Bethany is 16 years old and I currently lives in Northside with her grandmother, Bessie. She has lived with her since she was 10 when her mother died of a drug overdose. She still sees her father but only occasionally as he “suffers from mental health problems and is sometimes in a drug rehabilitation programme but often he also has had short periods in jail for possession and stuff as he lost his job and was badly affected by her mums’ death.”
At the antenatal clinic today that Bethany attends with her friend, Kathy. Bethany says her and James have been together for 6 months. They met a school friend’s party. She has told her grandma and her social worker that she wants move in with him and her grandma has agreed.
She used a home pregnancy testing kit and found out she was pregnant a couple of weeks ago and she “thinks she’s about 9 weeks gone.”
She tells you “her and James are happy about her being pregnant and want to keep the baby but she’s supposed to be taking her GCSE’s next summer but not sure what’s going to happen now.”
Activity One:
Which members of the MDT or other agencies do you think the midwife needs to involve in making a plan of care for Bethany?
What are your main priorities today in supporting Bethany?
Antenatal Visit
When you state that a HV will be contacting her she asks “Why is that – what will she ask me”? and later her grandmother rings the surgery to ask to speak to you stating that “I’ve heard mixed things about what to expect, some saying it’s just so that they can get to know you beforehand, others saying that they go through your entire house to make sure it’s suitable” and not keen to have lots of people round the house.
What are the reasons for an antenatal visit by a Health Visitor?
Answer
First visit – At 28 weeks pregnancy: Health Promoting Visit
The antenatal check is the first time that the health visitor will meet with parents. Together they will complete the health needs assessment covering physical health (such as not smoking and the benefits of breastfeeding), mental and emotional health. The health visitor will also discuss the transition to parenthood, how to enhance the parent-child bonding experience and how parents can help their baby’s early development.
The purpose of the visit is to make an assessment of family health needs – in practice yes, this means asking what can be considered ‘nosy’ questions. This then allows the HV (health visitor) to offer/facilitate the appropriate level of support.
The first visit gives mums-to-be the opportunity to talk about their emotional health prior to their baby’s birth, therefore helping them to build a therapeutic relationship early with their health visitor, especially with first time mums. It is also an opportunity for the health visitor to highlight any issues and reassure expectant parents before their baby’s birth. The purpose of the antennal visit is that those families who might need more support and intervention will be able to receive it earlier.
The antenatal visit also allows for an increased awareness of the role of the HV (health visitor) team for families. It enables the HV to discuss information about The Healthy Child Programme which includes;
- Smoking cessation pathway followed at every contact (with any smoking assessment and intervention recorded).
- Introduction of the childhood immunisation programme.
- Information about feeding especially the benefits of breast feeding as per breast feeding policy.
- Information about local services in the area in particular Children’s Centres.
- A discussion around the integrated team members and circumstances where information would be shared if required.
Reference:
Department of Health (2009) Healthy Child Programme: Pregnancy and the First Five years of Life. https://assets.publishing.service.gov.uk/government/uploads/system/file/550487/2000.pdf
Nursing & Midwifery Council. (2018). The code: Professional standards of practice and behaviour for nurses, midwives and nursing associates. London: Nursing & Midwifery Council.
Role of the Health visitor in antenatal mental health
- To be aware of and refer to local perinatal services.
- To signpost to voluntary agencies.
- To give self-help advice.
Pandas Foundation: http://www.pandasfoundation.org.uk/
MABIM – Leaders masterclass series 3 top tips: https://maternalmentalhealthalliance.org/projects/mumsandbabiesinmind/mabim-tools/
Role of the Health visitor in antenatal safeguarding
Health visitors will respond, in accordance with both the Trust and NSCB policy, in a co-ordinated manner to the assessed needs of children and their families where they consider a child at risk of being abused or neglected