Pregnancy and births: policy context

 

A Refreshed Framework for Maternity Care in Scotland developed by the Maternity Services Action Group. (2011) is intended as a refreshment of the national Framework for Maternity Services in Scotland, first published in 2001. The framework describes a number of overarching principles together with specific service descriptors for each part of a woman, baby and family's journey through maternity care.
 

Reducing Antenatal Health Inequalities (2011) gives pecific actions based on a review of what the evidence says needs to happen to:

  • Improve access to antenatal healthcare services 
  • Improve the assessment of health and social need 
  • Ensure equity in the quality of care


A new national framework on Improving Maternal and Infant Nutrition (2011) is based around four principles:

  • Women entering pregnancy are a healthy weight, in good nutritional health and that this continues throughout their pregnancy and beyond.
  • All parents receive full information they can understand on infant feeding to enable them to make an informed choice on how they will feed their infant.
  • All women receive the support they need to initiate and continue breastfeeding for as long as they wish.
  • Infants are given appropriate and timely complementary foods and continue to have a wide and varied healthy diet throughout early childhood.


Reduce the Risk of Cot Death (2011) is an updated national leaflet and a general update to the national Sudden Unexpected Death in Infancy website which provides resources for professions dealing with this issue.


Pathway for Normal Maternity Care (2009) has as a key principle the right of pregnant women to be provided with current evidence-based information and to be involved with decisions regarding their care and that of their baby. The pathway for normal maternity care is outlined as follows:

  • Green: midwife-led care – healthy women with uncomplicated pregnancies should be offered a midwife as their lead professional
  • Amber: assessment required – Women with any potential medical/obstetric/social risk factors should be further assessed or referred to the appropriate health professional for further assessment or support. 
  • Red: maternity team care – women with significant medical/obstetric risks factors should have a consultant obstetrician as the lead professional.

 

The Scottish Government MaternityServices Action Group (MSAG) established a Neonatal Services Review Sub-group in December 2006. Its aims were to describe the current provision of neonatal services in Scotland, identify any requirements for change and make recommendations to MSAG to ensure a sustainable, safe and high quality Scottish neonatal service.  In its review 'Maternity Services Action Group (MSAG): Neonatal Services Sub Group: Review of Neonatal Services in Scotland (2009)' it recommends: adoption and implementation of appropriate clinical standards; care pathways planned through regional networks; review of the collection of routine data on neonatal unit activity by ISD, and service providers; and an electronically based neonatal database, along with appropriate administrative support, should be established in each unit.

 

The Framework for Maternity Services in Scotland and Report of the Expert Group on Maternity Services (see below) endorse the promotion of pregnancy and childbirth as normal life events, advocating woman centred care, with services and care tailored to need. They recommend community focussed, midwife led care for healthy women experiencing uncomplicated pregnancies, and multidisciplinary maternity team care for women with more complexity. They suggest the midwife as the lead professional for the majority of low risk women, and ensuring a normal birth pathway for healthy women regardless of birth setting. Women should also have ongoing medical care provided by their general practitioner, as required, throughout the pregnancy episode. To address this, the Scottish Government Health Directorates (SGHD) established the multiprofessional Keeping Childbirth Natural and Dynamic (KCND) programme, aiming to support implementation of current maternity policy at NHS Board level. KCND aims to promote multiprofessional working and implementation of care pathways for women and babies based on need.

 

Health in Scotland (2002)  is a report on trends in health and outcomes in Scotland.  It includes a chapter on Women and Children’s Health which flags up the development of quality standards for pregnancy and newborn screening programmes by NHSQIS.  Also includes a revised remit for the Child Health Support Group.

 

The Expert Group on Maternity Services (2002) (EGAMS) was brought together by the SGHD to examine how the principles of the Framework for Maternity Services should be applied in practice to intrapartum services.  It aims to assist Boards to plan and configure their maternity services.  To underpin Principle 27 the reports says: ‘The development of a national Core Dataset for maternal fetal medicine must be consistent with the Scottish Birth Record and the Scottish Health Information Project.  A National Hand-held Maternity Record should be developed’.

 

Framework for maternity services in Scotland (Feb 2001) sets out a number of guiding principles for maternity care.  One group of these covers information and communication during pregnancy and childbirth and includes: planning and provision of maternity services to be underpinned by appropriate and comprehensive database and public and professional consultation; there should be a national unified and standardised women-held maternity record.  It recommends that an expert Group should inform and develop the Framework.  Workforce issues are also discussed.