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Nice 2010 pregnancy and complex social factors of obesity: Pregnancy and complex social factors: service provision overview

Because there are differences in the barriers to care and particular needs of these four groups, specific recommendations have been made for each group.

William Thompson
Thursday, May 14, 2020
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  • Birth published by Wiley Periodicals, Inc.

  • However, the following may result in additional costs or savings, depending on local circumstances: Offering a named midwife or doctor with specialised knowledge of, and experience in, the care of women who misuse substances.

  • Many women who have social care involvement during their pregnancy perceive health care services as a system of surveillance rather than support, impacting on their engagement. Merrill E, Grassley J.

Women better prepared and supported for the challenges of parenthood and able to demonstrate their ability in parenting assessments, evidence of care and empathy from HCP's, increased agency, value in engaging with services, avoidance of further financial hardship, distress, and isolation. All results remained significant following adjustment for socio-demographic variables, although the effect sizes reduced for all the BMI categories. National reports in the UK have identified that inadequate use of antenatal care was fold higher among women who died during pregnancy compared with those who survived [ 5 ], and only one quarter of women who died between and received the recommended care according to national guidelines [ 67 ]. All data coding and statistical analyses were performed using SPSS version There were some themes that were expected to be reported but were not.

Realist methodology attempts to understand what works, for whom, under what circumstances. RESULTS The full findings of this synthesis are detailed in 85 program theories 45 general theories and 40 that pregnancy and specific to different social risk factors and referenced to relevant included studies to demonstrate transparency see Table S2. Support Center Support Center. You can also search for this author in PubMed Google Scholar. This, as well as experiences of paternalistic care and discrimination, could be mitigated through the ability to develop trusting relationships. The association of obesity and cervical cancer screening: a systematic review and meta-analysis. The greatest effect size was observed among women with an obese BMI in the analysis of booking in the third trimester aOR 1.

Response to the NICE clinical guideline on depression It offers advice on improving access to care, maintaining contact with antenatal carers, and additional information and support for these women. Ans may include:. Recommendations This guideline includes recommendations on improving access to care for: all women with complex social factors pregnant women who misuse alcohol or drugs pregnant women who are recent migrants, asylum seekers or who have difficulty reading or speaking English young pregnant women aged under 20 pregnant women who experience abuse Who is it for? Medicines-related communication systems when. Next 1 Guidance 1.

Domestic abuse: an incident of threatening behaviour, violence or abuse psychological, physical, sexual, financial or emotional between adults who are or have been intimate partners or family members, regardless of gender or sexuality. Medicines-related communication systems when. This should include: clear referral pathways which set out how information and care will be provided latest government guidance sources of support and safety information plans for follow-up care recording of contact information for both the woman and others involved in her care.

Women who experience domestic abuse Slide 13 Provide information about pregnancy and antenatal services in a variety of: formats settings languages Recent migrants, asylum seekers and refugees Slide 14 At her first contact anr any healthcare professional: Discuss the need for antenatal care. The guideline applies to all pregnant women with complex social factors and contains a number of recommendations on standards of care for this population as a whole. Components may include:. It is for professional groups who are routinely involved in the care of pregnant women, including midwives, GPs and primary care professionals who may encounter pregnant women with complex social factors in the course of their professional duties.

Recommended BMI was the reference category for the analysis. Social class, ethnicity and attendance for antenatal care in the United Kingdom: a systematic review. Results Following exclusions for missing or unrealistic data About this article.

Embed Size px x x x x NICE interactive flowchart - Pregnancy and complex social factors: service provision Quality standard - Antenatal care. Particular attention should be paid to:.

They may also be overwhelmed by the involvement of multiple agencies. This should include: clear referral pathways which comples out how information and care will be provided latest government guidance sources of support and safety information plans for follow-up care recording of contact information for both the woman and others involved in her care. In this guideline the following definitions are used. The full guideline gives details of the methods and the evidence used to develop the guidance. Introduction Woman-centred care Key priorities for implementation 1 Guidance 2 Research recommendations Update information. However, four groups of women were identified as exemplars:.

NICE has also produced a guideline on the care that should be offered to all women during pregnancy. This guideline covers antenatal care for all pregnant women with complex social factors particularly alcohol or drug misuse, recent migrant or asylum seeker status, difficulty reading or speaking English, aged under 20, domestic abuse. Guideline development process How we develop NICE guidelines Your responsibility The recommendations in this guideline represent the view of NICE, arrived at after careful consideration of the evidence available. It is also for those who are responsible for commissioning and planning healthcare and social services.

  • All third trimester results remained significant following adjustment.

  • The number of women within each complex social factor grouping identified locally. Clinical guideline [CG] Published: 22 September

  • These final theories were grouped into the most commonly occurring themes and further refined into eight CMO configurations.

  • J Epidemiol Community Health.

NICE has also produced a guideline on the care that should be offered to all women during pregnancy. How we develop NICE guidelines. See also the evidence reviews and information about how the guideline was developedincluding details of the committee. This should include: clear referral pathways which set out how information and care will be provided latest government guidance sources of support and safety information plans for follow-up care recording of contact information for both the woman and others involved in her care.

Diabetes in pregnancy guideline GL protocols and However, the following may result in additional costs or savings, depending on local circumstances: Offering a named midwife or doctor with specialised knowledge of, and experience in, the care of women who misuse substances. All women with complex social factors: information and support Slide 15 Co-ordinate care and communicate sensitively. Category: Documents 0 download. Slide 17 Discussion What local processes are in place to ensure that data are collected regarding women with complex social factors?

Obesity : Obesity And Obesity

Healthcare professionals should be given training on nicr care of women known or suspected to be experiencing domestic abuse that includes:. Home NICE Guidance Conditions and diseases Fertility, pregnancy and childbirth Pregnancy Pregnancy and complex social factors: a model for service provision for pregnant women with complex social factors Clinical guideline [CG] Published: 22 September Response to the NICE clinical guideline on depression

  • Published online Aug 5.

  • Potential savings around the packaging of services and improving pregnancy outcomes.

  • Major risk factors for stillbirth in high-income countries: a systematic review and meta-analysis. Binge eating result to give a brief moment of satisfaction, compensation or maybe of recompense, but soon that instant disappear.

  • The following guidance is based on the best available evidence. The guideline applies to all pregnant women with complex social factors and contains a number of recommendations on standards of care for this population as a whole.

  • Pregnancy and complex social factors: a model for service provision for pregnant women with complex social factors NICE guideline CG

  • The data from women who expressed this were linked to perceptions of surveillance, which may explain why the thought of one known health care professional might be perceived as intimidating, and building a relationship may be viewed as an invasion of privacy.

This should include: clear referral pathways which set out how information and care will be provided latest government guidance sources of support and safety information plans for follow-up care recording of contact information for both the woman and others involved in her care. The recommendations in this guideline represent the view of NICE, arrived at after careful consideration of the evidence available. Home NICE Guidance Conditions and diseases Fertility, pregnancy and childbirth Pregnancy Pregnancy and complex social factors: a model for service provision for pregnant women with complex social factors Clinical guideline [CG] Published: 22 September Healthcare professionals Commissioners and providers Pregnant women who need additional support to use antenatal services, their families and carers Is this guideline up to date? It is not mandatory to apply the recommendations, and the guideline does not override the responsibility to make decisions appropriate to the circumstances of the individual, in consultation with them and their families and carers or guardian. What sources of information are available for women, and do they meet the needs of the population group for which they are intended? See also the evidence reviews and information about how the guideline was developedincluding details of the committee.

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Accessing care late in pregnancy misses opportunities for routine screening such as the fetal anomaly scan at 20 weeks gestation [ 4 ]. Existing maternal obesity guidelines may increase inequalities between ethnic groups: a national epidemiological study ofbirths in England. Received : 09 May London: National Perinatal Epidemiology Unit; Download references. These final theories were grouped into the most commonly occurring themes and further refined into eight CMO configurations. Five of the eight CMO configurations related to system resources: access, interpreter services, education, practical support, and continuity of care.

  • Predictors of socisl timing of initiation of antenatal care in an ethnically diverse urban cohort in the UK. While existing datasets provide relatively instant access to a wealth of data for research which would take decades to prospectively collect, they are often limited as they lack the entire group of variables that would be required to fully answer the research question.

  • These women need supportive and coordinated care during pregnancy.

  • Availability of data and materials Data used in this study are not currently publicly available.

  • Because there are differences in the barriers to care and particular needs of these four groups, specific recommendations have been made for each group. It is not mandatory to apply the recommendations, and the guideline does not override the responsibility to make decisions appropriate to the circumstances of the individual, in consultation with them and their families and carers or guardian.

Gilson L. The recommendations in this interactive flowchart represent the view of NICE, arrived at after careful consideration of the evidence available. An investigation of the relationship between the caseload model of midwifery for socially disadvantaged women and childbirth outcomes using routine data—a retrospective, observational study. Therefore the BMI of women who booked in the first trimester was not adjusted. External link. A limitation of this study is the lack of data available post Maternal body mass index and access to antenatal care: a retrospective analysis ofbirths in England.

Baker EC, Rajasingam D. Maternal Obesity in the UK: Findings from a national project. Article PubMed Google Scholar Phillimore A similar pattern of increasing proportion of women with each increase in booking trimester was observed for teenage pregnancies and for women aged 18—24 years; the BME groups Black or Black British, Chinese or Other Ethnic Group, and Mixed Ethnic Group; all categories of unemployment and women who were in education; and the second most deprived IMD Quintile 2 Table 1.

Phillimore Support Center Support Center. New York: The Free Press;

  • Avoidance of labeling women or making assumptions about their needs based on a perceived cultural background. Maternal Obesity in the UK: Findings from a national project.

  • Service organisation 1.

  • The review does not report on whether outcomes differed for socially disadvantaged women but recommended that future research should explore this population and the mechanisms underpinning the improved outcomes. Br J Gen Pract.

  • HCP's knowledge of maternity benefits and local support available to enable the provision of advice around practical matters such as housing, employment, education, and care of other children and family members. Hart JT.

Popular Essays. Weight management before, during and after pregnancy. Requests for vomplex to this dataset should be made to the corresponding author, and will require all necessary ethical approvals and data sharing agreements to be in place. When exercising their judgement, health professionals are expected to take these recommendations fully into account, alongside the individual needs, preferences and values of their patients. Department of Health. Int J Qual Meth.

J Health Serv Res Policy. Google Scholar Jomeen J, Redshaw M. Risk factors and newborn outcomes associated with maternal deaths abd the UK from to a national case—control study. Elliott and Bower also encourage antenatal assessment of maternal alcohol consumption and state that accurate recording of foetal alcohol exposure assists in identifying children who may benefit from paediatric assessment following birth. Underground Lives: Pregnancy and Modern Slavery. Merton RK.

Background

When exercising their judgement, professionals and practitioners are expected to take this guideline fully into account, alongside the individual needs, preferences and values of their patients or the people using their service. Slide 10 Work with local agencies to: co-locate services develop inter agency care plans which include information about opiate replacement therapy offer women information about other services. Young pregnant women aged under 20 may feel uncomfortable using antenatal care services in which the majority of service users are in older age groups.

Antenatal care for uncomplicated pregnancies. These socio-demographic factors were included in the adjusted analyses as potential confounding variables for the association between maternal BMI and late access to care, and also included as secondary exposure variables to explore their independent association given the existing evidence-base from previous localised studies [ 1112 ]. This study investigated the association between the stage of pregnancy women access antenatal care, BMI, and other socio-demographic factors. Health Expect. Bowleg L. There were

Extremely anxious women waited longer to seek antenatal care, particularly teenager mothers who reported feeling concerned about pregmancy associated stigma, fearful of health professionals informing their parents of the pregnancy, and relinquishing control [ 3940lbesity ]. Maternal age was defined as a dichotomous variable of teenage pregnancy less than 18 years of age, and not a teenage pregnancy reference category. For example, women who are unemployed are more likely to have a higher BMI, as are women from more deprived areas and among BME groups [ 2325 ]. Jomeen J, Redshaw M. Google Scholar There are significant and complex socio-demographic inequalities associated with the stage of pregnancy women access maternity care, particularly for women with obesity accessing care very late in their pregnancy, and among BME groups, teenagers, deprived and unemployed women. Was the research design appropriate to address the aims of the research?

Clinical Guideline: Hypertensive disorders of pregnancy. Category: Documents 0 download. Home NICE Guidance Conditions and diseases Fertility, pregnancy and childbirth Pregnancy Pregnancy and complex social factors: a model for service provision for pregnant women with complex social factors Clinical guideline [CG] Published: 22 September

Department of Health, Royal College of Midwives. Oppressive institutions of racism, sexism, ableism, classism, etc, are interconnected, impact on health inequalities, 62 and cannot be separated when trying to understand why obessity women experience maternity care differently to others. A further London-based study also identified that teenagers and multiparous women accessed care beyond 18 weeks, but the authors reported a high level of missing BMI data [ 38 ]. The proportion of women with a recommended or underweight BMI decreased as the booking trimester increased, whereas the proportion of women with an overweight or obese BMI increased with increasing booking trimester. London: CQC; For example, women who are unemployed are more likely to have a higher BMI, as are women from more deprived areas and among BME groups [ 2325 ].

The findings provide underlying theory and practical obesty on how to develop safe services that aim to reduce inequalities in women's experiences and birth outcomes. External link. You can also search for this author in PubMed Google Scholar. Increased perception of being cared for on a personal level and involved in decision making. Targeted support is required to address inequalities in access to antenatal care to encourage earlier access and optimum outcomes among high-risk groups.

Associated Data

Slide 10 Work with local agencies to: co-locate services develop inter agency care plans which include information about opiate replacement therapy offer women information about other services. Service organisation 1. Providing antenatal services in a more flexible way may encourage more women to attend and receive appropriate care and referrals.

However, there is limited comparative robust research specifically investigating maternal BMI and late access. Marmots' review of the social determinants of health encourages the development of partnerships, with those affected by social inequities working with their health practitioners. The data extraction process identified contexts Cmechanisms Mand outcomes 0. Table 4 Context, mechanism, and outcome configurations.

They'd chat to us before and afterwards. HCP's recognition of strengths and assets held by women and communities and respect for women's expertise of their own body, needs, and baby. Metrics details. The CMO configurations are not ordered in relation to importance as all are thought to be important in impacting outcomes depending on the specific contexts identified.

What is covered

Binge Eating Disorder Bed Words 8 Pages by some nive coping with the emotional problem; depression, anxiety, stress, low self-esteem and lack of confidence are associated with the loss gynoid obesity pictures fitness control. The included studies covered a range of social risk factors that were often multiple and overlapping. J Matern Fetal Neonatal Med. The synthesis contributes to knowledge by identifying how women with different social risk factors experience care in different ways, resulting in specific program theories tailored to more individualized need. Midwifery led continuity of care models are described as care given during the antenatal, intrapartum and postnatal period from a known and trusted midwife in order to empower a woman to have a healthy pregnancy and birth Sandall, Soltani and Gates,

Pregnancy and complex social factors Implementing NICE guidance NICE clinical guideline Slide 2 What this presentation covers Background Scope Key priorities for implementation Costs and savings Discussion Find out more Slide 3 Background Women with complex social factors are at higher risk of death during or after pregnancy than other women. All women with complex social factors Slide 8 Ensure that specific data are recorded for each complex social factor grouping relating to: gestation at booking attendance and non-attendance at scheduled appointments maternal and infant mortality or significant morbidity. The recommendations in this guideline represent the view of NICE, arrived at after careful consideration of the evidence available. Providing antenatal services in a more flexible way may encourage more women to attend and receive appropriate care and referrals. Medicines-related communication systems when. These women need supportive and coordinated care during pregnancy.

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NICE guideline. Clinical guideline [CG] Published: 22 September Recommendations This guideline includes recommendations on improving access to care for: all women with complex nice 2010 pregnancy and complex social factors of obesity factors pregnant women who misuse alcohol or drugs pregnant women who are recent migrants, asylum seekers or who have difficulty reading or speaking English young pregnant women aged under 20 pregnant women who experience abuse Who is it for? NICE guideline 5: Medicines optimisation: the safe and Access to full guideline and tools:. Clinical guideline [CG] Published: 22 September Domestic abuse: an incident of threatening behaviour, violence or abuse psychological, physical, sexual, financial or emotional between adults who are or have been intimate partners or family members, regardless of gender or sexuality.

Earlier access to services, avoidance of denial of service, increased candidacy, increased autonomous choice through early access to safe abortion and family planning services. World Health Organisation. This article has been cited by other articles in PMC. Merrill E, Grassley J.

Antenatal Care in Normal Pregnancy

Home NICE Guidance Conditions and diseases Fertility, pregnancy and childbirth Pregnancy Pregnancy and complex social factors: a model for service provision for pregnant women with 20110 social factors Clinical guideline [CG] Published: 22 September Women who experience domestic abuse Slide 13 Provide information about pregnancy and antenatal services in a variety of: formats settings languages Recent migrants, asylum seekers and refugees Slide 14 At her first contact with any healthcare professional: Discuss the need for antenatal care. Young pregnant women aged under 20 may feel uncomfortable using antenatal care services in which the majority of service users are in older age groups.

Potential savings around the packaging of services and improving pregnancy outcomes. The guideline has been developed in collaboration with the Social Care Institute for Excellence. A woman who is experiencing domestic abuse may have particular difficulties using antenatal care services: for example, the perpetrator of the abuse may try to prevent her from attending appointments. These women need supportive and coordinated care during pregnancy. What processes are in place to support joint working? When exercising their judgement, professionals and practitioners are expected to take this guideline fully into account, alongside the individual needs, preferences and values of their patients or the people using their service.

Moxey et al. The NICE guideline for Pregnancy and complex social factors recommends that midwives ask all pregnant women, regardless of social status, about alcohol intake so that appropriate referrals can be made. About What is prevnancy This NICE Pathway covers service provision for all pregnant women with complex social factors that is additional to routine antenatal care. Provision of advocacy through known HCP attendance at meetings, and other forms of emotional support during interactions with social care. Women's stories of their experiences as overweight patients. Women with an underweight BMI were significantly less likely to book late than women with a recommended BMI, and women with an overweight or obese BMI were significantly more likely to book late Table 2.

Antenatal care: guidelines

The following guidance is based on the best available evidence. To find out what NICE has said adn topics related to this guideline, see our web pages on: fertility, pregnancy and childbirth vulnerable groups mental health and behavioural conditions injuries, accidents and wounds medicines management: general and other community engagement smoking and tobacco See also the evidence reviews and information about how the guideline was developedincluding details of the committee. Clinical guideline [CG] Published: 22 September Medicines-related communication systems when. In this guideline the following definitions are used.

  • Google Scholar 9. The authors would like to thank Dr Justin Jagosh for his contribution to the protocol, methodology, interpretation, and presentation of the data.

  • They may be reluctant to recognise their pregnancy or inhibited by embarrassment and fear of parental reaction. Consider initiating a multi-agency needs assessment.

  • Barriers to routine gynecological cancer screening for white and African-American obese women.

  • Maternity experiences of mothers with multiple disadvantages in England: a qualitative study.

The Uk System Is That Of Health Visitors Words 7 Pages skilled at detecting mental health problems in pregnancy and the postpartum period and are able to conduct non-directive counseling and cognitive group work and recognize which women would benefit from additional visits and support Department of Health. Support Center Support Center. Positive outcomes, including less clinical intervention, shorter hospital stays, fewer neonatal unit admissions, and increased liaison with multidisciplinary services for women with social factors, have been associated with continuity of care models in the United Kingdom. Baalam and Thomson Oppressive institutions of racism, sexism, ableism, classism, etc, are interconnected, impact on health inequalities, 62 and cannot be separated when trying to understand why some women experience maternity care differently to others. Birth published by Wiley Periodicals, Inc. Consent for publication Not applicable.

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Provide training for healthcare kbesity on the social and psychological needs of women who misuse substances. See also the evidence reviews and information about obesity the guideline was developedincluding details of the committee. It can also include forced marriage, female genital mutilation and 'honour violence'. NICE guideline. Pregnancy and complex social factors Implementing NICE guidance NICE clinical guideline Slide 2 What this presentation covers Background Scope Key priorities for implementation Costs and savings Discussion Find out more Slide 3 Background Women with complex social factors are at higher risk of death during or after pregnancy than other women. Guideline development process How we develop NICE guidelines Your responsibility The recommendations in this guideline represent the view of NICE, arrived at after careful consideration of the evidence available. Download guidance PDF.

Existing maternal obesity guidelines may increase inequalities between ethnic groups: a national epidemiological study ofbirths in England. The proportion mice women with a recommended or underweight Nice 2010 pregnancy and complex social factors of obesity decreased as the booking trimester increased, whereas the proportion of women with an overweight or obese BMI increased with increasing booking trimester. The association with menstrual disturbances may further contribute to late access to antenatal care due to delayed realisation about conception, particularly among women with central adiposity, or those who developed obesity during childhood. What is covered This NICE Pathway covers service provision for all pregnant women with complex social factors that is additional to routine antenatal care.

Maternity — Management of Pregnancy Beyond 41 Weeks?? Commissioners and providers have a responsibility to promote an environmentally sustainable health and care system and should assess and reduce the environmental impact of implementing NICE recommendations wherever possible. Clinical guideline [CG] Published: 22 September

Introduction Woman-centred care Key priorities for implementation 1 Obesty 2 Research recommendations Update information. However, pregnant women with complex social factors may have additional needs. Slide 17 Discussion What local processes are in place to ensure that data are collected regarding women with complex social factors? Slide 10 Work with local agencies to: co-locate services develop inter agency care plans which include information about opiate replacement therapy offer women information about other services.

Explain why and when information may need to be shared with prgenancy agencies. Slide 10 Work with local agencies to: co-locate services develop inter agency care plans which include information about opiate replacement therapy offer women information about other services. This guideline sets out what healthcare professionals as individuals, and antenatal services as a whole, can do to address these needs and improve pregnancy outcomes in this group of women. Slide 4 Barriers to accessing care Barriers may include: unfamiliarity with antenatal care services difficulty communicating with healthcare staff attitudes of healthcare staff practical problems attending antenatal appointments involvement of multiple agencies. Maternity — Management of Pregnancy Beyond 41 Weeks?? Tags: care of women women information background women number of women care provision support slide social care providers scope antenatal care.

Additional significant socio-demographic associations with late access included women from minority ethnic groups, teenagers, unemployment and deprivation. Therefore the BMI of women who booked in the first trimester was not adjusted. Am J Public Health. Availability of data and materials Data used in this study are not currently publicly available.

They should do so in light of their duties to have due regard to the need to eliminate unlawful discrimination, to advance equality of opportunity and to pregnancy and complex health inequalities. Article Google Scholar. Obesity and menstrual disorders. A data extraction tool was devised and completed for each paper to identify explanatory contexts Cmechanisms Mand outcomes 0and to develop program theories arising from these configurations. BMJ Open. There are significant and complex socio-demographic inequalities associated with the stage of pregnancy women access maternity care, particularly for women with obesity accessing care very late in their pregnancy, and among BME groups, teenagers, deprived and unemployed women.

  • Obesity, stigma, and responsibility in health care: A synthesis of qualitative studies.

  • Because there are differences in the barriers to care and particular needs of these four groups, specific recommendations have been made for each group. Download guidance PDF.

  • A study for the UK Department of Health also grouped women into two distinct typologies: those who embraced their pregnancy such as women from Asian, Muslim, Somali and Romany communities; and those who were anxious about their pregnancy such as women who were homeless, drug and alcohol dependent, with learning difficulties and teenagers [ 40 ].

  • About this article. Bowleg L.

  • There are similarities between some of the adverse outcomes associated with BMI, and those associated with late pregjancy to antenatal care. Women better prepared and supported for the challenges of parenthood and able to demonstrate their ability in parenting assessments, evidence of care and empathy from HCP's, increased agency, value in engaging with services, avoidance of further financial hardship, distress, and isolation.

To find out what NICE has said on topics related to this guideline, see our web pages on: fertility, pregnancy and childbirth vulnerable groups mental health and behavioural conditions injuries, accidents and wounds medicines management: general and other community engagement smoking and tobacco See gynoid obesity pictures fitness the evidence reviews and information about how the guideline was developedincluding details of the committee. Access to full guideline and tools:. In addition to the recommendations in this guideline, the principles of woman-centred care and informed decision making outlined in 'Antenatal care' NICE clinical guideline 62specifically recommendations on the provision of antenatal information and individualised care, are of particular relevance to women with complex social factors. Slide 18 Find out more Visit www. Clinical guideline [CG] Published: 22 September Commissioners and providers have a responsibility to promote an environmentally sustainable health and care system and should assess and reduce the environmental impact of implementing NICE recommendations wherever possible. It offers advice on improving access to care, maintaining contact with antenatal carers, and additional information and support for these women.

This synthesis systematically identified qualitative literature that focused on the experiences of maternity care in the United Kingdom for women with social risk factors and used realist methodology to uncover the contexts and mechanisms that led to positive or negative experiences. Maternal age was defined as a dichotomous variable of teenage pregnancy less than 18 years of age, and not factors obesity teenage pregnancy reference category. These included the recognition of women's personal strengths and assets, and the impact of their community. A slightly increased association with booking beyond the first trimester was observed for women with an obese BMI, whereas the analysis of booking by trimester showed that the strongest association with maternal weight status and late booking was among women with obesity and booking very late in pregnancy, in the third trimester. Epidemiological analyses exploring associations between population characteristics and late access to antenatal care could inform targeted interventions and public health strategies to support high-risk populations. A further synthesis of women's views and literature focusing on the initiation of antenatal care by black and minority ethnic groups in the United Kingdom 23 identified a range of barriers experienced by women including unfamiliarity with the system, inadequate interpretation services, a lack of cultural sensitivity, and impersonal care.

It is also for those who are responsible for commissioning and planning healthcare and social services. Access to full guideline and tools:. They may also have practical problems such as difficulty getting to and from antenatal appointments. Healthcare professionals should be given training on the care of women known or suspected to be experiencing domestic abuse that includes:. Nothing in this guideline should be interpreted in a way that would be inconsistent with complying with those duties.

Search strategy parameters and inclusion criteria in synthesis of how women with social risk factors experience United Kingdom maternity care. Birth Berkeley, Calif. Int J Obes. It's our decision. Clinical, provider and sociodemographic determinants of the number of antenatal visits in England and Wales. The realist methodology takes the findings of the 22 included papers deeper by unearthing potential mechanisms that may improve or worsen experiences.

Pregnant women who are recent migrants, asylum seekers or refugees, or who have difficulty reading or speaking English, may not make full use of antenatal care services. Women who experience domestic abuse Slide 13 Provide information about pregnancy and antenatal services in a variety of: formats settings languages Recent migrants, asylum seekers and obfsity Slide 14 At her first contact with any healthcare professional: Discuss the need for antenatal care. To find out what NICE has said on topics fatcors to this guideline, see our web pages on: fertility, pregnancy and childbirth vulnerable groups mental health and behavioural conditions injuries, accidents and wounds medicines management: general and other community engagement smoking and tobacco See also the evidence reviews and information about how the guideline was developedincluding details of the committee. However, pregnant women with complex social factors may have additional needs. Recommendations This guideline includes recommendations on improving access to care for: all women with complex social factors pregnant women who misuse alcohol or drugs pregnant women who are recent migrants, asylum seekers or who have difficulty reading or speaking English young pregnant women aged under 20 pregnant women who experience abuse Who is it for? Offer a booking appointment in the first trimester if she wishes to continue the pregnancy. Slide 4 Barriers to accessing care Barriers may include: unfamiliarity with antenatal care services difficulty communicating with healthcare staff attitudes of healthcare staff practical problems attending antenatal appointments involvement of multiple agencies.

  • Phillimore J. Uncomplicated telephone access to interpreter services or online provision to register with services, arrange or reschedule appointments, organize travel to appointments, and to access advice from a health care professional.

  • Clinical guideline [CG] Published: 22 September

  • You understand… so I can… because the midwives there is different, and I don't know how to open to them. Audit Support for Antenatal Care.

  • Antenatal care and education for women under Download guidance PDF.

Diabetes in pregnancy guideline GL protocols and Management of pregnancy. They should do so in the context of local and national priorities for funding factor developing services, and in light of their duties to have due regard to the need to eliminate unlawful discrimination, to advance equality of opportunity and to reduce health inequalities. Slide 4 Barriers to accessing care Barriers may include: unfamiliarity with antenatal care services difficulty communicating with healthcare staff attitudes of healthcare staff practical problems attending antenatal appointments involvement of multiple agencies.

Explain why and when information may need to be shared with other agencies. All women with complex social factors Slide 8 Ensure that specific data are cimplex for each complex social factor grouping relating to: gestation at booking attendance and non-attendance at scheduled appointments maternal and infant mortality or significant morbidity. Service organisation 1. Offer a booking appointment in the first trimester if she wishes to continue the pregnancy. They are less likely to access antenatal care or stay in regular contact with maternity services. Particular attention should be paid to:. However, four groups of women were identified as exemplars:.

Discuss the womans fears in a non-judgmental manner, respecting socia right to confidentiality. The number of women within each complex social factor grouping identified locally. Tags: care of women women information background women number of women care provision support slide social care providers scope antenatal care. They are less likely to access antenatal care or stay in regular contact with maternity services. Provide training for healthcare professionals on the social and psychological needs of women who misuse substances.

Association between body mass index and the timing of pregnancy recognition and entry into prenatal care. Email: ku. A further limitation of this study relates to the nature of secondary analysis og a dataset which was collected for a different purpose. Additionally, the association with menstruation disturbances was stronger for early onset obesity potentially due to the leptin levels which regulates the gonadotropin surge initiating pubertal stages [ 32 ]. BMI in the first trimester closely represents the pre-pregnancy weight status as maternal weight does not alter dramatically during this early stage of pregnancy. Am J Public Health. Competing interests The authors declare that they have no competing interests.

Conclusions The findings provide underlying theory and practical guidance on how to develop safe services that aim to reduce inequalities in women's experiences and birth outcomes. Increased perception of being cared for on a personal level and involved in decision making. Obesity of the initiation of antenatal care: an exploratory qualitative study of women and service providers in East London. The dataset includedsingleton births between 1st January and 31st December in 34 maternity units in England, UK. Personalized, holistic care, increased engagement, trust, agency, candidacy, empowerment, sense of control, support, community integration, safety. Further research, using qualitative realist evaluation methodologies with all stakeholders, will help to answer these questions and test the program theories put forward in this synthesis. When it's one person, then you can open up.

Service organisation 1. Guideline: Trauma in pregnancy. Slide 18 Find out more Visit www. Nothing in this guideline should be interpreted in a way that would be inconsistent with complying with those duties.

Diabetes in pregnancy guideline GL protocols and All women with complex social factors: information and support Anf 15 Co-ordinate care and communicate sensitively. Download guidance PDF. Domestic abuse: an incident of threatening behaviour, violence or abuse psychological, physical, sexual, financial or emotional between adults who are or have been intimate partners or family members, regardless of gender or sexuality. Offer a booking appointment in the first trimester if she wishes to continue the pregnancy. See also the NICE guideline on domestic violence and abuse: multi-agency working.

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Jomeen and Redshaw This study is a pegnancy analysis of anonymised, routine hospital data which did not require consent to participate. Therefore, the prevalence of late access relating to overweight and obesity is likely to be higher today than that reported in this study. It is hypothesized that a lack of antenatal care and engagement with maternity services is directly linked to poor maternal and neonatal outcomes; therefore, policies are often focused on improving access to care. While existing datasets provide relatively instant access to a wealth of data for research which would take decades to prospectively collect, they are often limited as they lack the entire group of variables that would be required to fully answer the research question.

London, UK: Department of Health; Factors associated with maternal death from gactors pregnancy complications: a UK national case-control study. The included studies covered a range of social risk factors that were often multiple and overlapping. Haddrill et al. London: NHS England; Associated Data Supplementary Materials. Adjustments to maternal booking BMI were applied to correct for naturally incurred gestational weight gain for women who booked after the 1st trimester methods described in [ 24 ].

Potential savings around the packaging of services and improving pregnancy outcomes. NICE guideline. The number of women within each complex social factor grouping identified locally. The recommendations in this guideline represent the view of NICE, arrived at after careful consideration of the evidence available. Category: Documents 0 download.

However, the following may result in additional costs or savings, depending on local circumstances: Offering a named midwife or doctor with specialised knowledge of, and experience in, the care of women who misuse substances. Because there are differences in the barriers to care and particular needs of these four groups, specific recommendations have been made for each group. Local commissioners and providers of healthcare have a responsibility to enable the guideline to be applied when individual professionals and people using services wish to use it. Clinical guideline [CG] Published: 22 September Discuss the womans fears in a non-judgmental manner, respecting her right to confidentiality.

It is also for those who are responsible for commissioning and planning healthcare and social services. Clinical guideline [CG] Published: 22 September Download guidance PDF. Four exemplar populations. Components may include:. This guideline sets out what healthcare professionals as individuals, and antenatal services as a whole, can do to address these needs and improve pregnancy outcomes in this group of women. Slide 10 Work with local agencies to: co-locate services develop inter agency care plans which include information about opiate replacement therapy offer women information about other services.

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