CENTRAL HEALTH SOLUTIONS LIMITED
PRECONCEPTION CAMPAIGN Michelle Dyoss Public Health Specialist Director Central Health Solutions Limited CENTRAL HEALTH SOLUTIONS LIMITED With thanks from our sponsors
THE CAMPAIGN Why are we doing this
STATISTICS Infant Under 18 Smoking at Mortality Breastfeeding Low birth Conceptions time of Rate per Initiation weight per 1000 delivery 1000 Walsall 7.1 31.5 65.5% 13.2% 4.1% Sandwell 6.7 31.0 68.5% 9.8% 4.0% Wolverhampton 5.6 18.9 66.8% 17.7% 3.4% Dudley 5.5 20.4 55.3% 14.4% 3.6% West Midlands 5.9 21.4 68.9% 11.9% 3.2% National 3.9 18.8 74.5% 10.8% 2.8%
VARIATIONS ACROSS EACH AREA The wards in Wolverhampton with the lowest rates of teenage conception are Tettenhall Regis with 7.2. In comparison, East Park has 55.5 teenage conceptions per 1,000 which is nearly three times the national average. Infant mortality rates vary across Walsall with less than 5 per 1,000 live births in the least deprived areas compared with rates of 32 per 1,000 in the most deprived areas of Walsall. Low birth rates in Dudley are higher in Dudley Central (9.5%) Highest rates tend to be in areas of higher deprivation
INFANT MORTALITY Numerous risk factors are associated with infant mortality and stillbirth, including: Smoking Ethnicity Age Infant Nutrition/Breastfeeding Deprivation and Poverty Maternal obesity Infections
DUDLEY
SANDWELL
WALSALL
WOLVERHAMPTON
DEPRIVATION Stillbirth rates in the most socio-economically deprived areas are twice as high as those in the least deprived. Rates of smoking in pregnancy in the most deprived areas of England are 5 times those in the least deprived areas Folic acid use in early pregnancy varies by level of deprivation, with more women in the most deprived areas failing to take supplements. People living in deprived areas generally have poorer health.
SMOKING Smoking subjects the foetus to harmful chemicals which narrows blood vessels limiting the baby’s oxygen supply. Smoking increases the chance of the baby being born premature. Second-hand (passive) smoke can harm babies, so it is important to also encourage dad to quit. Smoking increases the risk of cot death (SIDS). The earlier mum stops smoking, the better , but even stopping in the last few weeks before birth still brings benefits to their babies.
MATERNAL WEIGHT Obesity in pregnancy can affect monitoring of the child which can include premature birth, and an increased risk of stillbirth (from an overall risk of 1 in 200 in the UK to 1 in 100 if you have a BMI of 30 or more). There is a higher risk of foetal abnormality, such as neural tube defects like spina bifida. More likely to suffer from pre-eclampsia and gestational diabetes. Children are 3.6 times more likely to be obese themselves if their mother is obese. NICE Guidelines advise that obese women are helped to lose weight before they become pregnant.
DIET Sperm quality is affected by diet. • Diets high in processed meat, alcohol, caffeine, red meat, saturated fats are linked to low quality sperm. • Diets rich in fruits, vegetables, wholegrains and fish are linked to better sperm quality. • Eating a portion of walnuts a day was shown to help with sperm motility. A healthy diet before pregnancy will affect the baby’s development in the womb and their health in the future. W omen should take folic acid tablets before getting pregnant to give maximum protection to the baby against neural tube defects such as spina bifida.
HEALTHY START VITAMINS W omen’s vitamin tablets (from 10 weeks pregnant) contain: folic acid, vitamin C and vitamin D Children’s vitamin drops (from four weeks old and who are having less than 500ml of infant formula a day) contain: vitamins A, C and D Available from Sure Start Centres, Health Centres and some Pharmacies
MATERNAL NUTRITION Cath Fairlie
ALCOHOL Alcohol passes from the blood through the placenta and to the baby. There is no known safe level for drinking during pregnancy, so the safest approach is not to drink at all while pregnant or trying for a baby. Foetal alcohol syndrome (FAS) is the name given to problems that are found in children whose mothers drank heavily during pregnancy. These include facial abnormalities, heart defects, poor growth and severe mental and developmental problems.
PHYSICAL ACTIVITY Being active can boost fertility. Women who do regular, moderate exercise get pregnant quicker than women who don’t exercise regularly. Being active and spending less time being sedentary can help with getting pregnant, pregnancy and mental wellbeing. Women who are fit, strong and flexible may find it easier to cope with pregnancy. Labour is easier for women who are active during pregnancy.
ETHNICITY South Asian women are 60% more likely to have a stillbirth than white women. And infant mortality is twice as common for babies born to Caribbean and Pakistani when than white women. These ethnicities may be more likely to live in a deprived area and more likely to have parents in a less advantaged socio-economic position. Biological factors such as variation in birthweight and length of gestation. Gestational hypertension is more common with black women. Congenital abnormalities and genetic diseases
WHAT INFLUENCES PEOPLES IDEAS ABOUT HEALTH ?
WHAT INFLUENCES PEOPLES IDEAS ABOUT HEALTH Social situations Circumstances Own expectations Knowledge Values Personal experiences Cultural factors
HOW TO HAVE HEALTHY CONVERSATIONS? Physical Activity Weight Diet Alcohol Making Every Contact Count Smoking
HOW TO HAVE HEALTHY CONVERSATIONS? How would you start a conversation? How would you break down barriers? How would you encourage a lifestyle change?
HOW DO YOU FEEL TODAY? T ell me what makes it a 4 and not a 1 What would it take to make you move further up the scale? What might prevent this? How confident are you that you can make this change?
IS THIS YOUR FIRST PREGNANCY? What do you fear? What is important to you right now?
PROVIDING BRIEF ADVICE Y ou don't have to be an expert Small but significant changes Non judgemental Signposting
MOTIVATIONAL INTERVIEWING Video clip
MOTIVATIONAL INTERVIEWING People are more likely to change if basic needs are attended to: • Autonomy in making decisions • A sense of their own competence in making the change • Being supported by key people around them (including healthcare professionals) • When patients hear themselves (as opposed to you) speaking about change, then their motivation improves and outcomes are better .
GOOD TIPS Active listening Paraphrasing Quiet place Share facts? Positive body language You are a healthcare professional, the public trust you!
CHECKING UNDERSTANDING ‘Can I just check that I have heard you right’ ‘So what you seem to be saying is...have I got that right?’ ‘Would it be ok if I summarised how I see the situation and you can tell me if I have got the correct picture?’
THE CAMPAIGN Support people before they conceive Supporting healthy pregnancies Supporting healthy births Supporting healthy babies and children
TOMMY’S TOOL T ommy's T ool
AUDIT
PAYMENTS Additional payments: 10 interventions = £15 Photos of campaign = £50 for 10 - 20 interventions = £25 best campaign, £25 each for 2 runners up At least 5 completed Tools = £20 Screenshots of completed Pharmacy staff feedback Tools = £50 for most screenshots, £25 each for 2 runners up
TO CLAIM www.1centralhealth.co.uk/pregnancy www.1centralhealth.co.uk/pregnancysignup
NEXT STEPS Evaluation report Possible extension/new service
VIDEO Video Clip
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