Helping midwives to identify social complexities

Carla Stanke, Public Health Specialist, explains how an innovative online tool developed by the Lambeth Early Action Partnership is now helping midwives across the UK to assess social risk factors in pregnant women.

Carla Stanke

A new interactive ‘Maternity Disadvantage Assessment Tool’ (MatDAT) is now available for midwives to help them more consistently identify social complexities in pregnant people. The tool has the potential to enable the provision of more personalised care and promote maternity equity.

The tool was originally developed by midwives working for the Lambeth Early Action Partnership (LEAP.) It has now been further developed and made widely available by the Royal College of Midwives (RCM.)

The MatDAT, along with a care planning template and an e-training module, was launched at the recent annual RCM Conference in Liverpool.

Why is this new tool needed?

There is a growing body of evidence demonstrating the impact of disadvantage, such as poverty and poor housing, on pregnancy and birth outcomes, which means a multi-agency approach is needed more than ever.

Until now, midwives have not had a tool for assessing social needs in the same way that GPs and health visitors do. Tools used by GPs and health visitors are not commonly used in midwifery and are not designed specifically for pregnancy. Midwives are proficient at safeguarding but there is variation in practice when managing women experiencing social complexities who do not reach safeguarding thresholds.

To address this gap, LEAP midwives developed the MatDAT, a standardised tool for assessing social complexity during maternity care based on women and birthing people’s broad social needs. The tool uses terminology that will resonate with other early years professionals as it mirrors models used within safeguarding.

The tool provides a framework for midwives to identify the woman’s care level (Level 1–4.) Each level of need is then mapped to local service provision, which allows midwives to develop a personalised care and support plan, as well as facilitating smooth communication with the multidisciplinary team.

LEAP delivers services in parts of Lambeth where families and young children experience greater inequalities than the rest of the borough, and 43% of the LEAP neighbourhoods are classified as ‘most deprived.’ Because worse maternal outcomes are associated with living in areas of deprivation, LEAP wanted to help improve systems of care so that pregnant women and their families have better outcomes.

How was it developed?

LEAP implemented an innovative multidisciplinary Health Team to support local implementation of the Healthy Child Programme by exploring the coordination of primary care during pregnancy and the early years. The team was comprised of one midwife from each of the two local trusts, a general practitioner, and a health visitor. In the team’s initial scoping work, they identified that maternity services did not have a standard universal tool to assess social complexity, unlike health visitors or GPs, so the team’s midwives developed one.

The early development of the tool was guided by a consultation with local stakeholders. Further input was provided by a steering group which had representation by experts from across the UK. A small feasibility pilot was run in 2021/22 and findings indicate that the tool has value as an internal threshold document for referral to multidisciplinary teams and specialist pathways, as well as the potential to support inexperienced or cautious midwives to make decisions about safeguarding.

How the MATDAT tool will help identify social risk factors

The MatDAT is a standardised tool for assessing social complexity during routine midwifery appointments. The tool divides social complexities into four levels and provides prompts at each level to help midwives identify individual women’s needs. Women at a level one are ‘thriving,’ with no mental or physical health issues and good family support. At level four are women and families at risk of immediate harm, who have an acute level of unmet complex needs and safeguarding issues that require urgent intervention. Using this scale supports midwives to determine the subsequent level of care and intervention women may require.

The companion Planning Guide maps each level of need to sources of support, tailored to that area. Once implemented on a wider scale, the MATDAT could result in fewer inequalities and greater health equity for pregnant people and their babies.

The RCM’s Chief Executive Gill Walton explains:

“While pregnancy and the perinatal period can be a happy and joyful time for some, for many women it can be an incredibly tough time. During the perinatal period women are at their most vulnerable and may require more support than they have ever needed at any other point in their life. RCM members right across the UK have told us they are seeing more and more women with social complexities. The impact that this has on the health and wellbeing of a woman and family during her pregnancy cannot be underestimated.
“MatDAT will support midwives to deliver care more woman-centred and responsive to needs. The scale of complexities means we must work in partnership with other health and social care professionals and national organisations and MatDAT will link midwives with appropriate services and external agencies for additional support when needed.”

The MatDat tool is available from the RCM

LEAP is one of five local partnerships which make up A Better Start, a national ten-year (2015-2025) test and learn programme funded by the National Lottery Community Fund that aims to improve the life chances of babies, very young children, and families.

About A Better Start

A Better Start is a ten-year (2015-2025), £215 million programme set-up by The National Lottery Community Fund, the largest funder of community activity in the UK.

Five A Better Start partnerships based in Blackpool, Bradford, Lambeth, Nottingham and Southend are supporting families to give their babies and very young children the best possible start in life. Working with local parents, the A Better Start partnerships are developing and testing ways to improve their children’s diet and nutrition, social and emotional development, and speech, language and communication.

The work of the programme is grounded in scientific evidence and research. A Better Start is place-based and enabling systems change. It aims to improve the way that organisations work together and with families to shift attitudes and spending towards preventing problems that can start in early life. It is one of five major programmes set up by The National Lottery Community Fund to test and learn from new approaches to designing services which aim to make people’s lives healthier and happier

The National Children’s Bureau is coordinating an ambitious programme of shared learning for A Better Start, disseminating the partnerships’ experiences in creating innovative services far and wide, so that others working in early childhood development or place-based systems change can benefit.

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Visit the A Better Start website to find out more.