Issue 2
Ko taku māma taku kai, taku parenga me tōku kāinga – mehemea kai te pai a ia, kai te pai ahau
My māma is my nutrition, my protection, and my home – if she is well, I am well.
The Best Start Early Pregnancy Assessment funded by an HRC DHB Collaborative Research Grant
This second of our quarterly newsletters outlines the progress of the Best Start Research project.
Modules 1 and 2 have been running parallel and similar issues related to early pregnancy assessment were identified from the two perspectives of the Hapū Māmā Village insights (Module 1) and the initial Clinical Practice team (Module 2).
Technological issues related to the Best Start Tool for the Clinical Team were noted, however most of these were resolved by awareness that the form could be re-opened, and additional data added or updated.
Module 1 Hapū Māmā Village
Hapū Māmā Village is the co-design activity led by Prevention Partner Healthy Families, where hapū māmā stories and journey through pregnancy mapping expressed the experiences at a series of hui. In addition, the Team met with a variety of health professionals working with hapū māmā. From these hui key themes were developed. Extensive data has been collected by the Hapū Māmā Village team from hapū māmā and health professionals. Many general comments were similar specifically with regard to the systemic and structural inadequacies of the current health system in supporting pregnant women in the primary health care sector.
To date, some of the issues identified include trust, communication, lack of reliable information, maternal mental health, lack of knowledge about the GP's role in early pregnancy, problems with referrals, inability to find a lead maternity carer (LMC Midwife), lack of antenatal and birthing education. The Hapū Māmā Village team are currently collating the vast amount of information gathered so that Insights can be published, alongside research evidence found and recommendations made.
The Team kept the Research Collaborative informed throughout of progress and a final 'walk through' of all the raw data was held with the opportunity for one-to-one questions and answers.
Module 2 Clinical Team
The Clinical Team at the lead research practice Gonville Health has been engaged in the initial stage of the research and has identified a number of clinical practice issues.
Clinical issues to date have included:
Systemic
- inconsistencies arising from the current
- system incomplete recordings
- inconsistent follow up processes
- minimal liaison with LMC midwives
- lack of access to shared maternity care records
- unstructured processes around early pregnancy care
- variable identification of clinical risk variable use of referral options
- insufficient time within 15 min GP appointment
- current structure of GP clinical visits is not meeting the needs of many hapū māmā
Medical
- STI/UTI management in pregnancy
- Iron deficiency management
- Cardiac including arrhythmias/palpitations; murmurs
- Hypothyroidism
- Cholelithiasis
- Tuberculosis contact
- Epilepsy
- Current alcohol or drug misuse/ dependency
- Depression and anxiety disorders
- Asthma
- Acute respiratory conditions including Influenza-like illness, Hepatitis B, low immunity
- Previous SUDI (Sudden unexplained death of an infant)
Postnatal
- Postnatal depression - need clarity for screening tools and diagnostic criteria
- Management of minor neonatal abnormalities
- Maternal medication with risk to pēpī
Smoking cessation support
- Close liaison with Stop Smoking Services
Clinical Team responses to date
- Dedicated Nurse Practitioner lead/pregnancy care coordination
- Safeguarded appointment times
- Option of minimum brief assessment with virtual follow up
- Default ‘warm handover’ during Best Start appointments to health coach
- Upload option for pregnancy data to Clinical Portal for LMC midwife access
- Clinical issues peer meetings
The value of appointing a dedicated Nurse Practitioner, a Health Information Profession and/or a counsellor was evident and has enhanced the care of hapū māmā at the Clinic.
Module 3
The Wrap Around module explores the support for any pregnancy wellbeing services that exist in the community. There are a number of excellent services offered but the referrals appear ad hoc and engagement with health services unstructured. Work is continuing on this module so that pregnancy related risk referrals, management and equity gaps can be addressed via appropriate pathways of care.
