Improving Maternal and Neonatal Health Outcomes by Engaging the

Whole Family

Duncan Fisher, OBELuis Figueira

| CEO, Maternity Assist

| Cloud Lead, Boxfusion Consulting

Oracle Open WorldSan Francisco, September 29th 2014

In 2012, there were the equivalent of 20,935 full-time midwives working in the NHS in England.

In 2012 there were 694,241 babies born in England

The RMC’s assessment of the shortage of midwives in the NHS in England in 2012 is around 4,800.

but the number of midwives working in the NHS in that year was only really suitable for 565,245 births

meaning there were 128,996 more births than the service was designed to cope with.

https://www.rcm.org.uk/sites/default/files/State%20of%20Maternity%20Services%20report%202013.pdf

+23%+23%

NHS midwives in England are getting older. The largest age group in 2001 was midwives aged between 35 and 39; the largest age group in 2012 was those aged 45 to 49.

https://www.rcm.org.uk/sites/default/files/State%20of%20Maternity%20Services%20report%202013.pdf

The effect of the higher number of births is multiplied by the growing complexity of pregnancies. For example:

https://www.rcm.org.uk/sites/default/files/State%20of%20Maternity%20Services%20report%202013.pdf

Increase in the number of births to older women

Older women require more assistance from midwives. They have a perfect right to all that additional care, of course, but it has an undeniable knock-on effect on workload.

+80%80%10%20%30%40%50%60%70%80%85%

The effect of the higher number of births is multiplied by the growing complexity of pregnancies. For example:

https://www.rcm.org.uk/sites/default/files/State%20of%20Maternity%20Services%20report%202013.pdf

Obesity in pregnancy

The incidence of maternal obesity in the first three months of pregnancy in England more than doubled from 7.6% to 15.6% between 1989 and 2007.

The result is extra women requiring more demanding care.

7.6% 2x

“[…] things are beginning to change – with a range of pressures making the work of midwives ever more challenging, unrewarding, and potentially dangerous for patients.”

“[…] As such, it is not just a change in the birth rate that increases the work load for midwives, but the management of the array of needs for each individual woman.”http://www.independent.co.uk/life-style/health-and-families/health-news/a-call-from-the-midwife-why-i-am-resigning-after-10-years-in-the-nhs-9035417.html

Slide with 55 items that need to be covered in the 45 min appointment

Quality issues

For patients:Access of content online (where current generation lives)Curation of informationWell-scheduled interactive information spread through the pregnancy instead of a barrowful of leaflets at the startConvenience / preference – easy ways to ask questions and raise worries outside antenatal appointments

For NHS:There are concerns about the quality of information found on the internetPublic health concerns, antenatal education, youth services for young parents, … introducing people to local services (housing, benefits)Save midwives’ time for higher risk familiesIdentify concerns of patients and their families early before they escalate

“Due to understaffing I regularly work for nearly 13 hours without

a break […]. These tasks are

essential to maintain the safety of women and their babies.”

PolicyAutomation

Service Cloud Platform

PolicyAutomation

Dynamic Interviews Compliance Management Rule Modeling Policy Lifecycle Policy Analytics Policy APIs

Extensibility & Integration Hosting & Operations Experience Management

Service Cloud Platform

Maternity AssistFeatures

Expectant mothers nominate other family members Self-help questionnaires On-line 24/7 content library “Ask-a-midwife” a question Linked to hospital records Multi-channel: email, twitter, phone, …

Maternity AssistFeatures

Expectant mothers nominate other family members Self-help questionnaires On-line 24/7 content library “Ask-a-midwife” a question Linked to hospital records Multi-channel: email, twitter, phone, …

Maternity AssistBenefits

Relieving overload of communications to families Making maternity services more accessible Systematically communicating health/social

information Engaging the whole family

Demo

[Demo of:- Registration process for mothers & F&F- Pregnancy information on midwife’s console: friends and family, relationship to baby- Segmentation based on above- Look at how different types of users receive different information]

[Demo of:- Segmentation based on weeks pregnant- Mailings on different pregnancy stages to different people]

Liverpool Women’s Hospital

Case Study

Screenshot of article with Mr and Mrs Fletcher video

• Smoking throughout pregnancy is one of the single most important avoidable causes of adverse pregnancy outcomes.

• Approximately one quarter of German mothers smoked during pregnancy.

Family centred care: the evidenceSocial networks and smoking reduction

Aveyard, P., Lawrence, T., Evans, O., & Cheng, K. K. (2005). The influence of in-pregnancy smoking

cessation programmes on partner quitting and women's social support mobilization: a randomized

controlled trial ISRCTN89131885. [Article]. Bmc Public Health, 5. doi: 10.1186/1471-2458-5-80

Nguyen, S. N., Von Kohorn, I., Schulman-Green, D., & Colson, E. R. (2012). The Importance of Social

Networks on Smoking: Perspectives of Women Who Quit Smoking During Pregnancy. [Article]. Maternal

and Child Health Journal, 16(6), 1312-1318. doi: 10.1007/s10995-011-0896-4

• Men‘s dominance in household and community decision-making in Niger, coupled with their lack of knowledge about the advantages of clinical care in childbirth, mean that many women are continuing to give birth at home, unattended. A mother dies in childbirth, and 6 newborn babies die, every two hours in Niger.

• A total of 1600 men are now involved in the scheme. In one district […] the rate of attended childbirth [rose] from 15% to 74% of births

Family centred care: the evidenceEngaging fathers saves babies’ lives

http://www.fatherhoodinstitute.org/2013/case-study-husband-schools-in-niger/

Family centred care: global interest

“To prevent mental health disorders, we need to prevent childhood adversities, and for this we need family-focused policies that strengthen the capabilities of parents to reduce violence, illness, and poor functioning.”

Report on UN Forum, "The Significance of Parents for Human Development”, June 2014

http://www.upf.org/global-day-of-parents-2014/5943-forum-at-the-un-discusses-the-significance-of-parents-for-human-and-societal-development

Prof Panter-Brick, Yale University, at UN Forum in June 2014, "The Significance of Parents for Human Development”