National Institute for Health and Clinical Excellence (NICE)
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NICE opens consultation to improve care for pregnant women with complex social factors

The National Institute for Health and Clinical Excellence (NICE) is developing guidance to help the NHS provide better and more effective antenatal services for pregnant women faced with difficult social circumstances. As part of this process, the draft version of the guideline, which contains recommendations for healthcare professionals, has been published on the NICE website and is now available for public consultation.

The guideline, which is being developed in collaboration with the Social Care Institute for Excellence (SCIE), is available on the NICE website. Comments on the draft recommendations contained in the guideline must be received by 12 April 2010. Only registered stakeholders such as professional and government organisations, patient and carer groups and companies can comment formally on consultations but organisations can register as a stakeholder at any time during the development of a guideline.

The complex social factors experienced by teenagers, recent immigrants, asylum seekers, refugees, those who misuse drugs and those who experience domestic abuse are consistently linked to poor birth outcomes. The risk of stillbirths and baby deaths in the first six weeks is highest in babies born to young women aged below 201.  Other complex social factors, including substance misuse or being a recent migrant, asylum seeker or refugee are associated with an increased risk of maternal and/or infant death around the time of birth.2,3 Domestic abuse, so often unrecognised, is another source of risk and complications for the mother and her baby.

Christine Carson, Programme Director for the Centre for Clinical Practice at NICE, said: “Expectant mothers need support throughout their pregnancy yet some groups of women do not access traditional antenatal care services because of issues such as domestic violence, teenage pregnancy or not having English as a first language. Although these women represent a small proportion of those having babies in the UK each year, they and their unborn children deserve the same level of care as anyone else.”

“We have asked an independent committee, including representation from both health and social care to consider all available evidence on this subject and they have made draft recommendations where appropriate, which are now out for consultation. We hope the final guideline, due to be published later this year, will help midwives, GPs, obstetricians, commissioners and managers across the NHS and social care  to develop services that will encourage these hard-to-reach groups of pregnant women to engage with services that help to deliver effective care and support.” 

This new guideline will focus on improving antenatal services for young women aged under 20, non-English speaking women, recent migrants, women with a substance misuse problem and those experiencing domestic abuse.

1,2Confidential Enquiry into Maternal and Child Health (CEMACH) Perinatal Mortality 2007: United Kingdom. CEMACH: London, 2009

3 Confidential Enquiry into Maternal and Child Health (CEMACH) Saving Mothers’ Lives 2003-2005: United Kingdom. CEMACH: London, 2007

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