Antenatal care has long been acknowledged as pivotal in influencing health choices of the population. Indeed, government reports throughout the past decade (Scottish Executive Health Directorate, 2001; Scottish Executive, 2003; Scottish Government, 2007; 2008) have reviewed the manner in which antenatal care is provided and recommend that women should have care packages tailored to individual needs. Scotland’s three key documents,
A refreshed framework for maternity care in Scotland: the maternity services action group (Scottish Government, 2011);
Reducing antenatal health inequalities: outcome focused evidence into action guidance (Scottish Government, 2011) and
Improving maternal and infant nutrition: a framework for action (Scottish Government, 2011) continue this theme and acknowledge the crucial role of maternity care in providing women and their families with the support they need.
All women are vulnerable when pregnant, some more than others, and midwives are aware that every antenatal contact is seen as an opportunity for health promotion.
However, disadvantaged groups are more likely not to access all or some aspects of maternity services. Midwives recognise the need to be creative in health information delivery, while acknowledging what is within their sphere of control.
A key principle of the ‘refreshed framework’ (2011) is to ensure that every health board communicates and imparts evidence-based information in a variety of formats clearly and consistently to women in relation to their maternity care.
NHS Lanarkshire records consistently low rates of breastfeeding; high rates of obesity, heart disease, alcohol addiction, deprivation and illiteracy. Only 39% of nought- to two-year-olds and 63% of adults are registered with a dentist (NHS Lanarkshire, 2009).
We provide antenatal education in written and verbal formats. The
Ready steady baby book is given to all women and is available in different languages. Our parenthood education classes are attended by approximately 33% of all our women and are predominantly educated, first-time mothers.
Many community midwives were concerned that the women who most needed antenatal education were not being reached. As a service, we wished to acknowledge and address the disparity in the quality of antenatal education between those who demand and achieve this, and those who most need it.
We wanted to know how effective our written and verbal antenatal information was in imparting health messages. A questionnaire was completed by 350 women. The results demonstrated only 62% of women read the literature given, the majority being first-time mothers. Verbal information with regards to smoking, alcohol consumption and breastfeeding demonstrated that over 90% of women received some information. However, subjects including oral health, exercise in pregnancy and vitamin supplementation appeared to be not understood or discussed. Gaps in antenatal education were evident.
A DVD format was suggested. Women want advice made available to them in different formats, modes and levels of intensities (GEN, 2008). We aimed to provide an alternative, user-friendly resource, which would enhance the information given by midwives, particularly on diet, exercise, breastfeeding, oral health, vitamin supplementation, smoking and alcohol consumption.
Vision to realityA proposal for funding was successful and £80,000 became available to tender the project to outside media companies. A team was formed to ensure the content was precise and contained evidence-based views.
Many women who refuse to engage feel too burdened by the complexity of their lives to be able to think about the possible benefits of the information they are given. There is a lack of trust for professionals, and they feel family or other supports are sufficient (Birch and Martin, 2010).
Indeed, the influence of the media, contemporary magazines and celebrities on lifestyle choices is evident. In producing a DVD, which capitalises on the interaction between women and families with media and celebrity influences, we intended our communication strategy to be more effective. The aim was to ensure that these women would collect their information, consume it and act upon it.
The project hoped to interest service users who would not normally attend parenthood education classes. In order to produce something that would appeal to them, focus groups were held with this sector of our population; the parents and the media company met to look at what would appeal most to our families.
Feedback from the focus group and questionnaires was invaluable, and with their ideas in mind production began on a DVD, which would be fun, informative and not too ‘preachy’.
The DVD was completed in April 2010 and was evaluated post-production in January 2011 with the help of 232 women and a group of nine mothers or partners. Ages ranged from 16 to 43, with 53% of the women residing in data zones ranked one and two, which are classed as most deprived (The Scottish Government, 2010).
All chapters were positively evaluated by women. In particular, 90% said they learned something new about foods and vitamins in pregnancy, and 84% admitted to trying out the exercises. They found the oral health chapter fun to watch and the breastfeeding diaries good because it was a family’s real experience. Only 24% of all women had tried any of the recipe challenges. Most agreed it was an excellent resource, particularly for first-time mothers. A total of 67% said their ‘significant others’ had watched the DVD.
Community midwives have also found the DVD a useful resource for engaging women on topics, which they would otherwise have found challenging.
The DVD is now displayed in hospitals and future funding of the resource is secured. It can also be accessed via YouTube, a resource underused by health providers but frequently viewed by teenagers.
We believe the project has been successful in imparting key messages regarding health to those who do not normally engage in antenatal services, as well as women who seek information from all sources. However, this project is just a small part of a large jigsaw of interventions that share the same goal. When all projects are successfully integrated into family care, there will be improvements to long-term health.
Topics covered by the DVD
✻ Antenatal screening
✻ Breastfeeding
✻ Exercise
✻ Healthy eating
✻ Oral health
✻ Vitamin supplementation and what to eat and what not to eat.
Further enquiries regarding the DVD should be sent to Maureen McSherry at:
maureen.mcsherry@lanarkshire.scot.nhs.uk
References
Birch A, Martin C. (2010)
Health and parenting information: meeting the needs of all parents. NHS Health Scotland: Edinburgh. See:
http://www.healthscotland.com/uploads/documents/14027-Healthandparentinginformation.pdf (accessed 14 November 2011).
Scottish Government. (2008)
Perspectives on early years services: qualitative research with service users. Scottish Government: Edinburgh. See:
http://www.scotland.gov.uk/Resource/Doc/237941/0065338.pdf (accessed 14 November 2011).
NHS Lanarkshire. (2009)
Public health 2008-09. The Annual Report of the Director of Public Health 2008-2009. The Department of Public Health, NHS Lanarkshire. See:
http://www.nhslanarkshire.org.uk/publications/Documents/Annual%20Report%20of%20the%20Director%20of%20Public%20Health%202009.pdf (accessed 14 November 2011).
Scottish Executive. (2003)
Expert Group on Acute Maternity Services: reference report. Scottish Government: Edinburgh. See:
http://www.scotland.gov.uk/Publications/2003/01/16018/15750 (accessed 14 November 2011).
Scottish Government. (2007)
Better health, better care: action plan. Scottish Government: Edinburgh. See:
http://www.scotland.gov.uk/Publications/2007/12/11103453/0 (accessed 14 November 2011).
Scottish Government. (2008)
Equally well: the report of the Ministerial Task Force on Health Inequalities. Scottish Government: Edinburgh. See:
http://www.scotland.gov.uk/Topics/Health/health/Inequalities/inequalitiestaskforce (accessed 14 November 2011).
Scottish Government Health Directorate. (2001)
Implementing a framework for maternity services. Scottish Executive: Edinburgh. See:
http://www.scotland.gov.uk/Resource/Doc/47021/0013919.pdf (accessed 14 November 2011).
Scottish Government. (2010)
The Scottish index of multiple deprivation. See:
http://www.scotland.gov.uk/Topics/Statistics/SIMD/Publications (accessed 14 November 2011).
Scottish Government. (2011)
A refreshed framework for maternity care in Scotland: The Maternity Services Action Group. Scottish Government: Edinburgh. See: http://www.scotland.gov.uk/Resource/Doc/337644/0110854.pdf (accessed 14 November 2011).
Scottish Government. (2011)
Improving maternal and infant nutrition: a framework for action. Scottish Government: Edinburgh. See:
http://www.scotland.gov.uk/Publications/2011/01/13095228/0 (accessed 14 November 2011).
Scottish Government. (2011)
Reducing antenatal health inequalities: outcome focused evidence into action guidance. Scottish Government: Edinburgh. See:
http://www.scotland.gov.uk/Resource/Doc/337678/0110857.pdf (accessed 14 November 2011).
