Pregnancy and infancy
Why is this issue important?
What happens during pregnancy and infancy has a lifelong effect on emotional and physical health and wellbeing. There is strong evidence that children’s life chances are most heavily predicated on their development in the first five years of life. Family background, parental education, good nurturing parenting, and the opportunities for learning and development together, matter more than money, in determining whether their potential is realised in adult life. The things that matter most are(1):
There were 5,375 live births in Kirklees in 2015.(2)28,600 babies and children aged 0 to 4 years make up around 7% of the Kirklees population. In 2015/16, around one in three new babies in Kirklees were from an ethnic minority group.(3) There were 6,595 conceptions in 2014, with a termination rate of 19% in Kirklees for all ages (compared with an England rate of 21%) and 77% for under 16 year olds (where the England rate is 63%).(4) The under 16 conception rate has fallen significantly from 9.8 per 1000 young women in 2009 to 3.4 per 1000 in 2014.(5)
What significant factors affect this issue?
Access to healthcare
A healthy woman is more likely to give birth to a healthy baby. Health professionals and trained peer support can help enable women, and their partners, to adopt positive health behaviours and reduce risk factors.(6) There are several issues which may affect access to maternity services including perceived barriers (such as language), not recognising the symptoms of pregnancy, location and fear.(7)
Good quality care throughout pregnancy can contribute to a more straightforward birth and a reduction in rates of Caesarean sections which are associated with increased risk (such as infection for the mother and breathing problems for the baby); Kirklees has a significantly lower rate of Caesarean section deliveries (24%) than the England average (26%).(8)
Access to postnatal care can ensure that children are immunised in line with the NHS vaccination schedule. Currently the European Region of the World Health Organisation (WHO) recommends that on a national basis at least 95% of children are immunised against preventable diseases – in 2013/14, 97% of babies in Kirklees completed the DTaP/IPV/Hib vaccine course before their first birthday compared with 94% of babies nationally; 96% of babies completed the MenC course compared to 94% nationally; 97% of babies Kirklees received the PCV vaccine before their first birthday compared with 94% nationally.(9)
Pregnant women are more likely to develop complications from the flu. In Kirklees the uptake of the flu vaccine among pregnant women is 41%, which compares to 40% nationally.(9)
Emotional health & wellbeing
People’s social circumstances – a stable family, strong, supportive relationships, friendships and social connections (or the reverse of these circumstances) – have an impact on emotional wellbeing, resilience, and the type and amount of practical and emotional support that parents and infants have. It is estimated that between 10% and 20% of women are affected by mental health problems at some point during pregnancy or the first year after childbirth which, if left untreated, can have adverse impacts on them and their families.(10) When mothers stay mentally healthy they are more able to provide sensitive, responsive care and their children are less likely to experience mental health problems or behavioural, social or learning difficulties.(10)
Peer support or befriending services, including the opportunity to share experiences, can lower the risk of mental illness, reduce symptoms, and improve the quality of life of people affected.(10) NHS Kirklees Primary Care Trust (PCT) commissioned the ongoing Auntie Pam’s Supporting Mums-to-be service in 2010 to engage more women of childbearing age with local services, with one of the key outcome objectives being the improvement of emotional wellbeing, self-esteem and motivation.
The antenatal course Preparation for Parenthood was developed by Kirklees Public Health Team in 2015, in partnership with Locala and local maternity services. This free, six session course aims to prepare parents for both the birth of their baby and for parenthood. One of the key objectives was to provide a platform for peer support and social support.
Furthermore, Kirklees Council commissioned the Homestart home visiting volunteer support service to help enable families with young children deal with the challenges they face. In October 2016, South West Yorkshire Partnership NHS Foundation Trust was awarded £2.1million by NHS England to provide specialist mental health support to women across Kirklees, Calderdale, Wakefield and Barnsley to support women during pregnancy and after their baby is born.
Figure 1 – Source: Public Health England: Health Matters
Personal choice and lifestyles (including diet, smoking, alcohol and substance use and physical activity levels) have a significant impact, for better or worse, on general health and wellbeing. They also have an impact on foetal, infant and child development. Eating healthily during pregnancy helps an unborn baby to develop and grow normally. Keeping active during pregnancy can help mothers cope better during pregnancy, labour and after their baby is born. Smoking in pregnancy is a major cause of avoidable differences in health between groups. It contributes to other pregnancy complications such as placental insufficiency, high blood pressure and deep vein thrombosis for the mother and it increases the risks of asthma in the child, preterm birth, stillbirth and infant mortality including SIDS. It also increases the risk of low birthweight in term babies.(11) Women who drink alcohol or take recreational drugs are at higher risk of preterm birth and having a baby with health complications.(12)
In Kirklees in 2015/16, mothers of white ethnicity had the highest proportion of smokers (17%) followed by mothers of mixed ethnicity (16%). Only 2% of South Asian mothers were smokers at the time of delivery.(13) Around one in eight (13%) mothers in Kirklees was a smoker at the time her baby was born. Excluding South Asian women, this proportion was around one in six (17%).(14)
Breastfeeding is a key indicator of child health and wellbeing as it has some of the most wide-reaching and long-lasting effects on development. Human milk is an affordable and sustainable source of nutrition and breastfeeding contributes to significant savings to the NHS. Babies who aren’t breastfed have an increased risk of gastro-intestinal, respiratory, ear, and urinary tract infections, childhood leukaemia, Sudden Infant Death Syndrome (SIDS), necrotising enterocolitis, type 1 and type 2 diabetes, obesity and allergic diseases (such as asthma and eczema) and suboptimal oral and neurological development. Despite this, the UK has one of the lowest breastfeeding rates in the world.(15) There are a number of multi-factorial predictors of whether or not a mother breastfeeds including perceived benefits, convenience, access to support, pain, medical issues, returning to work amongst many other complex cultural and social influences.(16)
In 2015/16 Kirklees 77% of new mothers started to breastfeed at birth (compared to 74% nationally in 2014/15), however by six to eight weeks after birth, breastfeeding rates had dropped to 43%.
In 2014/15 Kirklees had a significantly higher rate of babies under the age of one admitted to hospital for gastroenteritis (2.1%) and respiratory tract infections (6.4%) than the national average (1.7% and 5.2% respectively). By reception age, almost a quarter (24%) of children in Kirklees were above a normal weight, which is significantly higher than nationally (22%).(17)
Preterm birth, low birthweight babies (less than 2500g), stillbirth and infant mortality are indicators of the broader health and wellbeing of populations; they can be highly traumatic for those affected by them. Positive health behaviours, access to maternity and genetic counselling services and an increased understanding of the impact of pregnancy as a result of relationships within the extended family have all contributed to lower rates of preterm birth, stillbirth and infant mortality in recent years.
Babies who are born preterm (before 37 completed weeks of pregnancy) are not fully prepared to live outside the mother’s womb and have an increased risk of long-term physical and neurological health issues and mortality. Babies whose weight is normal are less likely to develop childhood asthma, become obese, or suffer diabetes late in life.(18) Babies who are born early are more likely to have a low birth weight although full term babies can also have a low birthweight. In 2014 in Kirklees, the proportion of full term babies who had low birth weight was 3.7% (which is significantly higher than the rate for England 2.9%) and there are clear inequalities depending on area; in 2015/16 Dewsbury and Mirfield District Committee had the highest rate (4.5%) whereas Kirklees Rural had the lowest (2.7%).(19)
In 2015, Kirklees had a similar rate of stillbirth compared to nationally (3.2 compared to 4.4 per 1000 births).(20) The infant mortality rate in Kirklees (2013-2015) has dropped in recent years, but still remains above the England rate: 5.1 per 1000 births in Kirklees compared to an England rate of 3.9/1000.(17).
Teenage pregnancy is also a Public Health issue due to the wider health and economic associations. There can be adverse impacts on training and employment and an increased risk of premature birth and low birth weight babies. In 2014, the rate of under-18 conceptions was 27 per 1000 which is higher than the national average (23/1000).
Figure 2 – Source: Public Health England: Health Matters
Where is this causing greatest concern?
- North Kirklees had significantly more mothers (15%) who were smokers when their babies were born compared to South Kirklees (11%). Excluding South Asian women, these proportions were 22% and 13%.(14) One in 6 (17%) of mothers living in the most deprived areas were smokers at the time their baby was born compared to one in 20 (5%) of those living in the least deprived areas.(21) In 2015/16, around three in 10 (29%) of mothers under the age of 20 were smokers at the time their baby was born compared to around one in 10 (9%) mothers aged 30 or over.(22)
- There is a difference in breastfeeding between North and South Kirklees, with 70% of mothers in North Kirklees starting to breastfeed in comparison to 83% in the South, and 38% of North Kirklees mothers still reporting breastfeeding at 6-8 weeks after birth in comparison to 48% in South Kirklees.(23)(24)
- There are inequalities in mortality rates depending on area; the rate was highest in Dewsbury and Mirfield (6.5/1000) and Batley and Spen (6.3/1000) and lowest in Kirklees Rural (1.9/1000).(25)
- The rolling figures for teenage pregnancy from 2012-14 indicated that the Wards with the lowest teenage conception rate were in Kirklees Rural; Denby Dale, Kirkburton and Holme Valley South all below 15/1000. The Ward with the highest teenage conception rate was Golcar followed by Dewsbury East and Cleckheaton.(26)
What are the assets around the issue?
Health assets are those things that enhance the ability of individuals, communities and populations to maintain and sustain health and well-being. These include things like skills, capacity, knowledge, networks and connections, the effectiveness of groups and organisations and local physical and economic resources. They also include services or interventions that are already being provided or beginning to emerge which contribute to improved health and wellbeing outcomes.
Assets are hugely important to how we feel about ourselves, the strength of our social and community connections and how these shape our health and wellbeing.
As part of our KJSA development we are piloting a range of methods to capture and understand the assets that are active in Kirklees. Please see the assets overview section for more information about our approach and if you are interested in place-based information about assets in Kirklees have a look at the assets section in each of our District Committee summaries (Batley and Spen, Dewsbury and Mirfield, Huddersfield and Kirklees Rural). Where possible and appropriate we will provide information about local assets supporting people across different stages of the life course.
Across Kirklees there are a number of initiatives supporting people through their pregnancy and infancy:
- Thriving Kirklees is a newly commissioned collaboration of services for children, young people aged 0 to 19 and their families. Thriving Kirklees includes the health visiting service which has expertise particularly for families and children aged 0-5 years. A specialist arm of health visiting – known as Family Nurse Partnership (FNP) – supports vulnerable parents-to-be, especially young mothers, from earlier in pregnancy. It can provide more intensive and extended support, building the confidence and skills of young parents in order for them to empathise and nurture a child. A wide range of specialist skills will be cascaded at appropriate levels across all staff and also extending to volunteers, peer supporters and the wider community. This will enable more face to face contact and support for young and expectant families and build the capacity to nurture within communities.
- The overall purpose of Nurturing Parents is to develop safe, healthy and happy children by supporting parents to bond, nurture and communicate with their child with the aim of giving every child in Kirklees the Best Start in Life. Nurturing Parents is about enabling and supporting parents to have a close and loving relationship with their child. It is about preparing for and coping with parenthood both during pregnancy and during the early weeks, months and years, as these are really important for ensuring children get the best start in life. The earliest experiences, from pregnancy onwards, shape a baby’s brain development and have a lifelong impact on mental and emotional health. Supporting good quality bonding and attachment therefore offers long term benefits for children which will continue into adulthood. Nurturing Parents is taking a partnership approach across the district, involving professionals and volunteers who support pregnant women and families. The Nurturing Parents ethos is at the heart of the Kirklees Integrated Healthy Child Programme.
- Preparation for Parenthood is one strand of Nurturing Parents. It was developed out of work undertaken with families in Kirklees, with local parents reporting that they felt that they could have been more prepared for becoming parents. Preparation for Parenthood was therefore created to fill a gap identified around antenatal information. Content was designed in partnership with parents and stakeholders such as Midwives and Health Visitors. It is a free six session course and aims to prepare parents for both the birth of their baby and for parenthood. It also supports parents to develop a close and loving relationship with their child during pregnancy and the early weeks and months. The courses have proved extremely popular with expectant parents. A robust evaluation of the initial pilot was undertaken in 2016 and is available on request.
- Auntie Pam’s Supporting Mums-to-be is a service which was commissioned by NHS Kirklees PCT and is now provided by Kirklees Council. It was launched in March 2010 with the opening of the Dewsbury centre. The Huddersfield centre was established in November 2014. The service provides a safe place for women of childbearing age to speak about the issues that matter to them. The aim is to empower these women to make positive lifestyle choices to ensure good health and wellbeing for themselves, their family and their community. Intensive scoping conducted prior to the launch of the service indicated that the women who weren’t accessing maternity services would be inclined to speak to “someone like them”. The service is therefore delivered by trained volunteer peer supporters who receive specialist training and are supported by Public Health professionals to ensure they have the skills and resources to provide the best possible service.
Views of Local People
Several pieces of insight generation work has taken place within the area of pregnancy in maternity as part of the process of designing the Nurturing Parents Preparation for Parenthood pilot and to further our understanding of infant feeding.
Some general engagement with mums and dads about their experiences of being a parent revealed several key insights:
- Feeling unprepared for the arrival of their new baby (particularly with practical aspects eg. dressing, bathing).
- Changes in their relationship following their baby’s birth.
- More knowledge needed about feeding and demand.
- Managing tiredness was a big issue for them.
- Needed more knowledge and understanding about postnatal depression, signs and symptoms and where to access support.
- The role of dads needs more clearly involved in the process.
As part of a drive by the Kirklees Infant Feeding group to better understand infant feeding locally, and more specifically to gain an insight into why some mothers were stopping breastfeeding very early, a survey was conducted in 2016(18), covering a range of topics such as thoughts about infant feeding before the baby was born, preparation for having a baby and support after the baby was born. Several key insights into pregnancy and maternity were found:
In 2014, an evaluation of the Auntie Pam’s Supporting Mums-to-be service in Dewsbury was conducted and was repeated in 2016 to take into account the opening of the Huddersfield branch in late 2014.
In 2016, the evaluation revealed:
- Over half of the clients (54%) attending Auntie Pam’s were first time mums.
- One in four (24%) clients in Dewsbury and one in five (20%) in Huddersfield were under the age of 20.
- 77% of service users were White British compared to 83% in 2014; ethnically, the client base is becoming slightly more reflective of the wider comparative population.
- The proportion of clients of Other White backgrounds was higher than the population average indicating that there may be barriers to pregnant migrant women accessing formal maternity care.
- Four in five (80%) received some kind of emotional support during their first visit.
- Since 2014, more service users discussed housing, jobs and parenting in a wider context (ie. relating to their other children).
- Auntie Pam’s has made referrals to around 80 other services; 79% of first contact referrals were relating to finance (benefits/money/rent etc.).
- There is a very high level of satisfaction amongst clients and volunteers.
Together this suggests that the service is a valued community asset which acts as a safety net for those not accessing, or not having their needs met by, formal care.
Healthwatch in Kirklees and Calderdale worked with Calderdale and Huddersfield Foundation Trust (CHFT) to help them improve the way they gather feedback and to look at how they can use feedback as a way to improve maternity services. Their 2017 report and the CHFT response can be found on the Maternity Services section of the Healthwatch website.
What could commissioners and service planners consider?
Commissioners, service planners and Councillors should consider local community assets such as those outlined above so that they can support and build on local strengths and also understand where there are gaps and unmet needs in particular places or amongst particular communities.
Early Intervention and Prevention are priorities for Kirklees Council. Shaping services to support the best start in life helps to support good developmental outcomes, and to reduce the likelihood that specialist services will be needed in the future. The fundamentals of a ‘best start’ include: having a safe, loving and stable home environment; a healthy physical environment; living without poverty.
- The priorities set out by Public Health England in Health Matters Giving Every Child the Best Start in Life should underpin local commissioning.
- Ensuring that organisations, services, workers, volunteers and peer supporters have a shared knowledge and understanding of the importance of early infant brain development, developing a secure attachment and sensitive, attuned parenting.
- The Council and its partners have developed the Healthy Child Programme together. This programme spans the 0 – 19 years age range (up to 25 year old for those with special educational needs). Any new commissioning activity should be shaped by, connect with and complement Healthy Child commissioning strategy and practice.
- Providing the infrastructure and circumstance that makes a healthy lifestyle easy and accessible, and where people have the information and opportunity to make an affordable healthy choice. Commissioners and providers can help to shape the local culture and environment, and create better opportunities to be active, eat well, enjoy better physical and mental health.
- Supporting and developing local community capacity to help people to help themselves and each other to nurture and support, be physically and emotionally well, and to access services in a timely and appropriate way. Family and woman-centred models of care and peer support are especially appropriate in this area.
- A range of accurate data and intelligence about interventions and outcomes to inform local actions, including qualitative information and insight is available through health intelligence specialists in the Intelligence Hub.
- Partners should continue to develop ways to combine resources and efforts to improve outcomes for women, children and families. Systems of collaboration and information sharing between agencies should be supported to reduce duplication and deliver more integrated services. Services should be differentiated to better address the needs of different social and geographic communities.
- Work towards ensuring that appropriate provision is in place to support the needs of those who do not readily access universal services. This will include analysing patterns of access; identifying the health inequalities that arise from (self) exclusion, and taking a co-production approach to identifying ways to change services to support increased access and better outcomes.
- Ensure all health professionals give consistent messages about food, physical activity, alcohol and tobacco, bonding and attachment especially to women of childbearing age.
- Enable further development of peer support delivery based on current insight and understanding of lifestyles, circumstances and choices of women of childbearing age. This will support women seeking solutions to issues, and offer personal development to volunteer peer supporters as they aspire to achieve, contributing to the building of individual and community assets.
- Encourage professionals to act as advocates in relevant planning systems for the health behaviours of women of childbearing age. This should focus on preparing to be a parent, being pregnant and being a parent, and the effect of these behaviours. Professionals need to take a broad approach, targeting women of childbearing age before they become pregnant or even plan pregnancy as well as promoting healthy lifestyle choices for pregnant women and women who already have children.(27)
- Field F. The Foundation Years: preventing poor children becoming poor adults. 2010.
- Office for National Statistics. Birth Summary Table 2015. Available from: https://www.ons.gov.uk/peoplepopulationandcommunity/birthsdeathsandmarriages/livebirths/datasets/birthsummarytables
- Public Health England. Child Health Profile 2016. Available from: http://www.chimat.org.uk/profiles
- Calderdale and Huddersfield Foundation Trust & Mid-Yorkshire Hospitals Trust. Maternity Indicators 2015-16. 2016.
- Office for National Statistics. Conception statistics, England and Wales. 2014. Available from: https://www.ons.gov.uk/peoplepopulationandcommunity/birthsdeathsandmarriages/conceptionandfertilityrates/datasets/conceptionstatisticsenglandandwalesreferencetables
- Public Health England. Health matters: giving every child the best start in life. 2016. Available from: https://www.gov.uk/government/publications/health-matters-giving-every-child-the-best-start-in-life/health-matters-giving-every-child-the-best-start-in-life#supporting-the-transition-to-parenthood
- Haddrill R, Jones GL, Mitchell C a, Anumba DO. Understanding delayed access to antenatal care: a qualitative interview study. BMC Pregnancy Childbirth. 2014;14(1):207. Available from: http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=4072485&tool=pmcentrez&rendertype=abstract
- Public Health England. Health Profiles. 2017. Available from: http://fingertips.phe.org.uk/profile/health-profiles
- ChiMat. Kirklees snapshot- infant mortality and stillbirths. Available from: https://www.chimat.org.uk/maternity/factsandfigures/
- Hogg S. Prevention in mind. 2013; Available from: https://www.nspcc.org.uk/globalassets/documents/research-reports/all-babies-count-spotlight-perinatal-mental-health.pdf
- Royal College of Obstetricians and Gynaecologists. Smoking and pregnancy. 2015.
- NHS Choices. Your pregnancy and baby guide. Available from: http://www.nhs.uk/Conditions/pregnancy-and-baby/pages/pregnancy-and-baby-care.aspx
- Calderdale and Huddersfield Foundation Trust & Mid-Yorkshire Hospitals Trust. Smoking by ethnicity. 2016.
- Calderdale and Huddersfield Foundation Trust & Mid-Yorkshire Hospitals Trust. Smoking at delivery. 2016.
- Unicef. The Benefits of Breastfeeding. Available from: https://www.unicef.org.uk/babyfriendly/what-is-baby-friendly/the-benefits-of-breastfeeding/
- Kirklees Council. Infant Feeding Survey. 2016.
- Public Health England. Children and Young People’s Health Benchmarking Tool. Available from: http://fingertips.phe.org.uk/cyphof
- Public Health Wales. Low Birth Weight Review of risk factors. 2014.
- Kirklees Council. Low birth weight by District Committee. 2016.
- Office for National Statistics. Stillbirth- Local Authority. 2015. Available from: https://www.ons.gov.uk/peoplepopulationandcommunity/birthsdeathsandmarriages/livebirths/datasets/birthsummarytables
- Calderdale and Huddersfield Foundation Trust & Mid-Yorkshire Hospitals Trust. Smoking by IMD. 2016.
- Calderdale and Huddersfield Foundation Trust & Mid-Yorkshire Hospitals Trust. Smoking by age. 2016.
- Breastfeeding at delivery 2015/16. 2016.
- Breastfeeding at 6 to 8 weeks 2015/16. 2016.
- Office for National Statistics. Infant mortality by District Committee. 2015.
- Kirklees Council. Teenage conceptions Ward level 2012-14. 2014.
- Department of Health. National service framework for children, young people and materniety services: Core standards. 2004;1–190.
Date this section was last reviewed