A systematic approach to development in maternal and child nutrition

A systematic approach to development in maternal and child nutrition Birmingham’s Strategy Dr Suzanne Tyler PMA Consultant Birmingham’s Issues • High rates of infant mortality • 11 wards with IMR >10/1000 compared to UK average of 5.3/1000 • High rates of social vulnerability and exclusion • • • • • Ethnic minorities Teenage mothers Women experiencing domestic violence Homeless families Asylum seekers Birmingham’s issues • Existing health and social services fragmented • Capacity issues in maternity services • Environment of care often poor • Little engagement between maternity services and other agencies • Highest density of Children’s Centres • 29 in 13 target wards What we aim to do • Improve access to antenatal care and other health services • Link to language support for newly arrived migrant women and others • Facilitate increased social support for women who are poor, isolated or vulnerable • Signpost women to other services that will improve uptake of benefits and entitlements • Promote early access • Facilitate continuity of carer Why nutrition is so important • Inadequate diet second most important factor in low birth weight • Poorer pregnant women are not eating a diet adequate for optimum fetal growth • Pregnant women with existing children tend to reduce their own eating • Women who are excessively under of over weight before pregnancy are at higher risk of low birth weight, CHD, noninsulin dependent diabetes • Young women dependent on means-tested benefits are unlikely to be able to afford an adequate pregnancy diet • Most pregnant teenagers aged 16-17 are not eligible for benefits Nutrition and pregnancy • “each pregnant woman has two visits early in pregnancy with a midwife who can advise her on her options for care on the basis of an in depth knowledge of local services” (Maternity NSF) Monitoring and Evaluation Dietary Advice PAS Data Set Clinical/Social Engaging Communities Early Pregnancy Testing Risk Assessment Children’s Centres One Stop Shop Maternity Link/ Support Workers Smoking in Pregnancy REDUCE INFANT MORTALITY IN BIRMINGHAM Improving Access Early Booking Confidential Enquiry Commissioning/Service/ Specs for Acute/Community Midwifery Capacity Communicating Children’s Centres as the focus for systematic service development • NSF White Paper (2004) When Midwives are located in Children Centres they tend to be more visible and accessible to the community. Consideration should be given to locating some midwives in children centres, managed as a single service providing both community and hospital based services. • Our Health White Paper (January 2006) Women will also be able to access antenatal and postnatal care in community settings, such as children centres. What our new service will offer • Access to additional services for pregnant women • Multi – agency approach • Sufficient working environments • Family centred environment • Continual engagement with the new mother and family Children’s Centres will provide • Every Child Matters-Better outcomes for children & families • Antenatal advice and support for parents • Community based approach • Multi-agency and partnership working • Building on existing practice Our Children’s Centres will provide • • • • • • Promoting Breastfeeding/ Baby Café Maternal Wellbeing/ Baby Massage Nutritional Support/ Healthy Start Language support Encouraging smoking cessation Raise awareness of Children Centre services (Antenatal/ Postnatal) • Welfare Benefit information The Nutrition Package • Raising awareness of Healthy Start amongst midwives and Children’s Centre staff • Weight management classes • Individualised dietary advice • Developing a nutrition checklist for use by support workers • 1.3wte dietician • 1wte Food Health Advisors Raising awareness • Tailored training and support on nutrition topics to those working with pregnant women • Midwives • Support workers • Children’s Centre staff Weight management classes • One to one dietary advice to women identified as at risk • Recall system for women who want to lose weight postnatally • Cook and taste sessions focusing on healthy eating on a budget Nutrition checklist • Aim to identify likely dietary deficiencies early in pregnancy • Ensure all those working with pregnant women are able to answer basic nutrition questions and know where to go for further advice • Backed up by culturally appropriate leaflets • Designed to be used in clinic or group settings or in 1:1 • Available in range of languages Reach • 400 women a month to use checklist • 96 women a month offered individual consultations • 5 cook and taste sessions Further details • Annette Williamson, Project Lead: annette.williamson@HoBtPCT.nhs.uk • Eleanor McGee, Dietician eleanor.mcgee@benpct.nhs.uk • Suzanne Tyler, Consultant to NRF: tylerdines@mac.com