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Community midwife care pathways and confidence levels in providing maternity care in areas of high deprivation
  1. F Cross-Sudworth,
  2. M Williams,
  3. I Bird,
  4. J Gardosi
  1. West Midlands Perinatal Institute, Birmingham, UK

Abstract

Background Good community based maternity care requires clear care pathways and confidence in their application. The authors wanted to investigate how well community midwives (CMWs) considered themselves able to deal with a set of problems.

Method Survey of 278 CMWs serving six large maternity units with above average levels of deprivation. Anonymised semistructured questionnaire included questions about 12 areas of care. Results were expressed as the proportion of CMWs who reported that they were unaware or unsure of a care pathway, and those who were not confident or unsure about that particular area of care.

Results 213 questionnaires were returned (response rate 77%). There was wide variation in presence of care pathways and confidence levels for different tasks, with better results for smoking, drugs & alcohol and mental health issues, and poor rates for issues such as poverty, housing, migrants & asylum seekers and women with physical and learning difficulties (table).

Unaware or unsure of a care pathway (%)Not confident or unsure in providing care (%)
Smoking cessation22.83.4
Drug/alcohol misuse17.527.8
Obesity46.550.0
Poverty89.057.0
Inadequate housing90.867.1
Non-English speaking migrants68.528.3
Asylum seekers84.974.0
Mental health problems12.718.0
Teenagers25.911.1
Child protection issues5.313.0
Domestic abuse23.233.1
Physical or learning difficulties77.276.

Conclusion There is an urgent need for standardised care pathways and better training to cover all areas of need, including those characteristic of deprived areas, to allow CMWs to deliver an equitable maternity service.

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