Working with disadvantaged mothers

Kuldip BharjDr Kuldip Bharj is a senior lecturer in midwifery and lead midwife for education at the University of Leeds and has 10 years of board level experience in the NHS. She writes:

Complex and multiple factors disadvantage mothers. Many policy initiatives acknowledge ‘disadvantage’ as an area of priority and focus on providing adequate and appropriate services, often harnessing a ‘woman-centred’ approach to care.

Like other mothers, disadvantaged mothers, consistently call for kind and approachable healthcare professionals with whom they can develop trusting relationships. They want to be treated with respect and dignity. They desire accurate and timely information to enable them to negotiate their way through their childbirth journeys and choose the kind of care they want. Some mothers do receive this but many do not.

Many healthcare professionals assert that they draw upon fundamental caring skills when delivering individualised care, confirming their competency to deliver culturally-sensitive and anti-discriminatory care.

Disappointingly, despite policy initiatives and competent healthcare professionals, there remains a variation in disadvantaged mothers’ experiences and outcomes. Evidence confirms that there are inequalities in health outcomes for disadvantaged mothers and their babies – they have a poorer experience and poorer access to services.

This raises many questions:
• What are the issues hindering translation of policy to practice?
• Do diverse policies lead to fragmentation?
• Would a summary of key directives leading to a care pathway be a way forward?
• What support do practitioners need to deliver woman-centred care to disadvantaged mothers?
• Are service models provided on ‘ad hoc’ bases or should they be mainstreamed?

2 Responses to “Working with disadvantaged mothers”

  1. As a qualified health visitor who is currently returning to midwifery practice[via PDip post graduate programme]I strongly believe that all mothers to be should be offered a ‘family assessment’at 12 weeks gestation[based on the common assessment framework],does every child really matter?Time and time again work is duplicated with health,social and education-surely this could be started in pregnancy and continued throughout the childs life on one ’system’?
    Sure start offers help to those who live in known geographical areas of deprivation,however there remain large numbers of deprived families who will be missed as resources continue to be directed to the profiled known areas!

  2. I have worked in the health service for 36yrs trained as a general nurse, midwife, health visitor, sexual and marital therapist. For the the past 15yrs I have worked in adolescent mental health service.My points are as following:
    For one year I researched the needs of parents with mental health problems whose children are known to cams services.We ran a parent group in a community mental health service. I delivered my findings which were well met. Howevever the management team response was that as this time with restructuring and ipac the time is not right. We still have no joint policies on meeeting the needs of parents or families.
    In [one city *] the unitry authority for children’s services are lead by education. we have the lowest gcse attainment in the country. I believe the multiagency working that we had has now been lost [moderated *]. An excample of the petty management is the request for funding for an educational pyschologist to attend our team meetings.
    Education pulled funding from a tier 2 cams service, too many children are referred to cams for ADHD, behavioral problems,school refusal. We have too many chidren being seeen in cams for a diagnosis to meet the poor performance on the part of schools, poor joint working ,and protocols to look at ADHD, or behaviour problems.
    The management within the city seemed driven by micro personal agendas, and the drive to meet individual agency targets and silo their thinking into protectivinesss of their own agenda leads.Agencies seem to be deaf to what family say they need , and the collabration with the community seems to be a skill that many proffessionals shy away from, we are protecting what? the possibilty there is lack of supervision to meet staff mental health needs.
    social services criteria is so high that often nurses are left picking up the needs of families when they do not have the relaionships with socail services to jointly work a case,caf seems only a paper exercise and no means to meet the chronic chiaotic nature of families with mulitifactoral issues particularly demostic violence.
    personally my career has been eventful but throughly enjoyable, I have learnt many things from the families I have served and it has been a privilidge to be part of families lives in seeking change and meeting their potential.
    one excample is that a family offered to care for my 4 year old daughter who was ill and stayed in the car between home visits. I was a single parent worried about my job and no emergency child care. the family were on the child protection register for neglect
    That family has stayed with me in my practice.

    * Comment edited by moderator to remove information that could identify an individual