A better start through maternity and antenatal care

Rachel Kent Horwood, Research and Development Assistant at the National Children’s Bureau, discusses how A Better Start (ABS) partnerships support families during both pregnancy and in the early weeks after birth.

The A Better Start ‘Programme Insight’ reports aim to share learning emerging from the work of ABS partnerships to inform others' work and improve babies and young children's outcomes. Issue number 9 in the series focuses on how ABS partnerships support families during pregnancy and the early weeks after birth. Evidence shows that supporting families at the earliest point reduces the need for later intervention and supports positive physical, social, and emotional development.

Making maternity and midwifery services work for families relies on collective efforts to put pregnant people and birthing partners in the lead to ensure services are driven by lived-experience and tailored to families’ needs. This is no easy task when caseloads are heavy and budgets are stretched. ABS partnerships have developed a range of approaches to tackle the issues within their local areas so that services provided during pregnancy are codesigned with the people who use them, holistic in their approach to family support, and build strong relationships between families and the workforce.

A Better Start Southend (ABSS) Perinatal Mental Health (PMH) service has instituted a ‘Think Family’ approach in response to families’ needs which aims to move away from the purely maternal thinking seen in traditional PMH services. Families and communities supported this work in line with ABSS’s inclusive, community-oriented ethos. During COVID and furlough, many fathers were at home and began to share their own thoughts, feelings and concerns during routine check-ups. ABSS responded by making appropriate adjustments to service delivery to better meet fathers’ specific needs. With this new approach, fathers and male carers are not simply considered as an add-on to the vital work they do with mothers but as a separate entity, equally in need of help.

In Nottingham, Small Steps Big Changes (SSBC) have also been listening to dads and have demonstrated their commitment to ensuring that male carers and partners feel included in the pre- and post-natal period. SSBC developed an Information Pack for New Fathers in response to a local consultation, where fathers said that they wanted a one-stop shop for evidence-informed advice. SSBC also provide “Think Dads” training; a training programme designed and developed in consultation with fathers and overseen by a Father Inclusive Practice group. The aim of the training is to improve the knowledge and confidence of practitioners in engaging with and working with male carers.

Blackpool has one of the highest rates in the country of babies being separated from their parents’ care at birth due to safeguarding concerns. Blackpool Better Start (BBS) found that mothers who experience this often face multiple adversities. Building on research from the national born into care guidelines, BBS committed to co-producing a local action plan to develop a more sensitive and humane practice. The BBS partnership recognised the opportunity to bring together parents and carers with lived experience of child protection and care proceedings, alongside midwives, social workers, and specialist services, to collaborate in bringing tangible change to local services and systems.

Better Start Bradford have been looking at ways in which improved maternity care could reduce health inequalities and address the higher infant mortality rates observed in Bradford. Evaluation has been embedded within each phase and has provided a unique opportunity to examine the impact on the experiences of both midwives and women. Many women supported in phases one and two suggested this model was crucial for helping them build trust with their midwives.

Lambeth Early Action Partnership (LEAP) Midwifery Continuity of Care (MCoC) service began providing care for pregnant people living in the LEAP area of London in 2018. Within the MCoC pathway, each pregnant person receives midwifery care by a named midwife throughout pregnancy, labour, birth and the postnatal period. Care is provided in the community and clients benefit from longer and more frequent appointments, depending on their needs. Feedback about the MCoC service is consistently positive and indicates that clients feel safe, cared for, listened to and respected. Watch a video which captures the experiences of four service users.

To find out more about the ways in which ABS partnerships are meeting the needs of families you can read the published programme insight reports.

About A Better Start

A Better Start is a ten-year (2015-2025), £215 million programme set-up by The National Lottery Community Fund, the largest funder of community activity in the UK.

Five A Better Start partnerships based in Blackpool, Bradford, Lambeth, Nottingham and Southend are supporting families to give their babies and very young children the best possible start in life. Working with local parents, the A Better Start partnerships are developing and testing ways to improve their children’s diet and nutrition, social and emotional development, and speech, language and communication.

The work of the programme is grounded in scientific evidence and research. A Better Start is place-based and enabling systems change. It aims to improve the way that organisations work together and with families to shift attitudes and spending towards preventing problems that can start in early life. It is one of five major programmes set up by The National Lottery Community Fund to test and learn from new approaches to designing services which aim to make people’s lives healthier and happier

The National Children’s Bureau is coordinating an ambitious programme of shared learning for A Better Start, disseminating the partnerships’ experiences in creating innovative services far and wide, so that others working in early childhood development or place-based systems change can benefit.

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Visit the A Better Start website to find out more.