The SAPlings project: an alternative antenatal care pathway

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.