In Brighton a specialist teenage midwife is funded to work with young mothers. The midwife is able to see her clients more regularly than normal, providing valuable support that benefits this group during their pregnancy.
In Brighton hard work by the NHS, councils and other partners has helped reduce the under-18 conception rate by 63 per cent, exceeding the national reduction. But while the prevention work continues, the city is also maintaining a focusing on improving outcomes for young parents.
A dedicated midwife post for teenagers was launched in Brighton and Hove in 2002 – and is still in place today. It was initially funded for one-day a week by the council, but gradually expanded to become a full-time job and is now paid for by Brighton and Sussex University Hospitals NHS Trust.
Mitch Denny has been in the role since just after it started. She said having a dedicated post is important because of the unique characteristics of this group.
“They are very vulnerable. They may be trying to decide what to do or they may not have told their parents. There can be issues around schooling or college and they can be struggling with all the other aspects of being a teenager. The support is vital.”
She said the initial meeting is key as it is likely to be their first contact with the NHS in any meaningful way. “At first it is about gaining their trust. They can come and see me in clinic, but I also go to their home or meet them in other places, like coffee shops.”
She said once trust has been gained, the next step is to identify what other support they may need. That can include counselling and mental health support, substance misuse or wellbeing services. “It is only once you have done this that you can get on with the midwifery side of things.”
Mitch provides more than the 10 antenatal appointments that NICE guidance recommends as the young women often need extra support. Normally her clients will get around 15 appointments – these are usually one-to-one. A trip to the labour ward is also organised as well as antenatal classes.
After birth, she tends to have eight contacts – more than twice what a community midwife would provide. She also provides advice seven days a week from 8.00am to 8.00pm and deals with requests via text.
Since the role became full time, Mitch has consistently had between 30 and 40 teenagers on her caseload at any one time. Her input is measured by monitoring outcomes such as birth weight, premature births and breast-feeding rates. For each, the outcomes have been good. For example, for this cohort normally one in five births are premature, but among the teenagers Mitch works with it is nearer to one in 20.
But it is also the impact on the individuals that demonstrates the value of the work. One of those she has supported is Morgan. When she became pregnant, she was worried she would not be able to keep her baby because of previous mental health problems.
However, Mitch immediately put her mind at ease and made sure she received support from the perinatal mental health service during pregnancy. In fact, the support was so good that it even inspired Morgan to become a midwife herself and she is now studying for a degree in midwifery.
Morgan said: “Mitch really took the time to make sure I understood the importance of looking after myself – keeping healthy not just for my body but also for my mind. She was there to help me keep on track so I’m now able to be the best mother I can be.”
Mitch said it is important that midwives fulfilling these roles are in senior positions. She is a band seven.
“I think it is unfair to ask a more junior midwife to do the work. There are a lot of safeguarding issues involved with teenage pregnancies. I have attended a number of serious case reviews and that means you have a lot of responsibility.”
Her experience has also taught her the importance of involving women who have become teenage mothers themselves in the support she provides. She runs antenatal classes at some children’s centres and has started organising them at the same time as new mothers meet at the centres.
“It means we have been able to invite the mothers in to talk to the pregnant teenagers. That has been really valued – to hear about the experience of someone who has gone through exactly what you have is so important.”
Mitch has also worked hard to make her appointments as accessible as possible. Clinics are held in the city centre and at one point there was money available to pay for bus passes for women to attend appointments.
How is the approach being sustained?
Over the past year, Mitch has extended the age range of the women she works with. She now provides midwifery care to those up to the age of 20 rather than 19.
“The declining rate of teenage pregnancy meant we could work with slightly older women. In many ways, they can be an even harder age group to engage.
“At 15 a girl will be respectful, will attend appointments. At 19 the woman will be more experienced and worldly wise. But they are still vulnerable so it is an important age group to work with.”
Teenage Pregnancy Midwife, Brighton and Sussex University Hospitals NHS Trust