ABSTRACT
This paper describes the implementation of a strategic approach to service user involvement in Stockport, demonstrating a strong culture of collaborative working, between service users, providers and commissioners. It explains the process we used and how we learn from the stories that parents share, enabling us to build on the strengths of our service and develop those areas which are highlighted as not meeting the needs of families. It describes the establishment of a Service User Forum and the subsequent launch of the MSLC, with service users forming approximately 75 per cent of the membership. It is an influential and well informed voice which continues to help change our service for the better. It ensures that what is important to women and theirfamilies lies at the centre of all we do.
Subject(s)
Cooperative Behavior , Health Promotion/organization & administration , Maternal Health Services/organization & administration , Midwifery/organization & administration , Patient Participation , Patient Satisfaction/statistics & numerical data , Quality Assurance, Health Care/organization & administration , Diffusion of Innovation , Humans , Program Evaluation , State Medicine , United KingdomABSTRACT
In the triennium 2006-2008, 261 women in the UK died directly or indirectly related to pregnancy. The overall maternal mortality rate was 11.39 per 100,000 maternities. Direct deaths decreased from 6.24 per 100,000 maternities in 2003-2005 to 4.67 per 100,000 maternities in 20062008 (p = 0.02). This decline is predominantly due to the reduction in deaths from thromboembolism and, to a lesser extent, haemorrhage. For the first time there has been a reduction in the inequalities gap, with a significant decrease in maternal mortality rates among those living in the most deprived areas and those in the lowest socio-economic group. Despite a decline in the overall UK maternal mortality rate, there has been an increase in deaths related to genital tract sepsis, particularly from community acquired Group A streptococcal disease. The mortality rate related to sepsis increased from 0.85 deaths per 100,000 maternities in 2003-2005 to 1.13 deaths in 2006-2008, and sepsis is now the most common cause of Direct maternal death. Cardiac disease is the most common cause of Indirect death; the Indirect maternal mortality rate has not changed significantly since 2003-2005. This Confidential Enquiry identified substandard care in 70% of Direct deaths and 55% of Indirect deaths. Many of the identified avoidable factors remain the same as those identified in previous Enquiries. Recommendations for improving care have been developed and are highlighted in this report. Implementing the Top ten recommendations should be prioritised in order to ensure the overall UK maternal mortality rate continues to decline.
Subject(s)
Maternal Health Services/standards , Pregnancy Complications/mortality , Counseling , Female , Health Status , Humans , Maternal Mortality , Patient Care Team , Practice Guidelines as Topic , Preconception Care , Pregnancy , Pregnancy Complications/therapy , Pregnancy Outcome , Prenatal Care/standards , Quality of Health Care , Referral and Consultation , United Kingdom/epidemiologyABSTRACT
BACKGROUND: Psychological distress is common in the antenatal period. In England, psychological distress is classified as mild, moderate or severe but only those who suffer severe psychological distress are referred to the specialist mental health services. Those who suffer mild to moderate psychological distress are managed by the primary care services. However, little is know about the psychosocial experiences of pregnant women who suffer from mild-moderate psychological distress. OBJECTIVE: This study explored the experiences of pregnant women who self-reported mild to moderate psychological distress during antenatal care. DESIGN: A qualitative study. Data were collected using digitally recorded, face-to-face, semi-structured interviews. Data were analysed using framework analysis. SETTING: A large teaching maternity hospital in North West England. PARTICIPANTS: Twenty-four pregnant women who self-reported mild to moderate psychological distress to their midwife during routine antenatal care. RESULTS: Three main themes emerged: the causes of, impact of, and ways of controlling self-reported mild to moderate psychological distress. A range of experiences caused psychological distress including past life and childbearing experiences, and current pregnancy concerns. Mild to moderate psychological distress took over the lives of these pregnant women. The strategies used to control mild to moderate psychological distress included both positive and negative coping elements. CONCLUSIONS: Psychological distress that is categorised as mild to moderate can be extremely debilitating for pregnant women. Identification of these women in clinical practice is crucial so that effective interventions can be targeted appropriately. Screening criteria that has the efficacy to identify depression and anxiety is needed. We recommend that a multidisciplinary approach to the management of care is developed to address the range of experiences that pregnant women who suffer mild to moderate prenatal psychological distress may have.
