Maternal health, by definition, encompasses the physical, emotional and social welfare of women during pregnancy, childbirth and the postnatal period.

"Poor lifestyle, social challenges and cutbacks in the public health system are all factors affecting maternal health."

“Where does maternal health start and end? It’s a huge area: as midwives, we’re seeing young girls right up to women getting pregnant in their late 40s now,” says Judy Evans, registered nurse, midwife, Midwifery Lecturer and Member of RCN Midwifery Forum Committee. “It’s everything from teenagers’ sexual health to menopause and mental health. It’s such a mixed bag. You have to look at the woman all round, in the context of today’s issues.”

 

Lifestyle choices

 

Among those issues, lifestyle is a huge influence, says Evans, and one where pregnant women can help themselves by using available services to find out their best course of action.

“Diabetes and obesity are massive now; it’s worrying the amount of overweight and obese women we see. And that can lead to complications for mother and baby."

"When I started my career, there were dieticians, but now it’s become another add-on for the midwives to take care of.”

Some maternity units run slimming programmes and offer advice in a variety of formats. There are mobile apps, the NHS Choices information website, Trusts (such as Basildon have Maternity Direct), which provides ‘i-midwives’ on call, and social media platforms like Facebook that help too. “They’re perfect for the digital natives, so make use of those.”

Pregnant women need to be aware of the advantages of breastfeeding, Evans believes, as it provides babies with nutritional and developmental requisites and has the added advantage of helping mothers lose weight, while protecting them against maternal cancers.

Smoking and substance abuse are other issues. “We have specialist midwives and baby clinics. We’re doing our best, but I’ve seen women light up a cigarette as they come out of having a scan. Often, entire families are living in one bedsit. The mothers get fed up and buy tobacco or food as a means of escape or to cheer themselves up.”

 

Cuts and shifts

 

Mental health problems have become prevalent, says Evans. “We see the whole gamut in maternity. Domestic violence, alcohol, substance abuse, smoking. There is even human trafficking going on under your nose.

“We have specialised midwives for vulnerable women and undertake clinical audits to see if care pathways are working and, if not, what to do next. Maternity units catch things fast. But a woman can be out of hospital two hours after giving birth - that’s so quick. We need to spend time making sure the mother is adjusting and can reintegrate before she goes back into a difficult or poor situation.”

"We have specialised midwives for vulnerable women."

The issues are compounded by cuts to education: “Last year was the first midwifery intake after training bursaries were cut and we’re already seeing a drop in numbers. This does not bode well for the future. We need more midwives. When money is tight, education is the first thing to go - that’s so sad.”

Evans encourages girls and women to take advantage of the available services: “Maternity units are friendly and open. There’s a lot of advice and plenty of support out there; use it - for your own and your baby’s sake.

“We’ve got to get women having babies right because it’s the future. If we can’t do that, all is lost.”