Protecting Health: Nursing and Midwifery Successes and Challenges David Foster, Deputy Director of Nursing at DH, offers his experiences and views on what health protection means for midwives.
It all came rushing back: the sticky carpet, the tatty curtains, the smoke, the chaos, the beautiful baby. It was bitterly cold and I was standing on a doorstep in Falkirk waiting to be invited in to do a routine post natal visit. “Hello, I’m David. I’m the midwife, I’ve come to …”. We had not met before, but the woman was very welcoming and despite her circumstances was giving her fourth child the best start she knew how. I’m not sure I did much to protect her health or her baby’s health but I do remember having a discussion about how she might cut back on her smoking and whether she had given any thought to what type of contraception she would consider for the future. She recognised the smoking was harmful to the baby and it was getting really expensive so she had the incentive to cut back. And as for contraception, well, she wanted something simple, but was not good with pills and her man, she reliably informed me, had not worn a condom since he was 14 so he’s not going to start now. So we explored other options. It was all too brief and superficial and with, I suspect for both of us, a not very satisfying outcome.
But that was a long time ago and in stark contrast to my recent visit to the award winning midwives in Poole. The thing that prompted my mind to flit back to that woman in Falkirk was the way the community midwives explained to me how they had reorganised themselves and their services to give better continuity of care. Unlike my experience, the midwife who has the final contact with a woman is the named midwife who did her booking and who has met her many times, not every time admittedly, but many times during her pregnancy. The trust and confidence this generates between midwife and the woman goes a long way to being able to open difficult conversations about health protection and other issues. The other message that struck me particularly came from the diabetes midwife specialist: early intervention is crucial. Women with diabetes before they are pregnant are generally aware of how to protect their health and what the risks of pregnancy could be, but they still need early contact with the midwife specialist to help navigate their way round a new service. The essence of what these inspiring midwives were suggesting was that the quality of their care hinges significantly on relationships – the relationship a midwife has with a woman and the relationships within the team which help make sure continuity of care is a good as possible.
From my discussions at Poole, it was evident midwives have a critical role to play in health protection and should seek opportunities to protect the public from preventable causes of ill health. But the evidence is varied and difficult to find. That is why we have worked with NICE to produce the evidence base of the public health contribution of nurses and midwives. The document can be found at: Link to Document
It gives useful information on the uptake of immunisations, HIV testing, prevention and control of healthcare acquired infections and tuberculosis.
All midwives will have experience and influence in those areas but there is a new and extremely important area of women’s health that midwives need to be aware of: female genital mutilation (FGM). Although not every midwife will come across FGM, it is estimated that 66,000 women resident in England and Wales in 2001 had undergone FGM.
For this reason, the Department of Health is taking steps to understand more about the national incidence and prevalence of FGM. Compulsory data collection is being implemented so that by September this year, all NHS acute hospitals will be reporting back to the Department of Health, on a monthly basis, information on how many girls and women they are treating who have had FGM. And, from April this year hospitals will be given guidance on how to use new clinical codes to record:
• if a woman has had FGM
• if there is a family history of FGM
• and if an FGM-related procedure has been carried out on a woman, for example de-infibulation.
FGM is illegal in the UK and midwives will can play a significant and influential part in protecting girls and women from FGM.
So whatever our sphere of practice, whatever the socio-economic and cultural background of the women we care for there are incredible opportunities to protect the health of individuals and communities.
To read about the Royal College of Midwives' key messages on Health Protection open the following link:Royal College of Midwives Health Protection
Follow David on Twitter @DavidFosterDH