Chatting about sex and contraception while brewing a pot of tea or making a sponge cake is all in a normal day’s work for Jinny Robinson, the winner of the NT Award for Maternity Services, sponsored by NHS North West. ‘People say all you do is make tea,’ she complains. ‘I may be making tea but I am having this conversation at the same time.’
Ms Robinson is the lead for teenage pregnancy for the Ashford Midwifery Project in Kent. Part of the project involves her running a young parents group with a Sure Start maternity care assistant and an education reintegration officer. The young able parents (YAP) group aims to teach young mothers about parenting and other life skills, and to break the downward spiral that often occurs with teenage pregnancy by encouraging them to go back to education and ensure their next pregnancy is planned.
When working with teenagers you really have to ‘break all the moulds’, Ms Robinson explains. ‘They don’t want to sit in a classroom and learn how to bath their babies – it reminds them of school.
‘We do cooking, we have pamper sessions, we take photos, we make Christmas cards and I provide health education by subtly introducing a topic and then they all start talking about it.
‘They get used to the commitment of a weekly group. We give them some responsibility, like clearing up, and it builds their confidence and group skills. Our aim is to move them on to what we want to call YAP Plus, where they will do short accredited courses such as “Speakeasy” and “Cook and Eat”.’
The group usually has six to eight regular attendees, who turn up for a few months and then move on. ‘Quite a lot have gone back to college. One wants to be a mechanic and another wants to be a hairdresser,’ Ms Robinson says proudly.
The government’s Teenage Pregnancy Strategy has set a target to increase the proportion of teenage parents in education, training or employment to 60% by 2010 as well as halve pregnancies in the under-18s.
It was the midwives’ involvement with initiatives such as this – which are not generally considered core maternity care – that persuaded the judges to present the NT Award for Maternity Services to the Ashford Midwifery Project. They praised the project for achieving so much in so many areas.
The project began as a Sure Start pilot in March 2006, providing midwifery services to vulnerable women and their families out of The Willow – a children’s centre in Ashford. The centre’s friendly non-clinical environment proved attractive to the women, a third of whom are under 20. As staff had hoped, they continued to use the centre once they had given birth. The project was made permanent and, bit by bit, its services were extended, aided in part by it being the first place in the country to take six-week postnatal checks over from GPs. The project now offers breastfeeding workshops, antenatal education and a family-planning clinic in partnership with Eastern and Coastal Kent PCT, as well as the young parents’ group.
Around 30% of all pregnancies are unplanned so NICE has recommended that long-acting reversible contraceptive (LARC) methods, such as injections, implants and intra-uterine devices are promoted, to try to reduce this figure. LARC methods are more effective than the contraceptive pill because patient compliance is not required. While LARC methods account for less than 10% of contraceptives used nationally, in Ashford rates have been driven up to 37%.
Unusually for the area, Ms Robinson and a couple of the other midwives are trained in family planning. Ms Robinson trained immediately after qualifying as an adult nurse in 2003 before becoming a midwife.
‘That is why we have achieved a high increase in the use of LARC methods,’ she adds. ‘Our background knowledge of contraception helps in the care management of these women. Instead of telling [clients] to wait for their six-week postnatal check, we bring women into the family-planning clinic after three weeks, so they have their implant fitted.’
Contraception is a subject Ms Robinson talks confidently about. ‘I bring it up in antenatal education, which I am not convinced happens elsewhere. It is quite unusual to go to a parenting class and talk about sex and contraception. Being trained in family planning gives you kudos. People trust what you are saying.’
It is for this reason that Ms Robinson has decided to spend the £1,000 prize money on contraceptive resources for the community midwives. ‘It will help them relay up-to-date and accurate information,’ she says.
Home-delivery rates have also been driven up to 5%, whereas the UK average is just 2%. Ms Robinson believes this has happened because the families using The Willow centre are friends and talk to each other. ‘Once one has a home delivery, they’ll all have them; it gives them reassurance.’
She adds that women who attend a GP surgery do not form the same sort of friendships with each other. In addition, the atmostphere in the centre has helped to push up breastfeeding rates at six weeks
to 45% – the rate in the PCT as a whole is just a third. ‘That is quite good, particularly as we are a disadvantaged area,’ explains Ms Robinson. ‘If you have got a friend who breastfeeds, you feel much more comfortable about doing it yourself.’
The project has also succeeded in encouraging the vast majority of fathers to attend antenatal classes, whereas typically only half would be expected to turn up. According to Ms Robinson there are two reasons for this: ‘Firstly we are multidisciplinary so we work with health visitors and we also have psychologists on board doing a lot of bonding. We also run the service out of hours, from 6–8pm, so more people are coming along, particularly the dads, who are normally at work.
The two biggest barriers that had to be overcome were GPs’ reluctance to let go of the six-week checks and persuading health visitors, who were not used to working out of hours, to provide the antenatal classes in the evening. Effective communication, including monthly lunches with health visitors, was key to overcoming these hurdles, Ms Robinson reveals. ‘Professional relationships are hard but because we talk to each other, everyone understands why it is important.’
Anne Jackson-Baker, former director at the Royal College of Midwives, who was one of the judges for the award, says Ms Robinson particularly impressed her because she let no obstacle block her progress. Ms Jackson-Baker describes her as someone with a lot of passion, energy and modesty, saying: ‘She had a real desire to make a difference and has also enthused others to be equally committed to the cause.’
Giving maternity services through a children’s centre
The pleasant, non-clinical environment of a children’s centre is often more appealing to young mothers than a GP surgery
Women attending a children’s centre for antenatal care become used to committing to a weekly group
Friendships formed act as a driver for change, such as encouraging breastfeeding and home births
Midwives’ bonds with mothers can be extended by taking over six-week checks from GPs
Family-planning training is a very useful tool for midwives
Unplanned pregnancies can be reduced by discussing future contraceptive options with parents
Use of long-acting reversible contraceptives reduces unplanned pregnancies because, unlike the contraceptive pill, effectiveness is not compromised by poor compliance, stomach upsets and drugs such as antibiotics
Running antenatal classes in the evening serves to boost attendance of fathers