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Healthy pregnancy

Healthy pregnancy refers to the health of a woman during:

  • Pregnancy.
  • Childbirth.
  • The postpartum period, which is up to about six weeks after the birth of a child.

During pregnancy and the first two years of a child’s life their brain and neurological pathways are set for life. It is the most important period for brain development. It is also a key determinant of intellectual, social and emotional health and well-being (Allen, 2011a).

We must give every child and young person the best start in life and prevent problems before they arise. This will enhance child outcomes.

The local picture

The following indicators can be used to assess healthy pregnancy:

Smoking status at the time of delivery during the year 2016/17 was 12.2% for Calderdale. While there has been a downward trend nationally, local and regional figures have fluctuated, with local prevalence currently significantly higher than national prevalence, but similar to the regional average.

The Breastfeeding initiation has consistently been significantly higher than the national average. For 2014/15 the rate was 77.5%, significantly higher than the regional and England figure.

However, breastfeeding prevalence at 6-8 weeks following delivery, has been significantly below the national average for a number of years. In 2014/15, the Calderdale figure was 40.3%, significantly below Yorkshire and Humber prevalence at 42.2% and England's at 43.8%. A new method for calculating this indicator was introduced in 2015/16. While this is not comparable to the previous indicator, it suggests that breastfeeding prevalence at 6-8 weeks is now similar to the national average.

Current provision

Interventions to reduce infant mortality and low birth weight include those that have a demonstrable impact on reducing health inequalities. These interventions, which link with "healthy pregnancy" include:

  • Reducing maternal obesity- this is a critical period to address obesity in a woman's life course and to initiate behaviour change. However, caution must be applied to avoid compromising foetal growth. Midwives check the Body Mass Index (BMI) of women as part of their booking appointment to assess maternal weight. Any pregnant woman who is overweight with a BMI 30+ at the point of 'presentation (usually around 12 weeks) is referred into the Better Living Mums Service.
  • Reducing maternal smoking - see section below on smoking status at time of delivery.
  • Reducing teenage pregnancies - For some young women having a child when young can represent a positive turning point in their lives, for many more teenagers bringing up a child is difficult. Teenage pregnancy often results in poor outcomes for both the teenage parent and child. For a picture on Under-18 conceptions in Calderdale, see: Sexual Health Chapter.
  • Reducing unexpected deaths (SIDS) in infancy, see: infant mortality and child deaths chapter.
  • Meet the child poverty target.
  • Prevention of maternal and infant infections. Pregnant women should be offered screening for infections, see screening and immunisations chapter.
  • Increasing breastfeeding can reduce infant mortality. See section on Breastfeeding (prevalence at 6-8 weeks)
  • Vitamin D provision - during pregnancy it is important for women to take 10 micrograms of vitamin D each day and to continue after the baby is born if the mother is breastfeeding.
  • Folic acid interventions - Folic acid supplements reduce the risk of Neural Tube Defects such as anencephaly and spina bifida. The recommendation is that women who could become pregnant or who are already pregnant take daily folic acid supplements prior to conception. Also, throughout the first 12 weeks of pregnancy. There are systems in place within Midwifery and the Public Health Early Years' Service to ensure that pregnant women and those parents/carers of children aged under 4, who may be eligible, are given information about the Healthy Start scheme. The Healthy Start scheme provides free vitamins and food vouchers to people on low incomes and to all pregnant mothers aged under 18 years regardless of their benefits status.

Smoking cessation services are available to everyone in Calderdale including pregnant women, their partners and family members. Midwives ask about smoking during pregnancy, with all women being asked to take a carbon monoxide breath test at their booking appointment which is usually between 7-10 weeks gestation. There is a care pathway in place for following up pregnant women that smoke at booking or who have recently stopped and a clear referral pathway into the appropriate support interventions.

The breastfeeding initiation and breastfeeding at 6-8 weeks indicators discussed above illustrate that breastfeeding maintenance in Calderdale significantly drops off in the weeks immediately after birth. Locally in Calderdale a sub-group has been established, with representatives from health, children's and young people's services and service users, to try and address breastfeeding maintenance. The group have met and analysed breastfeeding rates by wards, age, ethnicity and number of children.

Breastfeeding “drop off” is greater in to the most deprivation wards, as illustrated below. The local sub-group are conducting a pilot in Northowram to try to improve breastfeeding maintenance. This includes a follow-up phone call for breast feeding support within 48 hours of the mother giving birth. The scheme will be rolled out across Calderdale using peer supporters, particularly focused in areas where maintenance is poor.

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Breastfeeding Peer Support is available in Calderdale. One to one support is provided during antenatal appointments in Children's Centres, in the hospital and as home visits. In addition to the follow up phone call within 48 hours of the mother giving birth, telephone support is available via a breastfeeding peer supporter's phone line. Group support can be accessed from the Breastfeeding Baby café in Central Halifax and a future service development will see breastfeeding friendly groups, Baby Cafés, rolled out in other settings in each locality across Calderdale.

User views

The Public Health Early Years' Service incorporates “Healthy Pregnancy.” The Service has recently gone through the “mobilisation” stage of the commissioning cycle and went live as the Public Health Early Years' Service from the 1st July 2017. User views were collected as part of the consultation process for commissioning which was undertaken in March 2016 with parents / carers of children aged 0-5 years and existing providers of services for children aged 0-5 years.

Local parents said that during pregnancy their greatest concerns were around healthy eating (57%), breastfeeding (47%), preparation for parenthood (45%) and emotional wellbeing (38%). They were also concerned about their child's growth and development (39%). Around 17% were concerned about smoking. 76% of respondents rated the promotion of health pregnancy in Calderdale to be “good” or “excellent”.

Unmet need

As reported above, there is some fluctuation locally in smoking rates at the time of delivery. Latest data shows that for smoking at the time of delivery, Calderdale is significantly worse than national average for the first time since it has been reported (2010/11).

Whilst this may, in part, be due to small numbers, the prevalence of smoking in pregnancy in Calderdale is currently significantly higher than the national average, suggestive of unmet need in this area. It is interesting that this was not identified by parents in the recent consultation exercise as an area for which additional support was required, though this may be reflect reluctance to change.

Local parents have said they would like (2016):​

  • Additional support during pregnancy: Breastfeeding, preparation for parenthood, continuity of care
  • Continuity and consistency of care.
  • Care as close to home as possible.
  • Travel less than half an hour to appointments with good transport links.
  • Parents / carers would like choice.
  • Parents and carers said they wanted preparation for parenthood

Healthy Lifestyles

  • Parents / carers would like information, advice and guidance about healthy eating and cooking.

Infant feeding

  • Extra breastfeeding support is required.
  • Breastfeeding support and advice must be offered with a flexible approach and in a non-judgemental way. This must not be offered to the detriment of bottle feeding advice.

Projected future need

Birth predictions for Calderdale over the next five years are stable at around 2,500 births per annum, see demographics chapter.

Young parents are particularly vulnerable and evidence suggests this impacts on health outcomes for their child(ren). The younger the parents, the more intensive support they are likely to need (PHE, 2016).

Parents are likely to have more needs, because of:

  • mental health problems;
  • drug and alcohol problems;
  • experiencing or have experienced domestic abuse;
  • currently or previously being a Looked After Child or subject to a child protection plan;
  • living in poverty;
  • homeless;
  • arriving as migrant, seeking asylum, refugee status or where English is not the first language;
  • as will parents / carers and children with special education needs and / or disabilities.

Key considerations linked to the known evidence base (what works?)

The Public Health Early Years' Service provides universal support to all families in Calderdale with children aged 0-5 years. The Public Health Early Years' Service provides Health Visiting, Breastfeeding Support and Oral Heath. Health Visiting will have contact with families during the third trimester of the pregnancy in preparation for the care moving from midwifery into health visiting following the birth of the baby.

Healthy Early Years Support (HEYS) has been commissioned by Public Health as an early intervention and prevention service that will provide support to vulnerable families with children aged 0-5 years. This service will be available to families with their first child, either during pregnancy or in the child's first year, which have been identified according to a criteria for need. HEYS has been developed following guidance from Public Health England (2016) and the Department of Health (2013).

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