The SAPlings project: an alternative antenatal care pathway
There are increasing demands on the provision of antenatal care. In Oxfordshire, an alternative pathway for women with the most complex socio-economic and obstetric demands on their pregnancies was introduced to meet the needs of these women and reduce community midwives' caseload. A review of this cohort identified that they overaccessed both scheduled and unscheduled antenatal care, but they rarely accessed antenatal education programmes or children's centres. Therefore, an alternative model of antenatal care was planned, based on the Centering model. This aimed to better meet these women's antenatal care and education needs and reduce the impact on the maternity service. Initially, one group was piloted and this has now been expanded to four teams throughout Oxfordshire. The groups have grown and the feedback from women and midwives has been extremely positive.
Antenatal care in Oxfordshire is predominantly a shared-care model based on the National Institute for Health and Care Excellence (NICE) antenatal care pathway. Care is based in GP surgeries or children's centres and each appointment is generally limited to 20 minutes. With increasing demands on the provision of antenatal care, it was important to understand if the needs of women were being met for those with the most complex socio-economic and obstetric demands on their pregnancies, and consider if an alternative pathway may benefit women and community midwives.
Focus groups were set up to generate ideas and gauge reactions to potential changes in service provision (Scottish Health Council, 2019). The groups included community midwives, maternity support workers and children centre staff. The community midwives identified that women with complex socio-economic needs have the biggest impact on the pathway; they were seeing these women more frequently and appointments needed to be longer to enable them to meet their needs. The midwives also identified that they did not always have the knowledge to optimally manage some of the situations, often having to refer elsewhere or spend a significant time after their clinic sorting out problems. Common themes that were the most challenging on their time and knowledge included mental health concerns, housing, domestic violence, relationship issues and child protection.
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