Discuss full range of contraceptive choices available and her short, medium and longer-term pregnancy plans alongside appropriate preconception health advice. Ensure discussions take a contextual view of risk and a shared decision-making approach to fulfilling reproductive choices. Signpost to information.
Prioritise and reorient health service delivery to incorporate preconception care in maternity, including the creation of protocols and referral pathways for preconception care services.
Recognise that preconception period is a time to promote mental health. Discuss emotional wellbeing and promote mental health through a trauma informed approach to self-care. Recognise previous birth trauma, neonatal stay or pregnancy and baby loss (if applicable to her) can impact mental health and emotional well-being in subsequent pregnancies.
Promote for Planning for Pregnancy tool to be used to support general mental health and wellbeing for couples/women who are thinking of pregnancy within up to 3 years.
Complete a holistic needs assessment asking all women about any past or present severe mental illness, previous or current treatment, and any severe postpartum mental illness in a first degree relative. Recognise signs of emotional distress and mental health difficulties. Refer to a mental health professional, depending on the severity of the presenting problem.
Refer individuals with suspected or known severe mental illness to a secondary mental health service, preferably a specialist perinatal mental health service, for assessment and treatment.
Demonstrate mental health leadership, provide workforce development opportunities, and support the implementation of evidence-based services targeted to the local population, including collaborative care planning.
Integrate stepped care involving maternity, health visiting and general practice as not all women will meet the threshold for specialist services but may require additional support with their emotional and mental health.
Invest in perinatal mental health services, including preconception care, community outreach clinics and specialist services to achieve a green map of services available across all areas.
See the Safeguarding page here if you identify safeguarding concerns such as domestic violence or abuse, child protection issues or other welfare concerns.
Ensure they’re up to date with cervical screening and that any treatment for abnormalities completed prior to conception, if possible. Ensure under 25-year olds are part of the National Chlamydia Screening Programme. Offer a full sexual health screen for sexually transmitted infections and HIV.
Discuss the full range of contraceptive choices available and their short, medium and longer-term pregnancy plans alongside appropriate preconception health advice. Ensure discussions take a contextual view of risk and a shared decision-making approach to fulfilling reproductive choices. Signpost to information.
Check woman’s MMR status and offer outstanding doses of MMR vaccine to protect future pregnancies against rubella infection. If you do not offer vaccination as part of your service, signpost to the woman’s GP for her to receive the vaccine.
Ensure Health Visitors and Paediatric Teams receive notification of women with hepatitis B for adherence to the enhanced hepatitis B immunisation schedule.
Access ‘Adult weight management: short conversations with patients’ to inform your discussions with women about achieving and maintaining healthy weight.
Access ‘All Our Health: Adult Obesity’ for key evidence, data and signposting to trusted resources to prevent illness, protect health and promote wellbeing.
Identify weight status in all women by sensitively assessing their BMI, and confidently discuss the importance of achieving and maintaining a healthier weight with women with a BMI ≥25 (or less than 18.5). Offer appropriate referral to local support such as tier 2 and 3 weight management services if necessary.
Engage with the local community, including Maternity Voices Partnership, to co-develop services that are accessible, appropriate and not stigmatising for the local population.
Reduce health inequalities by commissioning services which respond to local need set against clear outcome measures, empowering providers to make service improvements. Monitor pre-pregnancy BMI prevalence in your service area(s).
Promote the ‘Healthy Start’ scheme and advise on ways they can improve their nutritional intake including vitamins and minerals. Signpost to information.
Give general oral health advice on healthy diet specifically reducing the amount and frequency of sugary foods and drink. Brush teeth at least twice daily with toothpaste containing at least 1350 ppm -1500ppm Fluoride. Promote dental attendance and referral for urgent needs.
Promote physical activity using the UK Chief Medical Officers’ guidelines on the amount and type of physical activity people should be doing for good health.
Access the ‘Physical Activity and Health’ Health Education England e-learning course for GPs, nurses and other healthcare professionals to support workforce learning and development.
ASK and record smoking status for all women, ADVISE that smoking can affect fertility and the best way to quit is with a combination of support and medication and ACT by referring or signposting to stop smoking service.
Provide stop smoking support that is appropriate for women and their families before pregnancy or when planning for pregnancy in line with government guidance.
Provide ‘Make Every Contact Count’ and ‘Very Brief Advice' stopping smoking training to help healthcare professionals support women and their partners to quit smoking.
Engage with the local community, including Maternity Voices Partnership, to co-develop services that are accessible, appropriate and not stigmatising for the local population.
Monitor and evaluate smoking rates, as well as stop smoking referral and uptake rates. Reduce health inequalities by commissioning services which respond to local need set against clear outcome measures, empowering providers to make service improvements.
Ask all women and their partners: ‘Are you drinking at the moment?’ Identify their response according to alcohol guidelines, provide brief advice and signpost to information and support if necessary. If you remain in contact with a patient who has reported using alcohol, review their use at each session.
Ask about illicit drug and medicine misuse, providing information, advice and help including advising women to abstain from drug use during while trying to conceive and referral into specialist treatment where indicated. If you remain in contact with a patient who has reported using drugs, review their drug use at each session.
Complete the misuse of ‘illicit drugs and medicines e-learning’ session. This brief interactive e-learning has been developed to increase the confidence and skills of health and care professionals, to embed drug misuse prevention in their day-to-day practice.
Make yourself aware of local specialist alcohol and drug services via your local authority public health team, or use this alcohol and drug services search facility.
Ensure that your therapeutic relationship with women from inclusion health groups is culturally and contextually appropriate and non-judgemental. Avoid making assumptions based on a woman's culture, ethnic origin or religious beliefs or living circumstance.
Deliver mandatory training for staff to better meet the needs of women with multiple complex social factors within a trauma-informed framework. Specialist organisations, such as Birth Companions, can deliver this training or work with maternity services to develop in-house training.
Commission health services that respond to the local characteristics and needs of inclusion health groups in your area, raise the profile of inclusion health and social exclusion, and advocate for the prioritisation of inclusion health groups and the consideration of their needs in service design and commissioning.
Reduce health inequalities by commissioning services which respond to local need set against clear outcome measures, empowering providers to make service improvements and monitoring progress regularly. Collaborate with relevant services to support the roll-out of continuity of carer models, those aimed at BAME and other vulnerable groups.
Identify signs of domestic abuse, including emotional, psychological, physical and financial. Signpost to NHS ‘Getting Help for Domestic Violence’ page and refer to support services if necessary.
Provide mandatory domestic violence training for staff through a trauma-informed framework. Local safeguarding teams, can deliver this training or specialist training be commissioned.
Understand and act on your professional responsibilities regarding Female Genital Mutilation, including mandatory reporting and supporting women at risk.
Deliver mandatory Female Genital Mutilation (FGM) training and updates on legal requirements so staff can better meet the needs of women who have been subject to FGM and who’s potential future offspring might be at risk to being subject to FGM. Local Safeguarding teams should be enabled to provide best practice training.
Access support information to help prevent murder and serious harm to black, Asian, minority ethnic and refugee women in England, Wales and Scotland as a result of domestic abuse and forced marriage and 'honour'-based violence here.
Promote pelvic floor health and the importance of strengthening their pelvic floor and appropriate exercises. Signpost to information and resources, including NHS Squeezy App and Tommy’s. Refer to relevant local services, including clinical pilates and women’s health physiotherapists if necessary.
Identify women who have Long Term Conditions (i.e. epilepsy, diabetes, chronic obstructive pulmonary disease, arthritis and hypertension) and multi-morbidity, and develop an appropriate care plan using NHS’s House of Care NHS and social care long-term conditions framework.
Utilise NHS Long Term Conditions Year of Care Commissioning Programme Implementation Handbook to drive effective integrative care modelling services for Long Term Conditions in your area.