Choice, equity and accessibility

This long-anticipated National Service Framework – which has much to say about disadvantaged groups, including disabled parents – is much welcomed, and offers an energising vision to overcome barriers to maternity services. Michele Wates comments on some key points in Standard 11, the section of the Framework concerned with maternity services.

Michele is currently preparing information on disabled parents' legal rights and access to services, for publication by Disabled Parents Network in spring 2005.

For more information on the National Service Framework visit: www.dppi.org.uk

The National Service Framework for Children, Young People and Maternity Services (NSF) was published by the Department of Health (England) in autumn 2004. Standard 11, the section of the Framework concerned with maternity services, delivers a challenge to managers and clinicians to ensure that services are equitable and accessible to all, offering choice and individualised care for everyone. It spells out what this should mean when providing appropriate maternity services to disabled mothers and fathers.

Overcoming barriers to care

The importance of early and responsive services for women living in disadvantaged communities and/or requiring specific services is underlined. Primary care trusts are urged to "systematically take account of the reasons why women from these groups find it difficult to access and maintain contact with maternity services ... actively designing services to overcome these barriers to care".

The Framework highlights the need to make sure that local maternity services include "women with learning and physical disabilities, taking into account their communication, equipment and support needs". Local maternity services are urged to make arrangements to provide "translation, interpreting and advocacy services based on an assessment of the needs of the local population".

Joined-up care by an integrated multi-disciplinary and multi-agency team is particularly important where parents are from disadvantaged groups or have particular needs. Maternity and social services are encouraged to have joint working arrangements in place, linking mothers to the appropriate specialist services. Community-based services are encouraged, which could mean services like antenatal clinics based in new children's centres are easier to reach. All NHS maternity care providers and maternity units are encouraged to be "innovative and flexible in meeting the needs of women with communication and other disabilities", and to find out about and make use of examples of good practice.

Managing pre-pregnancy health

The Framework stresses that some women with specific conditions will need information to manage their health before conception and during pregnancy. First time expectant parents are offered free books published by the Department of Health, which also produces area-based guides to maternity services that are free on request and should be available in a range of accessible formats. (E-mail: doh@prolog.uk or tel: 08701 555455.)

Preparation classes

Parenting and birth preparation classes should be available to all parents. Such classes are useful because they: give information and practical guidance; reassure and build confidence; and give parents-to-be a chance to meet up.

Classes should meet the needs of all parents _ including fathers as well as mothers, single parents and single sex couples, parents with learning difficulties, parents with mental health problems, Deaf and visually impaired parents and others. Access needs should be met. Examples include organising a British Sign Language interpreter for a Deaf parent, someone to explain things in plain English to a parent with learning difficulties, checking wheelchair access and providing help with transport.

Forward planning

Some maternity hospitals provide a service to plan for the needs of disabled mothers and fathers. This kind of planning is recommended in the Framework. Several maternity hospitals now have specialist midwives who make sure that the particular requirements that disabled mothers and fathers may have are addressed in good time.

A disabled woman's choices in childbirth should not be unreasonably limited. Disabled parents are sometimes told that they cannot use equipment such as the birthing pool, for example, or are automatically discouraged from giving birth at home. Research suggests that disabled women are more likely to be offered caesareans, sometimes without a known medical reason. The Framework emphasises that this should not happen.

The following are examples of practical matters that need to be sorted out well before a birth involving a disabled parent: booking an interpreter; getting hold of the right equipment for birthing and the early days of parenting; and finding accessible rooms and familiarising disabled parents with these.

Support for new parents

Life with a new baby is challenging.

It is a really important time for all parents to be able to find good support, practical help and encouragement. Good co-operation among general practitioners, midwives, health visitors, and specialist health and social services through the antenatal, birth and postnatal periods is really important.

The Framework recognises that many disabled mothers will need specialist advice: for example, up-to-date specialist advice about breastfeeding for mothers who are taking medicines.

The Framework notes that "Studies have shown that a new mother's health problems are often not identified or reported prior to post-natal discharge. Many of these health problems can persist in the long term leading to ongoing pain, disability and depression".

Joined-up care

Joined-up care can include a `key' worker, to make sure that all the relevant people work together to provide extra support where it is needed. So that multi-disciplinary co-operation across the maternity services, general health service and voluntary sector can become a reality, it is suggested that new roles may need to be developed; for example, appropriately trained maternity support workers, integrated into both the hospital and community postnatal care teams; new advocate and link worker roles; and new consultant midwife roles.

Postnatal support

There are many groups open to new parents.Some have a particular focus such as baby massage or dealing with challenging behaviour. Others are for parents in similar situations: for example, parents from ethnic minorities, single fathers, Deaf parents, parents with visual impairments, parents with disabled children, parents with learning difficulties, parents with mental health difficulties, or parents with drug or alcohol-related problems.

Disabled parents often welcome peer support and the opportunity to meet with others dealing with similar situations. At the same time, it is important that disabled parents have the fullest possible access to mainstream parent education and support.

Vision into reality

The law says that disabled parents should be treated fairly, and their privacy and family life respected. The way that health professionals treat disabled parents can make a huge difference in the critical early days of parenting.

In order to turn the Framework's vision of a truly responsive service into a reality, service providers will need to follow the lead of those who already exemplify good practice.

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