Heather (40) and Bruce (42) have been living together for 5 years. They have both been married before. Bruce keeps in touch with his ex partner, Karen, as they have 2 children, aged 8 and 9, who live with their mother in the week but stay with Bruce and Heather most weekends. Heather has one teenage son, Rick, who lives with them full time but he is aged 16 and wants to leave home. Neither have contact with her ex partner as that was an abusive relationship that ended acrimoniously soon after Rick was born. Heather meets her community midwife and is clearly shocked at finding out that she is already 13 weeks pregnant stating that “everything is different this time and I was certainly not planning this and I am not happy and I told him to sort this out.”
Both Heather and Bruce smoke between 10-20 cigarettes a day and admit than when no children are there also use recreational drugs occasionally. Heather works as a part time cleaner but since Bruce was made redundant has struggled to find full time work but sometimes helps his friend on his market stall.
Activity 1: 1st Antenatal appointment
a).What are likely to be Heather’s main concerns when she meets her midwife at 13 weeks to “book?”
b). What specific health and safety issues should the midwife advise Heather about whilst pregnant in view of her job?
c). Using a PISCES model think of one thing that may affect each of the following in relation to Heather’s wellbeing in the antenatal period?
PHYSICAL
INTELLECTUAL
SOCIAL
CULTURAL
EMOTIONAL
SPIRITUAL
d). Using the latest NICE Guidelines identify what are the key things the midwife needs to ask when Heather “booked” with her community midwife?
Activity 2 : Role of the Health Visitor in the antenatal period:
As her named midwife you advise her that a HV will be contacting her to undertake the 28 weeks pregnancy check.
Heather is clearly anxious and asks “Why is that – what will she ask me – that never happened before?
You explain that the health visitor is called Heidi and undertakes this 1st visit at 28 weeks pregnancy as a Health Promoting Visit and this antenatal check is the first time that the health visitor will meet with you. Together you will complete a health needs assessment covering physical health such as whether you smoke or not and the benefits of breastfeeding and discuss your mental and emotional health. The health visitor will also discuss becoming a parent, some of the things that have changed since Rick was born and what you and Bruce will want like which toys and equipment to buy.
Heather says “Well I’ve heard mixed things about what to expect, some one in the pub where I clean said it’s just so that they can get to know you beforehand, others though hat they go through your entire house to make sure it’s suitable whatever that means- we manage just fine.”
You can reassure her that “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 but this then allows the HV to offer/facilitate the appropriate level of support you may need.”
“This first visit will give you an opportunity to talk about your emotions prior to your baby’s birth, help you get to know Heidi who is going to be your health visitor for the next 5 years, especially as a lot has changed since Rick was born. The whole purpose of the antenatal visit is that those families who might need more support and intervention will be able to receive it earlier, so it is a fairly new idea that you meet the health visitor before pregnancy but sure you will find it really helpful.”
a) Review: Department of Health (2009) Healthy Child Programme: Pregnancy and the First Five years of Life.
Reference: https://assets.publishing.service.gov.uk/government/uploads/system/file/550487/2000.pdf
b) Make a list of all the information that the health visitor will discuss at this 28 week health promotion visit?
c) What support can Heather access at the local Children’s Centre?
antenatally
postnatally
Communication between all members of the multi disciplinary team (MDT) is crucial to offering high standards of care and to reducing risks of misinformation.
Activity 3:
a). List all members of the MDT and others agencies and the circumstances where information would be shared about Heather and Bruce.
b). List all the opportunities for discussion about Heather and Bruce between the members of the multi disciplinary team.
antenatally
postnatally
References.
Nursing & Midwifery Council. (2018). The code: Professional standards of practice and behaviour for nurses, midwives and nursing associates. London: Nursing & Midwifery Council.
Heidi arranges to talk to you as her named midwife as she has concerns re Heathers wellbeing. Heidi is aware of her working long hours with 3 jobs and has declined offers of help and has tried to contact her but is not answering her phone.
The role of the Health visitor in antenatal mental health is
- To be aware of and refer to local perinatal services.
- To signpost to voluntary agencies.
- To give self-help advice.
References: Pandas Foundation: http://www.pandasfoundation.org.uk/
MABIM – Leaders masterclass series 3 top tips: https://maternalmentalhealthalliance.org/projects/mumsandbabiesinmind/mabim-tools/
c) Review what services are available locally to support women with mental health issues in the antenatal period.
Health visitors have an statutory role in antenatal safeguarding and 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.
Activity 4:
Review local Safeguarding guidelines.
Activity 5: Making Every Contact Count:
Making every contact count MECC enables the opportunistic delivery of consistent and concise healthy lifestyle information and enables individuals to engage in conversations about their health at scale across organisations and populations.
https: //www.nice.org.uk/Guidance/PH49
https://www.gov.uk/government/publications/makimng-every-contact-count-mecc-practical-resources