through the provision of world class maternity services.


Challenges for Maternity Services in Wales

Pregnancy is a powerful motivator for change and a time when women and their partners, often for the first time, make positive lifestyle changes and choices in order to provide the optimal conditions to ensure the health and wellbeing of their unborn baby. This is particularly important, not just in the context of the pregnancy, but also because we know that when women make these changes, they significantly influence the lifestyle choices of their children and wider family. Pregnancy therefore presents a golden opportunity to impact on the health and wellbeing of individuals and communities.

The health of children is influenced by what happens throughout pregnancy and even before, so it is vitally important that efforts to ensure that mother and child are safe and healthy need to start well before the birth.


Obesity

Obesity in pregnancy is associated with an increased risk of a number of pregnancy-related complications and adverse outcomes and the babies of obese women have an increased risk of perinatal mortality compared with the general maternity population in the UK.


Smoking

The Centre for Disease Control (CDC 2010) identified that women who smoke before pregnancy have a 30% chance of being infertile and are more likely to experience delay in conception. Those women who smoke during pregnancy are about twice as likely to experience premature rupture of membranes and placental abruption during pregnancy. Babies born to women who smoke are 30% more likely to be born prematurely, are more likely to be born with low birth weight (less than 2500 grams), weigh an average of 200 grams less than babies born to mothers who do not smoke, and are 1.4 to 3 times more likely to die of Sudden Infant Death Syndrome (SID).


Alcohol

Drinking during pregnancy can result in Fetal Alcohol Syndrome (FAS). This disorder leads to lifelong intellectual and behavioural problems for the child.
According to the Department of Health Hospital Episode Statistics the number of cases of FAS in England was 95 in 2000-01, 90 in 2001-02 and 128 in 2002-03. In Scotland, there were four cases of FAS in 2000, five in 2001, four in 2002, two in 2003 and ten cases in 2004. This equated to 0.21 per 1,000 live births in 2004.
There are currently no data available for the incidence of FAS in Northern Ireland or Wales. In the USA, the incidence of FAS is reported to be between 0.5 and2 per 1,000 live births.


Teenage Conception

The 2006 Health Behaviour in School-aged Children Study showing that Wales had one of the highest proportions of 15 year olds in the 34 European and North American participating countries reporting having had sexual intercourse, at 41% of girls and 30% of boys.

Encouragingly, the latest update on the Child Poverty Milestones (WAG 20103) suggests a reduction in inequality between the most deprived fifth of Wales and the middle deprived fifth in relation to underage conceptions. Despite the latest figures for 2008 showing teenage conception rates to be 13% lower than they were in 1999, recent progress has been slow.


Breast Feeding

Breastfeeding gives babies protection from disease and infections and breastfed babies are less likely to develop asthma, eczema and diabetes. There are advantages for the mother too, as a breastfeeding mother is less likely to develop ovarian and pre-menopausal breast cancer.
The Infant Feeding Survey in 2005 shows that Wales lags behind other parts of the UK in sustaining breastfeeding through infancy, but rates of breastfeeding at birth rose in 2008 compared with previous years.


Policy Context

Maternity policy is focusing on increasing health care delivered closer to home. This will be achieved through integrated working across health and social care with greater involvement of women in decisions about their health and health care, as well as more public accountability and engagement of communities in the design and delivery of services.

Midwifery 2020 – Delivering Expectations states that midwives should become the first point of contact for pregnant women, co-ordinating pre and post-natal care and support and, where required, transferring women to the care of a consultant obstetrician.

Services

Screening Services

Child health clinics offer regular health and development reviews and immunisation for your baby or child. It’s run by health visitors and doctors.
Antenatal Screening Wales is funded by the National Assembly for Wales to support improvements in the standard of antental screening offered to women.
 
Newborn hearing screening was introduced in Wales in March 2003 and once fully implemented across Wales became the first national newborn screening programme in the UK. Early detection of hearing loss leads to improved outcomes in speech and language development and in the general well being of the child and family.
The Congenital Anomaly Register and Information Service for Wales (CARIS) is part of Public Health Wales. CARIS collects information about any foetus or baby who has or is suspected of having a congenital anomaly and whose mother is normally resident in Wales at time of birth.

 

Progress to date

‘Delivering the Future in Wales’ (WAG 20024) promoted women centred services with a focus on increasing choices in antenatal provision and place of birth. The availability of home birth and birth in a Midwife Led Unit has increased and Heads of Midwifery have made great strides in collaborative working by setting up an effective all Wales group that advises Welsh Assembly Government and shares and develops good practice across Wales.

The National Service Framework for Children, Young People and Maternity Service (2005) sets out evidence based standards and progressively, local NHS bodies have been bringing their services in line with these standards. The majority of these standards have now been delivered.

The Wales Audit Office Maternity Services Report (WAO 2009) stated that whilst most women were satisfied with their maternity care there were specific problems including;

  • Lack of an overall strategy for maternity services in Wales
  • More could be done to prevent unnecessary Caesarean sections
  • Some women felt they were not treated with dignity, respect, kindness and understanding
  • Significant deficiencies in the way that maternity services monitor performance and collect information

Improvements in these areas have now been introduced across Wales.

Programmes and Initiatives

The All Wales Clinical Pathway for Normal Labour provides support for midwives who wish to practice evidence-based clinical care of the highest standard with minimal unnecessary intervention. The pathway is designed to be shared with women so that women are both included and informed.

A project to establish an all Wales curriculum for maternity support workers (MSWs) was jointly funded by the National Leadership and Innovation Agency for Healthcare (NLIAH) and Skills for Health (SfH) working in collaboration with the Royal College of Midwives (RCM) Wales. You can download the document below for more information.

It's never too early to get your baby on the right path to a healthier, happier future. The Start4Life page provides information and useful tips on feeding and getting your little one on the move – and everything in between.

The Baby Friendly initiative provides training for health professionals to enable them to give breastfeeding mothers the help and support they need to breastfeed successfully.

Immunisation is one of the best means of protecting a child against many contagious diseases.

 

Resources

The Department for Public Health and Health Professions (DPHHP) provides the Pregnancy book free to mothers in Wales early in their pregnancy. Based on the Department of Health publication, it is revised updated for Wales, and is bilingual.

There are a number of publications available from the Welsh Assembly Government to download providing useful advice on breastfeeding.

 

Statistics

Summary information is published annually on the method of delivery of hospital births in Wales.
The source of the data for this Statistical Release is the Patient Episode Database for Wales (PEDW) which is a database of individual hospital patient records.

The Welsh Assembly Government reports on Teenage Conceptions in Wales.

The latest National Statistics on births and infant mortality produced by the Welsh Assembly Government were released on 9th March 2011 according to the arrangements approved by the UK Statistics Authority.

The All Wales Perinatal Survey began in 1993 as a continuous surveillance of perinatal and infant mortality in the Principality and is funded by the Welsh Assembly

The Public Health Wales Observatory - Maternal and Child Health pages contain links to sources of publications, evidence and data.