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Antenatal

The following pathway should not be read as stand-alone and MUST be read in conjunction with Section 3: Pathways.

During the antenatal period the Midwifery Service is the accountable professional and lead for the care of the mother and the unborn / newly born child(ren) and works as part of the Health Child Programme (HCP) team. Partner services will work collaboratively with the Midwife to provide continuity of care between the Antenatal and postnatal period. The Health Child Programme focuses greater emphasis on the antenatal period and for preparation to parenthood.

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Preconception

Preconception

Support pregnancy planning for mothers/partners with pre-exisiting conditions.

Maternal Mental Health

To support management of medication etc. during pregnancy to optimise the best outcome for the Mother and Baby Develop care plan including medication management prior to and during pregnancy to optimise best outcome for mother and baby.

Primary Care & GP

GPs to be involved in all cases where there is a past history of mental health issues.

GP should be consulted to provide necessary background.

If the mother has an identified issue Children’s social care (CSC) should also be involved.

Antenatal

12-40 weeks - Universal Partnership Plus

All services and corresponding rationale as for Universal with additional as detailed in this section for universal partnership plus.

To increase the chance of positive outcomes for mother and baby through the identification of need, appropriate referral and multiagency care planning.

Health Visiting

Ongoing liaison with MW, GP and mental health services team.

Midwifery

Midwifery team to notify health visiting team of pregnancy, includes assessment of maternal mental health using three WHO questions and clinical judgement, including needs of father and referrals to other agencies and action plan; this should be a particular consideration for women and fathers with complex social factors (NICE 110).

Following assessment categorised as:

High

  • Psychiatric team referral
  • Notify GP and HV services

Medium

  • Refer to GP
  • Refer to mental heatlh services if required
  • Notify HV
  • Liaise with CC’s

Maternal Mental Health

Multiagency team to engage with other services to support the family. and put a plan in place for mother and the baby’s care, with potential pathways and treatment explored to ensure a seamless service is delivered should she become unwell and urgent treatment is needed.

Plan support primarily for mother and her baby together (MBU), the family and also the professionals providing direct care such as midwife and health visitor with an agreed, accessible and timely pathway in place.

Reflect upon attachment needs collectively and developed “shared understanding”Teams work alongside mother and baby together, some professionals may have brief input with specific expertise i.e. Psychiatrist others such as H/V will have long term continuing input.

Refer to secondary mental health services or adult community mental health team as required.
Delivery of more intensive parenting programmes e.g. Mellow Bumps.

Primary Care & GP

GPs to be involved in all cases where there is a past history of mental health issues and mental health team if mother known to them.

GP should be consulted to provide necessary background if the mother has an identified issue Children’s social care (CSC) should also be involved.

Any point during Pregnancy

Care of vulnerable mother’s/families.

Health Visiting

Contribute to a CAF and form part of the team of relevant professionals/agencies needed to support the mother/family e.g.:

  • Specialist Teen Services - FNP & voluntary organisations.
  • Safeguarding services - social services Mental Health Team
  • DAT
  • LA - housing
  • Children’s Centre/LA parenting teams MARAC
  • SARAC - sexual exploitation

Midwifery

Initiate a CAF and involve relevant professionals/ agencies e.g.:

  • Specialist Teen Services - FNP & voluntary organisations.
  • Safeguarding services - social services Mental Health Team
  • DAT
  • LA - housing
  • Children’s Centre/LA parenting teams MARAC
  • SARAC - sexual exploitation

Childrens Centres & EYFS

As part of a multidisciplinary /agency team - with the family play an active role in the compilation of the CAF, referral to Child Protection (CP/Children in Need (CIN) service provider.

Attend Team Around the Child (TAC)/ Family (TAF) meetings where appropriate.

Liaise/communicate with other agencies in domestic abuse cases, substance and alcohol misuse.

Contribute to CP conference reports and attend conference and core groups as required

Primary Care & GP

Contribute to a CAF and form part of the team of relevant professionals/agencies needed to support the mother/family e.g.:

  • Specialist Teen Services - FNP & voluntary organisations.
  • Safeguarding services - social services Mental Health Team
  • DAT
  • LA - housing
  • Children’s Centre/LA parenting teams MARAC
  • SARAC - sexual exploitation

Any point during pregnancy

Provision of co-ordinated support to increase the chance of positive outcomes for mother and baby.

Health Visiting

Assessment to identify requirement to refer to secondary mental health services or adult community mental health team.

PIMH Consultation (see MH categories tab/sheet ) provide ongoing care as part of integrated care plan.

Midwifery

Assessment to identify requirement to refer to secondary mental health servcies or adult community mental health team.

PIMH Consultation (see MH categories tab/sheet ) provide ongoing care as part of integrated care plan.

Primary Care & GP

Assessment to identify requirement to refer to secondary mental health services or adult community mental health team (see MH categories tab/sheet) provide ongoing care as part of integrated care plan.

By 20 weeks

Facilitate information sharing and support joint working.

Health Visiting

Receipt of notification of pregnancy from midwife.

Health Visiting

Following initial Midwifery assessment, provide notification of pregnancy to the Health Visitor detailing information relating to issues such as:

  • Actual or potential vulnerability of the family
  • Previous sudden infant deaths
  • History of physical and mental health problem
  • Safeguarding issues and any child protection
  • concerns
  • Domestic abuse
  • Immigration
  • Language barriers - need for interpreter services.
  • Lifestyle issues e.g. alcoholic, drug addict.
  • Mental Health Service
  • Additional contacts
  • Benefits awareness
  • Parenting rights
  • Domestic abuse

Early Pregnancy optimum but no later than 20 weeks

Appropriate support for mother/family.

Midwifery

Ensuring appropriate PBB (Pregnancy, Birth & Beyond) services is available and accessed working with partners such as FNP, HV etc.

Any point during pregnancy

Appropriate support for mother/family and delivery of joint working.

Midwifery

Liaison with FNP as required/appropriate.

28 weeks +

Core Purpose 1, 2, 3

Delivery of (targeted) additional support to reduce risk of/actual child abuse/neglect.

Childrens Centres & EYFS

Vulnerable families who need multi-agency support. TAF/C.

Targeted services initiated via a CAF with a lead professional/agency.

Support for vulnerable /targeted families as part of a multi-disciplinary/agency team.

Reduce risk of/actual child abuse/neglect.

28 weeks to new birth

Follow-up antenatal visit.

To facilitate enhanced partnership working with Midwife and other appropriate agencies to further establish therapeutic relationship and provide support ready for postnatal period.

Health Visiting

Multi-professional / agency action planning, liaison and information sharing to provide additional early support and intervention to:

  • Reduce the risk to the child.
  • Promote positive physical and mental health and development of the child.
  • Identify at an early stage any parental mental health issues.
  • Provide further advice & support relating to issues such as:
    • Domestic Abuse, parent who is a Looked After Child (LAC), vulnerabilities of the family.
    • Foetal abnormalities and parenting concerns.
  • Promote parental understanding of baby brain development and an awareness of attachment theory using Solihull approach.

Repeat NICE recommended prediction questions



Maternal Mental Health

Collaborative working with MW, HV, GP and specialist mental health services to assess needs and ensure informed choice for future planning and medication management ( NICE 110).

Develop individualised postnatal care plan prepared in conjunction with MW / HV (NICE 37).

8 weeks to new birth

Additional Visit

Health Visiting

  • Support and education for parents with a range of complex needs
  • Support with accessing other services and sources of information and advice
  • Environmental issues addressed where appropriate
  • Emotional and psychological problems addressed
  • Support for parents in prison / refuge
  • Crisis and safety planning for victims of domestic abuse.

28 weeks to new birth

Conduct Listening Visits to assess need and identify requirement for further support.

Health Visiting

Use evidence based assessment tool e.g Whooley in accordance with Nice Guidance to :-

To identify and support:

  • Emotional and psychological problems
  • Parental mental health history including antenatal depression / emotional well being
  • Need for referral to antenatal counselling / CBT
  • Intervention for factors that could underlie poor parental mental health for example CONI

As these assessments do not consider anxiety levels a separate assessment may need to be undertaken.

Liaison and referral to GP’s and as appropriate.

28 weeks to new birth

Multi-agency meetings to facilitate liaison, information sharing, risk assessment, communication.

Health Visiting

  • Plan care in conjunction with parents and specialist services and local initiatives.
  • Liaise with CAF/TAC/CP/CIN service providers.
  • Liaise with Named Nurse Safeguarding re Social Care involvement especially if non-engaging, hostile or uncooperative
  • Referral and on-going partnership working with appropriate specialist services.