Prioritising the most vulnerable women and their babies – adapting and restoring community maternity services

Case study summary

Key learnings from East Suffolk and North Essex NHS Foundation Trust (ESNEFT):

  • Maternity services adapted and face-to-face community midwife appointments reintroduced for women in vulnerable Roma communities
  • Antenatal interventions provided the opportunity to build relationships and provide vital information and support around safe sleeping.
  • The importance of tailoring services to meet the needs of the most vulnerable, particularly during a pandemic.
  • Consider and mitigate against digital exclusion in service models to ensure the continued delivery of safe care

Background to learning

During the COVID-19 pandemic, maternity services have had to adapt to continue to safely support and care for women across the maternity experience at a time when there has been extra pressure on healthcare services.

Many services have found themselves reducing staff commitments outside maternity units and have re-organised staffing to deliver care differently. Consultations have been offered by phone or by video link when this was appropriate.  However, services have worked creatively to keep some visits in person, when routine checks have been vital for the wellbeing of mother and baby.

This case study looks at how maternity services have been adapted and face-to-face community midwife appointments reintroduced for women in vulnerable Roma communities.

Learning and advice to be shared

The Roma community served by ESNEFT is a vulnerable population with whom the trust works hard to engage. Many women do not speak English and traditionally, may not be engaged with maternity services at any time through their pregnancy.  In some parts of the Roma community in the East Sussex and North Essex area, there is evidence of women having been affected by people-trafficking.

At the beginning of the COVID-19 lockdown very few home visits were able to be carried out.  Midwives who supported Roma women continued to provide advice and support whilst the women were inpatients.

This reduced service was reviewed very early during lockdown, due to two sad episodes of sudden infant deaths which were found to be directly related to sleeping arrangements. Following the two incidents, the service was quickly adapted to prioritise the most vulnerable groups, including ESNEFT’s significant Roma population, to have an antenatal visit at home.  This gave ESNEFT the opportunity to discuss safe-sleeping and recommend that families prepare an appropriate sleep space prior to their baby’s arrival to the home.

Given the potential vulnerability across this community, midwives recognised the need to prioritise the resumption of community services as the initial pandemic peak subsided.  It was recognised that community midwife appointments in the home were a priority for this vulnerable community and were therefore organised accordingly.  This enabled community midwives to develop trusting relationships from the outset, which allowed them to address sensitive issues such as safe sleeping and to undertake routine checks that may otherwise not have been accessed by the Roma women.

Similarly, the first community midwife visit after discharge and first health visitor appointment was speedily re-established, to provide support to vulnerable mums and their babies.

Would it be beneficial to retain these changes?

The introduction of antenatal interventions for the Roma population within ESNEFT has provided the opportunity to build relationships and provide vital information and support around safe sleeping within this vulnerable group.

It is the intention of ESNEFT to continue this essential service, and ESNEFT have learnt the importance of tailoring their services to meet the needs of the most vulnerable, particularly during a pandemic.

Successfully adapting services has highlighted specific challenges faced by Roma communities across ESNEFT.  As the ability to deliver community services was constrained during the first peak of the pandemic, the trust recognised that remote and virtual service provision could limit access in this vulnerable group.

The trust’s approach to care during this period mirrors similar approaches across health and care where issues such as digital exclusion are being considered and mitigated as service models are adapted to ensure the continued delivery of safe care.

Case study led by Clair Barker, Lead Midwife (Community East Team), East Suffolk and North Essex NHS Foundation Trust. For any further detail on this case study or to connect with Clair, please contact england.1professionalvoice@nhs.net