Emma Adamson
Betsi Cadwaladr University Health Board
Project Background:
Information provision is an essential component of pregnancy & childbirth (NICE, 2023). Women & their partners are receptive to the provision of information during pregnancy & high-quality, consistent & appropriate information can have a myriad of benefits including:
- Help to reduce maternal stress
- Improve self-efficacy
- Support informed decision making
- Improve maternal & neonatal outcomes
- Promote transition to parenthood
One important element of information provision is the Antenatal Education Session, which can support a number of improved outcomes including reduced caesarean section rate, increased breastfeeding rates & increased maternal satisfaction.
In BCUHB, these sessions vary significantly in terms of format, content & quality. Whilst a number of midwifery teams provide sessions which are very well received, lots of women & their birth partners continue to report feeling unprepared, uninformed& with unrealistic expectations.
Project Aims & Objectives:
Overarching Aim: To provide quality, standardised antenatal education sessions to help improve parental preparedness for labour, birth and early parenthood
- Objective 1: To establish a working group of professionals from midwifery, health visiting, mental health and local authority services, along with representatives from appropriate third sector organisations
- Objective 2: Using feedback from both service users and staff, devise a programme of antenatal education, which provides a standardised level of content to women and birthing partners, across North Wales, but with the flexibility to meet the needs of the group in a specific locality
- Objective 3: To evaluate the impact of the sessions on both experiential and empirical outcomes to determine long-term viability of the programme
Barriers & Challenges:
Capacity Issues – Gaps in the Maternity Service Senior Leadership Team required project lead to provide cover, meaning significantly reduced capacity to support the progression of the project
Stakeholder buy-in – Service user engagement was successful & buy-in from the Maternity Voices Partnership Group was evident, however engaging staff, particularly midwives, proved extremely difficult & there was reluctance at becoming involved in a review of service provision & due to reduced capacity, the ability to promote the project & maintain momentum was affected
Cultural Issues – Anecdotally the above appeared to be a longstanding cultural issue within community midwifery teams, where a small number of midwives passionate about the delivery of quality antenatal education sessions, were responsible for delivering almost all of the sessions across North Wales. The remainder of midwives either did not appear to have an interest in this vital aspect of their role or did not feel comfortable delivering these sessions, having never received any formal training
Covid-19 – The change to the format & delivery of antenatal education sessions due to the pandemic contributed to the above; midwives had spent a number of years not having to consider delivery of sessions, their only responsibility being to signpost women to online resources.
Service User & Staff Feedback:
82% of respondents were expecting their first baby
72% of respondents would prefer face to face sessions, 50% stated they would prefer to attend weekday evening sessions
Reasons for declining to attend community midwifery led sessions were time was inconvenient or had attended sessions outside of NHS
16% of women were not offered the opportunity to attend a session
More than 80% of those who had attended a session reported that the session:
- Provided them with all the info they needed
- Was delivered in effective way
- Was held in a suitable venue
- Was an appropriate length
- Made them feel and their birth partner feel prepared
However, 49% of respondents had attended a session delivered by a single midwife from one just one of 15 midwifery teams across BCUHB, comprised of approximately 100 midwives.
Achievements:
Great feedback from women & families about what elements of current offer are working well
Interesting insight from both service users & staff about what content should be included in
Content agreed for mental health & wellbeing element & currently in process of developing pelvic health / postnatal recovery content
