Despite talk of ‘woman-centred care’, much of the care provided by the NHS is based on guidelines directed at the whole population, rather than tailored to the individual. In time-pressured maternity services, it is common for public health information to be conveyed via leaflets and generic advice, meaning important messages may be diluted, misunderstood, or even missed altogether.
In mainstream media coverage of health-related evidence, potential risks may be distorted. Recent data from the Department of Health (2016) revealed a 15% rise in abortions for women aged 35+ in England and Wales from 2005–15. One likely reason for this is the ubiquitous concept of the ‘biological clock’, giving the impression that it is almost impossible for women to conceive once they hit their mid-30s; as a result, many may underestimate their fertility and experience unwanted pregnancy. Given the vast amount of information available on pregnancy, birth and parenting—particularly from unregulated sources such as online forums and blogs—it is hardly surprising that women fall victim to mixed messages.
It takes time for evidence-based guidelines to be developed and reviewed; meanwhile, the media often report on emerging evidence, untested theories and independent reviews, which may contradict official recommendations. As this issue of BJM went to press, Public Health England (PHE, 2016) was at pains to refute ‘irresponsible’ claims made in a paper from the National Obesity Forum and Public Health Collaboration advising people to ‘eat fat to stay thin’. But to the general public, why should PHE be a more reliable source of information than other organisations? The cacophony of conflicting claims about all manner of health issues leaves many people unsure of what or whom to believe. As a result, they often end up following the pieces of advice that suit their lifestyle and ignoring those that do not.
I recently saw Professor Helen Ball, director of the Parent-Infant Sleep Lab at Durham University, present research from the Bradford Infant Care Study, which surveyed UK Pakistani and White British families, the former of whom have a four times lower rate of sudden infant death syndrome than the latter. The study found that both groups heeded some public health advice while ignoring other aspects. Particularly revealing was a quote from a Pakistani woman who, in reference to advice on smoking, said she felt that such health promotion was geared towards ‘English mums’ and did not apply to her. This is the risk of a standardised message: people may feel that because some of it is not relevant to them, none of it is.
It is refreshing, then, that the Royal College of Midwives (2016) is focusing on improving the delivery of public health messages in midwifery. It has developed the Stepping Up to Public Health model, one component of which is to give women a ‘menu’ of public health topics ahead of their initial midwife appointment, so they can choose the advice they want or need. Crucially, the woman herself will then have to sign to confirm what information has been covered at each appointment. Hopefully this will mean not only that messages are tailored to individuals, but also that midwives can feel confident that the women in their care have understood the information provided. This is a positive step towards truly putting each woman at the centre of her own maternity care.