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Nice 2010 pregnancy and complex social factors of obesity – The Nice Guideline For Pregnancy And Complex Social Factors

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

William Murphy
Sunday, July 8, 2018
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  • Published online Aug 5.

  • Category: Documents 0 download. Consider initiating a multi-agency needs assessment.

  • This may be because the women interviewed felt these were not important, because the research approach did not explore these themes, or because they were not included in final published work. 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,

  • Secondary outcomes were trimester of access, and the association between late access and other socio-demographic variables. Person-centred care People have the right to be involved in discussions and make informed decisions about their care, as described in your care.

Oscial recommendations in this guideline represent the view of NICE, arrived at after careful consideration of the evidence available. Nice 2010 pregnancy and complex social factors of obesity Woman-centred care Key priorities for implementation 1 Guidance 2 Research recommendations Update information. 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. Potential savings around the packaging of services and improving pregnancy outcomes. Because there are differences in the barriers to care and particular needs of these four groups, specific recommendations have been made for each group.

London Maternal Deaths. Associated Data Supplementary Materials. Other studies in England have reported similar associations with late access among BME groups, young women and unemployment [ 111213 ]. Obstet Gynecol.

It is also for those who are responsible for commissioning and planning healthcare and social services. Maternity — Management of Pregnancy Beyond 41 Weeks?? Guideline: Trauma in pregnancy. Healthcare professionals should be given training on the care of women known or suspected to be experiencing domestic abuse that includes:. Offer referral to sexual health services if she is considering termination of pregnancy.

  • This could be mitigated through the ability to develop trusting relationships, health care professionals' knowledge of safeguarding and reporting mechanisms, and processes put in place to ensure women's safety.

  • Women who misuse substances Slide 11 Women aged under 20 Consider commissioning a specialist antenatal service for women aged under 20 using a flexible model of care tailored to local need This may include provision of education and care in peer group settings such as GP surgeries, childrens centres and schools Slide 12 Develop a joint protocol with social care providers, the police and third sector agencies. See also the evidence reviews and information about how the guideline was developedincluding details of the committee.

  • Binge eating result to give a brief moment of satisfaction, compensation or maybe of recompense, but soon that instant disappear.

  • There are similarities between some of the adverse outcomes associated with BMI, and those associated with late access to antenatal care.

  • Introduction Woman-centred care Key priorities for implementation 1 Guidance 2 Research recommendations Update information. 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.

  • Women who experience disadvantage, discrimination, stigma, and stereotyping based on their race, class, ability, age, and other sources of oppression.

Our study identified the strongest associations with late access among women from BME social factors, and previous studies nce the UK report that South Asian women had fewer antenatal appointments and waited longer before seeking antenatal care when compared with White women [ 1041 ], and women from BME groups report being insufficiently involved in decisions about their maternity care to have confidence and trust in the staff [ 42 ]. Parity categories were 0 reference category1, 2, and 3 or more. The association of obesity and cervical cancer screening: a systematic review and meta-analysis. There was no funding for this research which was carried out for a student dissertation CB as part of a Biomedical Sciences degree programme, supervised by JR and NH. Almost half of the women population that have attained childbearing age in England are either.

Obes Rev. Chi-squared tests were carried out to provide a descriptive summary of the dataset and the independent association between each exposure variable BMI and socio-demographic factors and the trimester of booking. Accessed March 20, Effects of maternal obesity on antenatal, perinatal and neonatal outcomes. The inverse care law.

Particular attention should be paid to:. Ad may also be overwhelmed by the involvement of multiple agencies. NICE interactive flowchart - Pregnancy and complex social factors: service provision Quality standard - Antenatal care. 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. However, pregnant women with complex social factors may have additional needs.

London: CQC; It focuses on 4 population groups:. Probably people who may have obesiry learned how to face up difficult situations or complex emotion find in food a repair from the emotional distress. Social and ethnic differences in attendance for antenatal care in England. In September research was published supporting midwifery-led continuity of care, which they found was linked to a number of benefits for both mothers and babies, in contrast with obstetrically led.

All women with complex social factors: information fachors support Slide 15 Co-ordinate care and communicate sensitively. Provide training for healthcare professionals on the social and psychological needs of women who misuse substances. 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 Tags: care of women women information background women number of women care provision support slide social care providers scope antenatal care.

  • Similar to obesity, both unemployment and BME groups are overrepresented among maternal deaths in the UK, [ 69 ], identifying further inequalities soocial maternal and perinatal risk for these populations. For example, there is an increased risk of maternal and perinatal mortality, gestational diabetes, pre-eclampsia, pre- and post-term birth, stillbirth and congenital anomalies when mothers have a BMI in the overweight or obese ranges compared with women who have a BMI in the recommended range [ 7141516171819 ].

  • 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. Clinical Guideline: Hypertensive disorders of pregnancy.

  • There is potential for this phenomenon of delayed access to health services among obese populations to extend into antenatal care, although this is an under explored area of research. Corresponding author.

  • Particular attention should be paid to:.

  • 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.

Particular attention should be paid to: integrating care from different services ensuring that the attitudes of staff do not prevent women from using services addressing women's fears about the involvement of children's services and potential removal of their child, by providing information tailored to their needs addressing women's feelings of guilt about their misuse of substances and the potential effects on their baby. Components may include:. 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 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?

Potential savings around the packaging and complex services and improving pregnancy outcomes. Discuss the womans fears in a non-judgmental manner, respecting her right to confidentiality. 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. However, pregnant women with complex social factors may have additional needs. 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.

Associated Data

Service organisation 1. Pregnant women who misuse substances may be anxious about the attitudes of healthcare staff and the potential role of social services. All problems adverse events related to a medicine or medical device used for treatment or in a procedure should be reported to the Medicines and Healthcare products Regulatory Agency using the Yellow Card Scheme. 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.

They'd give us private rooms… to go and talk in if we pregnancy and complex to, away from the ward. Asking different questions: a call to action for research to improve the quality of care for every woman, every child. J Public Health. The Role of a Midwife in Maternity Care Words 6 Pages provide women with the essential care, supervision and advice during their pregnancy, labour and postpartum period, and to care for both mother and child International Confederation for Midwives Social factors associated with increased risk divided into two groups 23451315161922 Most people who have never learned to deal with difficult situations or complex emotion find in food as a source of relief from emotional distress.

These women need supportive and coordinated care during pregnancy. Four exemplar populations. All women with complex social factors: care provision Slide 16 Costs and savings The guideline is unlikely to result in a significant change in resource use in the NHS. Slide 18 Find out more Visit www.

We found no new evidence that affects the recommendations of this 20100. 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. Discuss the womans fears in a non-judgmental manner, respecting her right to confidentiality. The number of women presenting for antenatal care with any complex social factor [ 6 ].

Requests for access 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. Malterud K, Ulriksen K. Association between body mass index and the timing of pregnancy recognition and entry into prenatal care. For women with experience of trauma, or those who lack a sense of control, a trusting relationship with a health care professional was key to regaining trust. The upper gestational age of 44 weeks was used as some women present for the first time during labour unbooked pregnanciesand it is realistic that these pregnancies may have progressed up to 44 weeks if women were not engaged with antenatal care and therefore not offered any intervention such as induction for post-term birth, or women may have declined to be induced.

  • Table 3 Logistic regression analyses: association between maternal BMI, socio-demographic variables, and trimester at booking Full size table.

  • 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.

  • The BMI change between the first trimester and the gestational week of booking for all women who booked after the first trimester was estimated using published data described in [ 24 ] and used to adjust the booking BMI to an estimate BMI which was more comparable to the women who booked in the first trimester. Article PubMed Google Scholar

  • Sources NICE guidance and other sources used to create this interactive flowchart.

  • BMC Public Health. This may be because the women interviewed felt these were not important, because the research approach did not explore these themes, or because they were not included in final published work.

The eighth report on confidential enquiries into maternal deaths in the United Kingdom. Discussion This study has identified ans associations between maternal BMI and the stage of pregnancy women book for antenatal care in England. Disabled women's experiences of accessing and utilising maternity services when they are affected by domestic abuse: a critical incident technique study. A realist synthesis.

Download guidance PDF. Because there are differences in sicial barriers to care and particular needs of these four groups, specific recommendations have been made for each group. It can also include forced marriage, female genital mutilation and 'honour violence'. 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.

Antenatal Care in Normal Pregnancy

The woman may be afraid that disclosure of the abuse to a healthcare professional will worsen her situation, or anxious about the reaction of the healthcare professional. Commissioners and providers have a responsibility to pregnancy and complex an environmentally sustainable health and care system and should assess and reduce the environmental impact of implementing NICE recommendations wherever possible. It is also for those who are responsible for commissioning and planning healthcare and social services. They may also have practical problems such as difficulty getting to and from antenatal appointments. Nothing in this guideline should be interpreted in a way that would be inconsistent with complying with those duties.

It can also include forced marriage, female genital nice 2010 pregnancy and complex social factors of obesity and 'honour violence'. Offer referral to sexual health services if she is considering termination of pregnancy. 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. Slide 6 Key priorities for implementation The areas identified as key priorities for implementation are: Service organisation - actions for commissioners and service organisers Information and support for women Care provision Slide 7 Define populations locally by ensuring data collection for: the number of women presenting for antenatal care with any complex social factor the number of women within each complex social factor grouping identified locally. Healthcare professionals should be given training on the care of women known or suspected to be experiencing domestic abuse that includes:.

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Article Google Scholar. Women booking in their second or third trimester were significantly less likely to have an underweight BMI and more likely to have an overweight or obese BMI Table 3. Was the research design appropriate to address the aims of the research? Future epidemiological research investigating predictors of late access to antenatal care, and maternity or public health interventions to improve access to care, should consider the relationships between these complex factors particularly maternal BMI, employment, teenage pregnancy and ethnic minority groups. Thomson et al. Subject to Notice of rights.

Social and ethnic differences lregnancy attendance for antenatal care in England. There were significant associations with all of the additional socio-demographic variables included in the analyses for late booking, many of which had a greater effect size than the BMI categories. Consent for publication Not applicable. All third trimester results remained significant following adjustment.

There was no funding for this research which was carried out for a student dissertation CB as part of a Biomedical Sciences degree programme, supervised by JR and NH. London: Sage; The perception of a health care professional to be respectful, understanding, kind, and helpful. To test those theories, a full evaluation of how women experience specialist models of care is required. Jagosh J. Phillips and Thomas

All women with complex social factors: information and support Slide 15 Co-ordinate care and communicate prenancy. They may also be overwhelmed by the involvement of multiple agencies. Embed Size px x x x x 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.

Am J Public Health. Deprivation and poor psychosocial support are key determinants of late antenatal presentation and poor fetal outcomes-a combined retrospective and prospective study. All rights reserved. A realist synthesis. Download citation.

It's our decision. Access to interpretation services throughout antenatal, intrapartum, and postnatal period, including emergency admissions. 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. London: Sage; The dataset includedsingleton births between 1st January and 31st December in 34 maternity units in England, UK.

Obesity : Obesity And Obesity

Download guidance PDF. 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. This may be because of unfamiliarity with the health service or because they find it hard to communicate with healthcare staff. 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 Access to full guideline and tools:.

By focusing on single social risk factors when designing research or services, the complexity of social deprivation and oppression complwx be overlooked and deficits within the system disregarded. Correspondence to Nicola Heslehurst. Larger effect sizes were observed for all BMI categories in the third trimester analyses than were observed for the second trimester analyses. This collected the voices of women with various social risk factors.

Jomeen and Redshaw This might be overcome by placing services in local communities where complex social factors care professionals are immersed in local cultures and recognize the strengths and assets held by women and their communities. Do women with lower socioeconomic status have lower expectations of maternity services? Results of realist synthesis of literature exploring how women with social risk factors experience United Kingdom maternity care. Attempts to limit the effect of false positives of overweight and obesity were made by adjusting the BMI data for women who booked after the first trimester of pregnancy. Late access to maternity services results in a lack of important antenatal care provision and intervention such as fetal anomaly screening, and is associated with adverse pregnancy outcomes including maternal and perinatal mortality and congenital anomalies [ 1234 ]. Understanding delayed access to antenatal care: a qualitative interview study.

Antenatal care: guidelines

BMI is a significant predictor of maternal and perinatal health outcomes. Women described the impact of trust in health care professionals and trust in the system as a whole. Impact of maternal body mass index on the antenatal detection of congenital anomalies. So talking is better

Where [can I leave] them? J Reprod Infant Psychol. Self-reported weight is often underestimated and this may have caused an underrepresentation of overweight and obesity in the sample. Google Scholar 7. There was an emphasis on seeking medical advice from the family and distrust among certain groups of medical professionals [ 40 ]. 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. Using trust databases to identify predictors of late booking for antenatal care within the UK.

Unrealistic gestation at booking was defined as a negative gestational age e. Additional pregancy variables were deprivation, ethnic group, employment, maternal age, and parity. 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. National Institute for Health and Care Excellence. Primary care support for tackling obesity: a qualitative study of the perceptions of obese patients.

Contact us Submission enquiries: bmcpregnancyandchildbirth biomedcentral. Google Scholar. However, among the population nice 2010 pregnancy and complex social factors of obesity as being anxious, reasons for late access related to difficulties accepting the pregnancy, or that accessing care was less important than other priorities such as finding housing [ 40 ]. Future epidemiological research investigating predictors of late access to antenatal care, and maternity or public health interventions to improve access to care, should consider the relationships between these complex factors particularly maternal BMI, employment, teenage pregnancy and ethnic minority groups. Predictors of the timing of initiation of antenatal care in an ethnically diverse urban cohort in the UK.

Healthcare professionals Commissioners and providers Pregnant women who need aocial support to use antenatal services, their families and carers Is this guideline up to date? All women with complex social factors Slide 9 Involve women in service development: ensure that women are asked about their satisfaction with services ensure that this information is recorded, monitored, and used to guide service development. Maternity — Management of Pregnancy Beyond 41 Weeks?? Next 1 Guidance 1. Offer a booking appointment in the first trimester if she wishes to continue the pregnancy.

  • The greatest effect size was observed among women with an obese BMI in the analysis of booking in the third trimester aOR 1.

  • During antenatal care: Provide each woman with a one-to-one consultation on at least one occasion.

  • Accessing care late in pregnancy misses opportunities for routine screening such as the fetal anomaly scan at 20 weeks gestation [ 4 ]. Factors associated with maternal death from direct pregnancy complications: a UK national case-control study.

  • Clinical guideline [CG] Published: 22 September Recent migrants: women who moved to the UK within the previous 12 months.

  • Download guidance PDF.

Methods Using realist methodology, 22 papers exploring how women with a wide range of social risk factors experience maternity care in the United Kingdom were included. New York: The Free Press; Download PDF. BMI is a significant predictor of maternal and perinatal health outcomes. Figure 1. Subject to Notice of rights. Please review our privacy policy.

Phillips L, Thomas D. Oppressive institutions domplex 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. Skip to main content. Abstract Background Late access to antenatal care increases risks of adverse outcomes including maternal and perinatal mortality. A systematic review.

What is covered

Int J Obes. There is a wealth of literature on the benefits of continuity of care on women's outcomes. A systematic review. Additionally, reliance on routine maternity data means it is not possible to identify whether the BMI data represents self-reported pre-pregnancy weight or measured booking pregnancy weight. June

Close dialog window. Pregnanncy Uk System Is That Of Health Visitors Words 7 Pages skilled at detecting mental health problems in pregnancy and the postpartum period and obesitj able to conduct non-directive counseling and cognitive group work and recognize which women would benefit from additional visits and support Department of Health. Universal antenatal screening for alcohol consumption in pregnancy is beneficial in preventing foetal alcohol exposure or identifying the need for and providing early intervention which in turn improves health outcomes for women and infants Seib et al. When I arrived, they told me I needed a passport and proof of address. Macleod A, Weaver S. The perception of a health care professional to be respectful, understanding, kind, and helpful. 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.

Response to the NICE clinical guideline on depression 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 Sociwl her first contact with any healthcare professional: Discuss the need for antenatal care. How we develop NICE guidelines. Healthcare professionals should be given training on the care of women known or suspected to be experiencing domestic abuse that includes:. 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. Download guidance PDF. During antenatal care: Provide each woman with a one-to-one consultation on at least one occasion.

It is, therefore, important to try to tackle these inequalities ov access to antenatal care in a way which holistically targets disadvantaged populations. Nonetheless, many complex societal and behavioral factors contribute to the sources of obesity. 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 ]. Binge eating gives a brief moment of satisfaction and compensation, but as soon as it disappears, the episodes revives back again and the patients starts to get the sense of guilt. Similar to our findings, the authors identified that late or no access to antenatal care was more likely among women from BME groups, teenagers and multiparous mothers [ 37 ].

Background

I struggled when I was pregnant. When prevnancy their judgement, healthcare professionals are expected to take these recommendations fully into account. The findings of this research, and the existing qualitative research, highlight the complexity of socio-demographic inequalities associated with late access to antenatal care which are often interrelated. This criterion aimed to reflect the NICE 20 guidance for women with social complex factors and to compare findings with previous systematic reviews of women's experiences of antenatal care.

BMI is a significant predictor of oesity and perinatal health outcomes. The research has a large sample size of overbirths, which is comparable to the national average pregnancy population in terms of maternal characteristics such as age [ 24 ]. Is a qualitative methodology appropriate? Association between body mass index and the timing of pregnancy recognition and entry into prenatal care.

Major risk factors for stillbirth in high-income countries: a systematic review and meta-analysis. Article Google Scholar In addition to the similarity in socio-demographic factors and pregnancy outcomes among women with obesity and those accessing care late, there are also potential physiological and psycho-social associations. These knowledge gaps should be explored in future research and considered when planning services for this vulnerable population. Most people who have never learned to deal with difficult situations or complex emotion find in food as a source of relief from emotional distress. Email: ku.

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. BMJ Open. The state of the world's midwifery: a universal pathway, a woman's right to health. Google Scholar

They may also be overwhelmed by the involvement of multiple agencies. Next 1 Guidance 1. The recommendations in this guideline represent the view of NICE, arrived at after careful consideration of the evidence available. We found no new evidence that affects the recommendations of this guideline. Slide 17 Discussion What local processes are in place to ensure that data are collected regarding women with complex social factors?

This guideline covers antenatal care for ohesity 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. Access to full guideline and tools:. Embed Size px x x x x NICE has also produced a guideline on the care that should be offered to all women during pregnancy. It offers advice on improving access to care, maintaining contact with antenatal carers, and additional information and support for these women.

Maternity — Management of Pregnancy Beyond 41 Weeks?? The guideline describes how access to care can be improved, how contact with antenatal carers can be nce, the additional support and consultations that are required and the additional information that should be offered to pregnant women with complex social factors. 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 also the evidence reviews and information about how the guideline was developedincluding details of the committee. Introduction Woman-centred care Key priorities for implementation 1 Guidance 2 Research recommendations Update information. All women with complex social factors: information and support Slide 15 Co-ordinate care and communicate sensitively.

Article PubMed Google Scholar. Nonetheless, many complex societal and behavioral factors contribute to the sources of obesity. Effects of maternal obesity on antenatal, perinatal and neonatal outcomes. As autonomous practitioners, they act as an advocate for the woman by supporting her and encouraging her to make her own independent decisions Royal College of Midwives

Pregnancy and complex social factors: service provision prsgnancy. Therefore, the prevalence of late access relating to overweight and obesity is likely to be higher today than that reported in this study. Has the relationship between researcher and participants been considered? These conflicting theories give insight into what works in different contexts and for different populations. Primary and secondary amenorrhoea.

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Gestational age at booking was calculated using the date of booking, date of delivery, and gestational age at delivery. London: Sage; Contact us Submission enquiries: bmcpregnancyandchildbirth biomedcentral. 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. BMC Pregnancy Childbirth.

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. 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. 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. 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. The guideline describes how access to care can be improved, how contact with antenatal carers can be maintained, the additional support and consultations that are required and the additional information that should be offered to pregnant women with complex social factors. Service organisation 1.

Women's involvement in the process of reporting safeguarding concerns in an open manner that encourages them to identify their needs. Predictors of the timing of initiation of antenatal care in an ethnically diverse urban cohort in the UK. Future research, public health and maternity interventions should aim to identify ways to engage with women from these high risk groups earlier in pregnancy, considering the complex and inter-related nature of the associated inequalities. Br J Gen Pract.

Jomeen Or, Redshaw M. The authors described an absence of good quality published studies with a lack of consideration of confounders such as maternal age and parity in the analyses, and recommended further research to determine the extent of social inequalities in antenatal care [ 10 ]. Accepted : 28 August

The guideline describes how access to care can be improved, how contact with antenatal preynancy can be maintained, the additional support and consultations that are required and the additional information that should be offered to pregnant women with complex social factors. Offer referral to sexual health services if she is considering termination of pregnancy. Antenatal care and education for women under Discuss the womans fears in a non-judgmental manner, respecting her right to confidentiality. Embed Size px x x x x

This was thought to be the most appropriate methodology for the review question posed as it not only recognizes the complexity of social risk factors and maternity services, but also allows the structured development of program theories pregnancy and break these complex phenomena down into more manageable hypotheses to test what works in improving women's experiences of maternity care. Binary logistic regression analyses were used to examine associations between the exposure variable categories and late access to care. In September research was published supporting midwifery-led continuity of care, which they found was linked to a number of benefits for both mothers and babies, in contrast with obstetrically led. Bick et al. Association between body mass index and the timing of pregnancy recognition and entry into prenatal care.

  • How valuable is the research? The greatest effect size was observed among women with an overweight BMI in the analysis of booking in the second trimester aOR 1.

  • Diabetes in pregnancy guideline GL protocols and

  • Docherty et al. Compared to women receiving standard care, a recently updated Cochrane review 24 found that women who received continuity of care from a known midwife experienced significantly fewer preterm births, fetal losses, neonatal deaths, and clinical interventions and greater satisfaction.

  • Pregnant women who misuse substances may be anxious about the attitudes of healthcare staff and the potential role of social services.

  • 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.

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 rise their independent association given the existing evidence-base from previous localised nnice [ 1112 ]. Comparison of included and excluded data. 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. Background Late access to maternity services results in a lack of important antenatal care provision and intervention such as fetal anomaly screening, and is associated with adverse pregnancy outcomes including maternal and perinatal mortality and congenital anomalies [ 1234 ]. National Center for Biotechnology InformationU. BMC Pregnancy Childbirth 17,

Download guidance PDF. 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 skcial individualised care, are of particular relevance and complex women with complex social factors. 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 Clinical guideline [CG] Published: 22 September NICE guideline. All women with complex social factors: information and support Slide 15 Co-ordinate care and communicate sensitively. 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.

Retrospective analysis of routine hospital data from 34 NHS maternity units in England, UK, includingsingleton births between and Risk factors for first trimester miscarriage—results from a UK-population-based case—control study. Group antenatal care has also been identified as a possible way of reducing health inequalities for socially disadvantaged women, but the evidence to date is limited.

What is covered This NICE Pathway covers service provision for all pregnant women with complex social factors noce is additional to routine antenatal care. Probably people who may have never learned how to face up difficult situations or complex emotion find in food a repair from the emotional distress. BMI is a significant predictor of maternal and perinatal health outcomes. The Health Visitor often lone works and needs. Factors associated with maternal death from direct pregnancy complications: a UK national case-control study. Article Google Scholar.

Next 1 Guidance 1. Pregnancy and complex social factors Implementing NICE guidance NICE clinical guideline Ahd 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. However, obesiyt following may result nice 2010 pregnancy and complex social factors of obesity 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. 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. Slide 6 Key priorities for implementation The areas identified as key priorities for implementation are: Service organisation - actions for commissioners and service organisers Information and support for women Care provision Slide 7 Define populations locally by ensuring data collection for: the number of women presenting for antenatal care with any complex social factor the number of women within each complex social factor grouping identified locally.

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? Providing antenatal services in a more flexible way may encourage more women to attend and receive appropriate care and referrals. The following guidance is based on the best available evidence. What sources of information are available for women, and do they meet the needs of the population group for which they are intended?

Data extraction A data extraction tool was devised and completed for each paper to identify explanatory contexts Cmechanisms Mand outcomes 0and to socila program theories arising from these configurations. The eighth report on confidential enquiries into maternal deaths in the United Kingdom. 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. Svetlana Glinianaia for advice on the analysis.

  • Alshawish et al. Similar to obesity, both unemployment and BME groups are overrepresented among maternal deaths in the UK, [ 69 ], identifying further inequalities in maternal and perinatal risk for these populations.

  • NICE guideline 5: Medicines optimisation: the safe and

  • Competing interests The authors declare that they have no competing interests.

The BMI change between the first trimester and the gestational week of booking for all women who booked after the first trimester was estimated using published data nice 2010 pregnancy and complex social factors of obesity in [ 24 ] and used to adjust the booking BMI to an estimate BMI which was more comparable to the women who booked in the first trimester. The findings contribute to knowledge by providing detailed insight into how different social risk factors affect women's ability and willingness to access and engage with services. Multiple pregnancy: The management of twin and triplet pregnancies in the antenatal period. J Health Serv Res Policy.

World Health Organization. J Matern Fetal Neonatal Med. Am J Prev Med. It is different reading it than talking to someone and sometimes you don't understand the leaflets. Additional significant socio-demographic associations with late access included women from minority ethnic groups, teenagers, unemployment and deprivation.

The data extraction process identified contexts Cmechanisms Mand outcomes 0. Mcleish J, Redshaw M. J Public Health. The aim of this realist synthesis was to uncover the mechanisms that affect women's experiences of maternity care. You can also search for this author in PubMed Google Scholar.

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