Background
Methods
Results
Ante Natal Care
Intra-partum care
Major unforeseeable complication | Affluent | Better Off | Average | Poor | Deprived | Total | % of total deliveries (2543) |
---|---|---|---|---|---|---|---|
Shoulder dystocia | 0 | 2 | 2 | 4 | 3 | 11 | 0.4 |
Fetal distress | 57 | 40 | 69 | 60 | 151 | 380 | 14.9 |
Cord prolapse | 0 | 1 | 1 | 2 | 4 | 0.2 | |
Obstructed labour | 26 | 12 | 24 | 19 | 35 | 116 | 4.6 |
Grand total
|
83
|
55
|
95
|
84
|
191
|
511
|
20.1
|
Total births
|
406
|
299
|
497
|
360
|
952
|
2543
| |
% by socio-economic group
|
20.4
|
18.4
|
19.1
|
23.3
|
20.1
|
20.1
|
Postnatal care
Socio-economic group | % Breastfeeding (including mixed) | % Bottle feeding | Feeding status unknown |
---|---|---|---|
Affluent | 69.7 | 15.1 | 15.1 |
Better off | 68.6 | 12.1 | 19.3 |
Average | 63.8 | 22.1 | 14.1 |
Poor | 58.7 | 30.7 | 10.7 |
Deprived | 52.9 | 34.4 | 12.7 |
Discussion
Limitations of the study
Ante natal care
Intrapartum care
Antenatal care
| Clear targeted investment of ante natal care in the most deprived areas. Links to Children's Centres and other agencies. Investment in alternative models of care, e.g. peer educators, health trainers, in addition to community midwives. |
Hospital and labour care
| Robust supervision of midwives on the MLU. Strict protocols for identification of high-risk pregnancies antenatally and advice to mothers not to use the MLU. Strict protocols for rapid identification of labour complications and rapid transfer. MLU midwives to be trained in neonatal life support. Resuscitation equipment available on the MLU. Telemedicine links with the obstetric-led unit. |
Transport
| Implementation of a range of travel support schemes particularly targeted to low-income groups, e.g. improved bus routes, taxi vouchers, national travel tokens, free shuttle service. |
Sustainability of MLU
| Ongoing hospital trust board support for the MLU and development of skills and capacity within it. |
Antenatal care
| Skills mix and range of staff in additional antenatal care. Antenatal risk management. Inequalities in access and outcome – particularly gestation at booking, smoking status, high-risk pregnancy management, access by minority ethnic groups and teenage mothers. |
Hospital care
| Midwifery resuscitation skills. Use of resuscitation equipment at the Huddersfield MLU. Perineal tears, episiotomies, significant blood loss or problems after delivery, length of labour at Huddersfield MLU. Transfer rates from HRI to CRH. Do they match the estimated 1–2 women per week? Transfer times. Mobilisation times of ambulance crews from the time of being alerted to the time they arrive at the MLU door. Patient satisfaction of community services and MLU. |
Transport
| Uptake of transport and travel schemes by postcode and ethnicity. |
Post natal
| Breastfeeding initiation and continuation. Infant mortality. Postnatal depression rates. |
Conduct of the HIA
Tips for others undertaking HIA |
• HIA can be done quickly with simple analysis. |
• Use literature to make informed judgements where there is limited local data. |
• Get to the nub of key concerns from stakeholders quickly, particularly where there is opposition. Focus your analysis here, but bear in mind that even the best quality analysis might not overcome trenchant or philosophical opposition to a policy proposal. |
• Timing – ensure the analysis is complete in good time to influence or inform decision making. There is a balance between early analysis – that might be useful in swaying opinions of stakeholders versus late analysis that is done 'just in time' to inform a decision. |