26 PROFESSIONAL
Midwives play an essential role in promoting public health
Judith Cutter describes the scope and responsibilities of the public health midwife role
I n 1988 , the former UK chief medical officer Sir Donald Acheson defined public health as ‘ the art and science of preventing disease , prolonging life and promoting health through the organised efforts of society ’. 1 The Royal College of Midwives , in its 2017 Stepping up to Public Health maternity model 2 , states that public health ‘ seeks to identify risks to health and find the best ways to minimise them , in order to give everyone the best chance of leading a healthy life ’.
The importance of these functions has been highlighted by the Covid-19 pandemic , especially within areas of deprivation .
Good public health advice is a fundamental part of the role of midwives , who need to promote family-centred care through meaningful conversations with women about healthy lifestyle choices in pregnancy , making every contact count . The small changes a woman can make to her lifestyle choices can increase her chances of a healthy pregnancy , birth and baby . The 2019 publication Maternity Care in Wales 3 advocates that pregnancy and childbirth should be safe and positive experiences , with parents supported to give their child the best start in life . This support can also benefit the ongoing health of the mother and her children .
The Royal College of Midwives ’ ( RCM ’ s ) maternity model sets out key public health themes . It discusses important areas of practice such as : infant feeding ; smoking cessation ; screening ; perinatal mental health ; obesity ; contraception and sexual health ; sudden infant death syndrome ; immunisations , infection prevention ; and a general healthy lifestyle . It also addresses the barriers and facilitators that are encountered by midwives as they seek to offer women this range of information on a day-to-day basis . The document also touches on other topics and identifies areas where additional training might be required , such as female genital mutilation ( FGM ), bereavement , substance misuse , domestic abuse , homelessness , honour-based violence and forced marriage .
As a consultant midwife in public health , my role encompasses both clinical frontline practice and a strategic focus on improving public health to enable patients to optimise their health in the antenatal , intrapartum and postnatal periods .
Perinatal mental health issues
affect around
1 in 5 women
Key public health messages Pregnancy is a time when women are likely to be more motivated to achieve optimal health and therefore an opportune moment to impart health information . Midwives are a vital source of this information , protecting and enhancing the health and social wellbeing of women and enabling wise lifestyle choices . This in turn promotes wider health and wellbeing in society by helping to reduce health inequalities , stillbirth , preterm birth and low birthweight babies . Delivering public health messages should not be seen as additional work for midwives but as a part of their everyday practice .
Smoking It is well documented that smoking is detrimental to both mother and baby , and increases the chance of foetal abnormalities , stillbirth and babies who are small for their gestational age . 4 We have worked closely with health teams in Cardiff and Vale University Health Board to develop a dedicated specialist maternity support worker post to work alongside midwives to help women stop smoking .
Obesity The Royal College of Obstetricians and Gynaecologists stresses the importance of maintaining a healthy weight and lifestyle during pregnancy to reduce morbidity and mortality . 5 The named midwife will be the main source of advice on healthy diet and exercise in pregnancy . In Cardiff and Vale we have established a specialist midwife-led healthy pregnancy clinic , which aims to offer tailored care and support to women . This has been done alongside local public health dietitians .
Perinatal mental health Pregnancy may exacerbate existing mental health problems or create new ones . Perinatal mental health issues affect around one woman in five , with 15 % suffering from anxiety and depression disorders . 6 Midwives may be the first point of contact for women seeking help and advice on this issue . As a maternity team in Cardiff and Vale , we work closely with specialist perinatal mental health teams and a perinatal mental health midwife to offer women individualised support .
References 1 Acheson , E . On the state of the public health . Public Health 1988 ; 102 ( 5 ): 431-437 2 RCM . Stepping up to Public Health . 2017 . London : RCM , 2017 . bit . ly / 2TzFSub 3 Maternity Care in Wales . Cardiff : Welsh Government , 2019 . bit . ly / 3vTHEol 4 NICE . Smoking : stopping in pregnancy and after childbirth . London : NICE , 2010 . nice . org . uk / ph26 5 RCOG . Care of women with obesity in pregnancy . London : RCOG , 2018 . bit . ly / 3paORxp 6 National Collaborating Centre for Mental Health . The Perinatal Mental Health Care Pathways . London : NCCMH , 2018 . bit . ly / 3g1eGMj 7 Female Genital Mutilation Act 2003 . London : Stationery Office , 2003 . bit . ly / 3uJsRee 8 Serious Crime Act 2015 . London : Stationery Office , 2015 . bit . ly / 2TtA05r 9 RCOG . Post-partum family planning . London : RCOG , 2021 . bit . ly / 3g4wuGi 10 FSRH . Contraception after pregnancy . London : FSRH , 2017 . bit . ly / 3g0o4zP nursinginpractice . com Summer 2021