7- Normal pregnancy and labour (Antenatal care con: Safeguarding and mothers mental health) Flashcards
vulnerable women in pregnancy include
o Women aged 19 or under at booking
o Disclosure of substance misuse
o Disclosure of domestic violence
o Learning disabilities
o Recent migrants, asylum seekers and refugees
when should relevant vulnerabilites be identified
first contact- i.e. booking appointment
what sort of questions should be asked in regard to safeguarding concerns
- age
- substance misuse
- domestic violence
- residency status
- domestic violence
- learning disability
pregnancy in women <19
Women giving birth in their teenage years are at higher risk of adverse birth outcomes
including:
- stillbirth
- perinatal death
- neonatal death
Young parents are disproportionately more likely to have
experienced poverty, poor housing and educational under-achievement.
substance abuse in pregnancy
greater risk of
- maternal death
- miscarriage
- stillbirth
- malformations
- neurokogical damage
There is a direct adverse impact on the physical, mental and emotional development of the children of parents with addictions. Women
with addictions will face many barriers to accessing care and may have additional needs including being at risk of exploitation, poor
sexual health and homelessness.
support for pregnant women <19
- Specialist nurses
- Social support i.e. housing and debt
support for pregnant women with substance misuse problems
- drug and alcohol change services
define domestic abuse
“Any incident of threatening behaviour, violence or abuse (psychological, physical, sexual, financial or emotional)
between adults who are or have been intimate partners or family members, regardless of gender or sexuality”
Domestic abuse in pregnancy
- increases in pregnancy
can cause
- infections
- premature birth
- miscarriage
- injury
- dethas
- stress and anxiety
support for pregnant women experience DV
- advice
- contact numbers
- safe places
- social services
pregnancy and migrants, asylum seekers and refuggees
Women who are recent migrants, asylum seekers or refugees are at a higher risk of poor birth outcomes, particularly when there are
language barriers. Key issues for these women can include poor physical and mental health, medical conditions, FGM, trauma, fears
about immigration status, exploitation and language difficulties (NICE 2010). Women who are new to this country and in difficult
circumstances, may have poor understanding of the healthcare system and how to access care and services.
learning disabilities in pregnancy
- Women with learning disabilities can parent successfully and confidently with the right support; care should be planned to enable them to
have an equal chance to do so. - Barriers to women with learning disabilities receiving care equal to that of women without include
inadequate diagnosis and identification of learning needs, and a lack of effective multidisciplinary working (Malouf et al 2017b). Women
with learning disabilities feel less confidence in maternity staff and perceive that their concerns will be taken less seriously compared to
women without a learning disability; a comprehensive assessment of needs early in pregnancy is needed (Malouf et al 2017a). - Women with learning disabilities are more likely to have their child taken into care, usually due to other social complexities, however there
is no clear evidence linking intellectual ability with parenting competence, and there is evidence that robust support can lead to positive
parenting outcomes for these women.
female genital mutiltation and prgenancy
Should be asked about on booking
Some women with FGM may find it difficult to become pregnant, and those who do conceive can have problems in childbirth.
what is FGM
All procedures involving partial or total removal of the external female genitalia or other injury to the female genital organs, whether for cultural or other non-therapeutic reasons
why does FGM happen
o Mistaken religious practice
o Culture- purification
o Social acceptance, family honour- esp for marriage
o Fear of exclusion
types of FGM
Consequences and complications of FGM
- Infection
- Pain (can be chronic)
- Childbirth problems
- Acute haemorrhage
- Sexual difficulties – fertility issues
- Obstetric
- Psychological
is FGM legal in the UK
how can FGM affect birth
- increased risk of caesarean section
- episiotomy
- post-partum haemorrhage
- extended hospital stay
perinatal mental health def
refers to a womens mental health during pregnancya nd the first year after giving brith
- includes pre-existing and new mental health problems relating to the oregnancy
perinatal mental health disorders
- anxiety
- depression (inc postnatal dep)
- puerperal psychosis
- PTSD
- pre-existing illness
impact/importance of perinatal mental health
perinatal red flags for mental health proble ms
simple lifestyle advice for mild low mood and anxiety
services to support perinatal mental health
perinatal mental health: pre-conceptual counselling
- Women on psychotropic medications should be advised NOT to discontinue treatment if they find themselves pregnant without consultation with health care professional
- Contraception use and pregnancy plans
- Implications of pregnancy and childbirth for mental illness and risk of relapse
- Implications of and treatment in pregnancy- maternal, fetal and neonatal effects
- Risks of no treatment or poor compliance with treatment
- Psychiatric review- options of switching to safer treatments of treatment combinations
- Option of discontinuing treatment safely
management of puerperal psychosis
Women with puerperal psychosis need urgent assessment and input from specialist mental health services.
Treatment is directed by specialist services, and may involve:
- Admission to the mother and baby unit
- Cognitive behavioural therapy
- Medications (antidepressants, antipsychotics or mood stabilisers)
- Electroconvulsive therapy (ECT)
