Parent_Education

EBL Parent Education What Provision Is In Place for Women With More Complex Needs' Too many women faced with difficult social circumstances are not accessing or engaging with maternity services with potential negative consequences for them and their baby's health. Pregnant women in these situations often do not attend antenatal appointments as traditional services are often not adequate for their needs. However, a lack of good antenatal care can increase the risk of women dying from complications during pregnancy or after birth, with women living in areas of high deprivation in England five times more likely to die during pregnancy or after childbirth than women in more affluent areas (from Confidential Enquiry into Maternal and Child Health (CEMACH) Saving Mothers' Lives 2003-2005: United Kingdom. CEMACH: London, 2007). Babies born into these circumstances are also around twice as likely to be stillborn or die shortly after birth as those who are not (from Confidential Enquiry into Maternal and Child Health (CEMACH) Perinatal Mortality 2007: United Kingdom. CEMACH: London, 2009). During pregnancy, and as parents, disabled people come into contact with many health care workers including midwives and nurses from the acute sector, as well as practice, community, mental health, learning disability and specialist community public health nurses and GPs. They may also use other community services, including occupational, social and children and young people’s services. All these providers are responsible for making sure equality of service delivery, and inclusion for disabled people, is incorporated into the care philosophy of their organisational structure (DoH 2006). The most significant barrier cited by many disabled people is the inappropriate attitudes, behaviours and lack of disability awareness demonstrated by the National Health Service (NHS). Clients with disabilities may have physical, mental, sensory or learning disabilities, or other impairments that are less easy to classify. All people with an impairment that fit the criteria of the DDA 1995 are defined as disabled. Impairments can be wide-ranging and people face barriers in society that make them disabled. The categories of impairment are (Diamond 2004): * Physical impairment * Sensory impairment * Learning Disability * Progressive disease * Mental health illness Carers need knowledge and awareness of conditions, including those that are hereditary or congenital in order to ask specific and appropriate questions and provide information. Understanding disability is the key to providing positive pregnancy care experiences (RCN 2006). Some general practice points in terms of effective antenatal care include indentifying disabled clients early, referring to the specialist or named midwife with responsibility for disability, robust and flexible referral systems encouraging disabled women to refer themselves for specialist care are essential, the first booking visit should be comprehensive and the woman’s preferred medium of communication should be identified and finally the midwife should offer antenatal care in the home; it usually provides a non-threatening environment and ‘safe place’ for disabled women (Morris et al 2006). There are various practice points that should be implemented when working with people with learning disabilities, these practice points ensure that the needs of the woman are met. The person who best knows the parent should inform the midwife about most effective ways to communicate and the assumption that information is understood the first time of telling needs to be avoided. It is vital that midwives ensure that all information is accessible; consider using visual and tactile aids; speech therapists and language specialists can provide support (RCN, 2006). Practitioners can check what is being said is understood by asking for feedback, and should take into account that home is usually the best place to teach and support parenting and other new skills with new information (Wharton et al 2005). Working with people with physical impairments poses significantly different barriers and practice should be adjusted to adhere to the different needs of these clients. It is best to provide as much care at home as is possible. Working in close partnership with other service providers is also essential to support removing barriers for women with physical impairments (Rotheram 2002). In terms of hearing impairment antenatal care needs to be adapted. Midwives should remember that, even though the client has a hearing impairment, they should still speak normally and clearly and face the woman so they can lip read, even if they have some hearing or an aid. Forward planning is vital in the care of these women and the organisation of suitably qualified BSL interpreters or lip speakers where necessary is imperative. Information can also be backed up with visual materials (Iqbal 2004). In terms of visual impairment and antenatal care, midwives should take the following practice points into consideration and apply where appropriate. Providing extra lighting in rooms and magnifying equipment are simple ways to break down some of the barriers related directly to visual impairments. All literature provided to sighted women should be provided in a format accessible to those with visual impairments. Communications should all be made by telephone or other audio media (McKay-Moffat 2003). The aim of all staff should be to respect the diversity and individuality of people with disabilities. Midwives must work in partnership with agencies and disabled people themselves to promote health, deliver care in new ways and become advocates of good practice. A health service that meets the needs of disabled women who are pregnant will meet the needs of all childbearing women well; in effect, a health service that’s built around the needs of disabled people enhances the quality of care provided in general and works more effectively. The aim is to deliver services for childbearing women that value diversity and see the woman first, and disability second (Rotheram 2000). Teenage girls who are pregnant -- especially if they don't have support from their parents -- are at risk of not getting adequate prenatal care. Antenatal care is critical, especially in the first months of pregnancy. Especially for teens who think they can't tell their parents they're pregnant, feeling scared, isolated, and alone can be a real problem. Without the support of family or other adults, pregnant teens are less likely to eat well, exercise, or get plenty of rest. And they are less likely to get to their regular Antenatal visits. Having at least one trusted, supportive adult -- someone nearby in the community, if not a family member -- is invaluable in helping them get the Antenatal care and emotional support they need to stay healthy during this time (Allen et al 2000). Key recommendations to raise standards of care for pregnant women under the age of 20 consist of working in partnership with local education authorities and voluntary agencies to improve access to, and continuing contact with, antenatal services for young women aged under 20; Consider commissioning a specialist antenatal service for young women under the age of 20. This could include antenatal care and education in peer groups in different locations (e.g. schools, colleges, GP surgeries) or offering peer group support at the same time as antenatal appointments in a one-stop shop where a range of services can be accessed at the same time; Offering a named midwife, who should take responsibility for and provide the majority of the woman's antenatal care, and provide a direct phone number for the midwife; Training for healthcare professionals to ensure they are knowledgeable about safeguarding responsibilities for both the young woman and her unborn baby and the most recent government guidance on consent for examination or treatment; Be aware that the young woman may be dealing with other social problems and offer age-appropriate information in a variety of formats (NICE 2007). The new guideline, developed by the National Institute for Health and Clinical Excellence (NICE) in close collaboration with the Social Care Institute for Excellence (SCIE), calls on antenatal services to become flexible and supportive. This includes the NHS working with social care providers and, in some cases charities and the police, where appropriate, in order to properly care for these vulnerable women. Its aim is to help encourage access to and uptake of effective care for pregnant women with complex social factors to ensure they and their babies are kept as safe and healthy during pregnancy as possible. Reference List Allen, J. Hippisley-Cox, J. (2000) Teenage Pregnancy in the UK: Where are we going wrong' International Journal of Adolescent Medicine and Health, 12 (4), pp. 261-273 Department of Health (2006) Mental health and the Disability Discrimination Act, http://www.direct.gov.uk/en/DisabledPeople/HealthAndSupport/MentalHealth Diamond B (2004) Disability Discrimination, British Journal of Midwifery, 12 (9), p.560 Iqbal S (2004) Pregnancy and Birth: A guide for deaf women, London: RNID and NCT Morris J and Wates M (2006) Supporting disabled parents with additional needs, London: SCIE McKay-Moffat S (2003) Meeting the needs of women with disabilities, The Practicing Midwife, 6 (7), pp. 12-15 National Institute for Clincal Excellence (2007) Antenatal and Postnatal mental health: Critical management and service guidance, London. NICE Rotheram J (2000) Caring for the minority within the minority, Brithish Journal of Midwifery, 6 (9), p. 596 Rotheram J (2002) Maternity needs of disabled women, Disability, Pregnancy and Parenthood International, 40, pp. 10-11 Royal College of Nursing (2006) Meeting health needs of people with learning disabilities: guidance for nursing staff, London: RCN Wharton S et al (2005) Assessing parenting skills when working with parents with learning disabilities, Learning Disability Practice, 8 (4), pp. 12-14