Introduction

This policy statement is intended to apply to all parts of the UK. The first 1000 days of life (from conception) are crucial for the long term health and wellbeing of families and society in general. The SHA wants adequate NHS, fully funded, woman-centred maternity care, for all women, potential parents, partners and their family/support networks (including all migrant women).  This care is from pre-conception to 6 weeks after birth and beyond.  This is because care needs to focus on long term outcomes as the evidence is that the environment in the uterus and after birth can be detrimental to individuals’ health throughout their lives. It needs to avoid the ‘business’ approach that concentrates on short term targets. To achieve this, the following is necessary:

Overall principles

  1. To address maternal, paternal and child poverty in order to improve outcomes and to relieve stress related damage, good nutrition should be accessible to all, before, during and after pregnancy. To achieve this, public health measures, which make the healthy choice the easier choice, should be developed.
  2. The voices of women, potential parents and their support networks should be heard and listened to at all the stages of planning and evaluation of maternity services.
  3. There should be high quality physical and mental health care appropriate in a diverse society. There should be a proportionate universalist approach to give every child the best start in life. This includes migrant women and their babies.
  4. Pre-pregnancy care must be available to all to achieve the healthiest pregnancy possible. It should cover the very harmful factors in the wider and personal environment, such as tobacco, alcohol and substance misuse, air and industrial pollution, and domestic abuse, which can have devastating consequences on babies from conception and throughout their lives. Improvements are required to ensure the quality and consistency of health and safety in the workplace for pregnant women and potential fathers.
  5. Adequate time and funding for maternity leave, maternity pay, paternity leave and pay and parental leave should be available to all. Partners of pregnant women should have a legal right to take time off in the event of problems developing during the pregnancy.  Pregnant women and new mothers in education at the time of birth, and all those caring for young babies, must be supported to ensure that they are not denied educational opportunities.

Specific stages of care

  1. Antenatal care and education should be accessible to women and potential parents (and their families) from all backgrounds and cultures. Those working should have the right to paid leave to attend. Such education can be provided one to one or within groups.  The groups can be women only or mixed or with special provision for marginalised groups as deemed appropriate in local areas.  Collaboration between midwives and health visitors (and others as appropriate) to facilitate this education is ideal.
  2. All parents should have access to parenting skills support, particularly to prevent and mitigate adverse childhood experiences. The roll out of the Flying Start scheme in Wales is a good development, in contrast with the huge cuts to Sure Start schemes in England.
  3. All care should aim for a safe, respectful and positive birth experience for all women. Women should have a fully resourced, real choice of place of birth (home, midwifery or obstetric unit) having been fully informed about how these will meet their individual medical and personal needs. To achieve this, home birth should be backed up when there is an emergency with adequate pre hospital care (provided by community-based midwives and paramedics specifically educated on maternity care).  Such pre hospital care should enable safe, timely and appropriate transfer to hospital obstetric and neonatal paediatric services.  Midwife–led units should be available to women, and hospital based care should respect and support women’s decisions.
  4. Continuity of care from midwives (and other relevant health care professionals) is crucial. All women should have a named midwife, who works as part of a community-based team of midwives, and who coordinates care with others, such as obstetricians, health visitors, GPs, physiotherapists, and dietitians, as necessary. Ideally there should be continuity of carer throughout the antenatal, intrapartum and postnatal periods. All women should have one to one care during established labour.
  5. Women and their partners, families/support networks should be supported emotionally and physically in the early days after birth. There needs to be adequate and realistic help with breast feeding, including midwifery, health visitor and peer support. Postnatal education and support should be available, via groups or on a one to one basis, ideally continuing educational provision stated during pregnancy.
  6. Community based mental health services need to be available to support women (collaborating with midwives, GPs and health visitors), as well as sufficient mother and baby inpatient psychiatric provision.
  7. There should be full funding of neonatal special and intensive (levels 2 and 3) care.

Staffing

  1. More staff should be recruited to end the use of agency staff. This includes keeping staff from EU countries and making them very welcome. NHS staff should be actively supported and valued in order to relieve work-related stress and burnout and prevent attrition, so that in turn they are able to give the best quality care.  The culture of risk, fear and blame should be resolved.

Research and education

  1. Funding for research into maternity care, preterm birth, still birth, neonatal and perinatal mortality and birth injuries should be increased.
  2. Investment is required in the education of healthcare professional students involved in maternity care. These students should receive non means tested NHS bursaries while being educated. Where appropriate there should be joint education between students such as midwives, paramedics, health visitors and doctors (potential future GPs, obstetricians and paediatricians) both before and after qualification. The latter should not have to be funded by the clinicians themselves.

(References to back up the recommendations of this policy are available on request)

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