Our latest Maternity and Neonatal Partnership Meeting was held at the Friendship Cafe in Gloucester on 12th June 2024.

We were very excited to welcome everyone to this event, we had 22 service users attend (along with some babies and toddlers) and 3 representatives from community groups, representing the voice of service users. 24 NHS/public health professionals, including midwives, GPs, and health visitors, also attended. In total we had 49 adults.

The purpose of these events is to bring everyone together, discuss the current situation within maternity care, listen to feedback about women and birthing people’s experiences and co-produce ideas and solutions. These can then be taken away as actions to improve services.

Below you can see a summary of what was discussed.

Focus group – Antenatal Pathway

The antenatal clinics (ANC) at Gloucester and Cheltenham hospitals are busy, overbooked, and fast paced. This leads to chaotic and stressful clinics for staff and long waits for women and birthing people.

We have set up a working group with midwives, consultants, operational mangers, external advisors and MNVP members to look deeper into the issues around the clinics, and address these.

We wanted to welcome further discussion on how the experience can be improved.

Consultant appointments

  • Appointments very short
  • Seeing different consultants each time
  • Not knowing when next appointment would be

Timing of appointments

  • All service users described issues with scans being cancelled or delayed
  • Long wait times for appointments

Planning

  • Not having enough time to talk through birth options
  • Difficult to change consultant plan
  • Continuity of notes between fetal medicine doctor and delivery suite

Information

  • Not enough information given around options to enable informed choice, or enough time given to consider options properly
  • Lack of information around how to book appointments, what to expect in clinics and what each clinic is for
  • Timeline in handheld notes was very useful

Actions

  • Improve communications about expectations for induction of labour
  • Create some materials about what to expect when you are on a consultant led pathway
  • Look at improving digital integration of notes
  • Review how patients are informed of appointments
  • Clarify whose responsibility it is to book outpatient appointments, or chase when these are not booked in

Focus Group – Support during pregnancy and after your baby

We wanted to hear about any support women and birthing people felt might have been missing during pregnancy, or what worked well to support them.

In Bristol, a group called ‘Black Mothers Matters’ has been set up.

‘Black Mothers Matter is a founded and directed by three Black mothers who after being a vital support network for each other in the perinatal period wanted to extend that support to others.’

We want to hear what type of support is wanted by women and birthing people in Gloucestershire.

Experiences we heard

  • Feeling unheard
  • Not knowing where to go for urgent help
  • Feeling rushed to be discharged following c-section
  • Would have liked support with home Fragmin injections

Points raised

  • The group felt that the Marvellous Mums group was very supportive and more personal than others with a warm and welcoming atmosphere. Physio is available and they go on organised trips as well with continued peer support being encouraged. There is now a kaleidoscope group. One of the service users in this group asked if white women have such supportive groups.
  • The group felt that the Black Mothers Matter group (Bristol) would be welcome here and would be well attended.
  • The group felt that antenatal groups should be less prescriptive with someone from the community helping to run them. It was noted that they would attend women’s only groups being culturally sensitive.
  • The group suggested that post-natal groups could have baby hubs attached.
  • The service users in this group were unaware of how to access tours of the unit.
  • There was a general feeling that they didn’t receive information about antenatal education groups and if they had known about them, they would have attended.

Actions

  • Increase communications around antenatal groups
  • Consider the logistics of running a Black Mothers Matters group in Gloucestershire. It was noted during the focus group that lots of service users who live in Gloucestershire travel to Bristol just to attend this group.
  • Increase communications around the health visiting service, the role of a health visitor, and what else the service offers

Focus Group – Booking your first midwife appointment

Gloucestershire health services are looking at ways to support and engage with families to make sure that everyone has safe and equitable care.

We know that some people may tell maternity services about their pregnancy later then 10 weeks. There are some reasons why maternity like to know about a pregnancy earlier, such as assigning a midwife, booking scans and taking bloods. It would be useful to understand why some women and birthing people might not report their pregnancy before 10 weeks.

The group identified that if it is your first baby you may not know how to book and that we rely a lot on family and friends to know what we are supposed to be doing and when. The group agreed that most women would contact their GP to inform them of the pregnancy if they were unaware of the maternity booking line and the GP would provide them the link for this.

A large discussion took place regarding language barriers and immigration status.

Considerations

  • What if the online self-referral for booking isn’t available in your language?
  • What if you don’t have access to a mobile phone, computer, or internet?
  • What if you find it difficult contacting your GP due to language barriers?
  • What if you are unsure of your right to maternity care due to immigration or haven’t registered with a GP?
  • What if you distrust the institution and this is reinforced by family and friends?
  • What if you have had previous involvement with social services or bad experiences with institutions and are now fearful of actions they may take if they know that you are having a baby?

Points raised

  • Some service users are unaware they are pregnant, and this can cause a delay in booking
  • Antenatal appointments, tests, and scans can add pressure to expectant mothers, and this may also be a reason to delay booking
  • If a woman or birthing person doesn’t have a right to remain, they may not book due to fear of medical costs or scrutiny over their immigration status
  • If a woman or birthing person has had previous involvement with social services or even had a child removed, they may fear that it will happen again and therefore delay booking
  • Women and birthing people may feel more comfortable seeking advice from their community rather than a midwife as they understand their cultural needs more. It was suggested that midwives should be allowed to visit cultural groups to gain a better understanding.
  • Some of the women and birthing people questioned why they don’t see a midwife until after eight weeks, citing that this is different to what they may expect in their home countries.
  • A service user said that midwives will ask about mental health and Black women will say they’re fine, as it’s how their culture responds, but in truth they might not be fine.

Actions

  • Consider a conversation with GP surgeries to raise the issue surrounding language barriers and immigration status.
  • Consider the information available about the antenatal care pathway and the reasons behind the timeline of tests, investigations, and appointments with care providers.
  • Consider providing information and signposting to baby groups at booking so women and birthing people can begin building relationships with each other early on.
  • Explore better ways to phrase questions surrounding mental health to encourage Black women to open up. Identify what the barriers are to having these open conversations with their midwives.

Focus Group – Neonatal feeding

The neonatal team want to support families to get early breast milk to their babies who are taken to the neonatal unit after birth, and to support ongoing established breast milk feeding. This focus group was a discussion about supporting families who have a baby on the neonatal ward, what support and information is needed, and what might need to change within hospital processes to support families.

Expressing milk

  • Expressing without skin to skin/being near baby is really hard
  • Feeling that you could go home sooner if bottle feeding as milk intake can be measured
  • Use of language by some staff not very encouraging
  • Help from staff to express milk or to be with baby invaluable
  • Staff sometimes disagree on advice (maybe because of a training need, or own views and experiences)

Donor milk

  • There is no donor bank for breastmilk in Gloucestershire – so any milk comes from or goes to Bristol
  • People have rather mixed views on donated breastmilk, or not aware it is a thing
  • While you are expressing breastmilk on the ward, if you’ve got more than your baby needs, it isn’t possible for you to donate the excess unless you’ve had all the blood tests that are required before you started expressing
  • Midwives considering talking to bereaved parents about donating milk.

Information needs

  • Information for mums who know their baby may arrive early
  • Visits to the neonatal unit antenatally, or virtual tour – help parents feel prepared and informed.
  • Neonatal feeding videos
  • Awareness that sometimes, the unit in Gloucestershire is full, and this might mean they end up in a unit elsewhere
  • Awareness that pumps are available to borrow when mums leave hospital
  • Breastfeeding support and advice needs to be tailored for those who cannot get skin-to-skin with their baby
  • Information on what’s OK for breastfeeding babies in the unit – e.g information about nipple shields, supplement feeding etc.

Support afterwards

  • Once I was home from the unit, I found a breastfeeding support group really helpful
  • Sometimes health visitors don’t know that parents and babies have been discharged – it seems to depend on whether the midwife/nurse thinks about it and makes a phone call
  • While babies are in the unit, they don’t have their Red Book. It would be really helpful if information on height and weight could be recorded to that it can be added to the Red Book retrospectively

Actions

  • Consider what information is available about infant feeding to prepare women and birthing people if there is a likelihood of their baby being born prematurely.
  • Discuss the possibility of a neonatal infant feeding video
  • Find out what policies and procedures are in place regarding discharge from the midwife to the health visitor.

Focus Group – Personalised care

The BadgerNotes app is now being used by everyone who is pregnant in Gloucestershire. All notes are now stored and shared on the app. Maternity staff can input and share results, appointments and leaflets.

Women and birthing people can use to app to start a personalised care plan for their antenatal care, their birth preferences and postnatal care.

We know that this function is not being used by women and birthing people. We are keen to understand why this might be, and to support the use of this, so that women and birthing people are involved in decisions around their care.

The first discussion raised was the limited number of languages that BadgerNotes can translate to. The group identified the following languages as being needed in Gloucestershire:

  • Urdu
  • Bangladeshi
  • Alabamium
  • Tamil – Sri Lanka

The group looked at the BadgerNotes app and found some of content will translate, such as the heading, but not all, such as the information added to care plans and recommended reading.

We talked about how the conversation function of the app can help women and birthing people tell their midwife about any safeguarding concerns they may have, as long as they are sure their partner doesn’t read the app.

Experiences we heard in this focus group

  • Difficult to contact midwife outside of appointments
  • Difficult to repeat your story at each appointment
  • Woman not offered an interpreter at all during antenatal, birth and postnatally.
  • A few women told us that they didn’t feel they had choices and the options were not explained.
  • Seeing different midwives at each appointment
  • Not enough time spent on birth plan, and midwives did not read it during birth.
  • Home birth kit arrived late

Actions

  • Speak to the BadgerNotes team about the functionality of in-app/webpage translation. What are the limitations?
  • Clinicians need to ask if someone wants an interpreter at all appointments and birth, and postnatally – action for maternity and health visiting.
  • Discuss how can we help women feel prepared for their 36 week birth planning appointment – what do women need to know for this appointment beforehand?
  • Could the plans from Badger Notes be printed somehow?
  • Find out if midwives can respond on the conversations function of badger notes. There seemed to be a confusion about this at the focus group – promote the result of this action.

Our next meeting

Our next partnership meeting will be on Tuesday 22nd October, 10am – 12pm at Wheatpieces Community Centre in Tewkesbury.

Find out more and book your place here.