Early intervention in the second trimester of pregnancy

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Early intervention in the second trimester of
pregnancy

• Christina Louise
• Lindhardt
• RN, Health Visitor, Msc
• Odense University
• Hospital
• Denmark

2

• This project was funded by the Board of Health,
  Denmark in 2006.
• It was conducted with participation from
• The Health Visitors in Dalum, Odense
  Municipality.
• The Midwifery Centre, The Region of South
  Denmark.

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Guidelines

• The aim from the Danish National Board of
  Healths Recommendations of the pregnancy and
  post natal guidelines
• All pregnant women in Denmark who fill in the
  criteria of being vulnerable are offered a home
  visit from the Health Visitor during pregnancy.

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Question

• Can early intervention in the second trimester
• of pregnancy and interdiciplinary
  collaberation increase the health of vulnerable
  pregnant women?

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Conclusion

• Higher transferral of vulnerable women to the
  Antenatal clinic.
• Increased collaberation between the
• General Practioners
• Midwives
• Health Visitors
• Social workers

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Results

• By transferring the vulnerable pregnant women
  in the early stage of the second trimester from
  the GP and the Midwife it became possible to get
  access to those women who by chosen criteria were
  vulrable.

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Criteria for participation

• Under 25 years
• BMI more than 27
• Have been left by partner under pregnancy
• Have had previous abuse of drugs/ alchohol
• Been in fostercare or abrupt childhood
• Been treated for depression at earlier stage
• Signs of sadness, insomnia, antenatal blues
• Older first time mothers (38 years)
• Have had foetus mors or other loss

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Interdiciplinary collaberation

• The GP meets the pregnant woman at the first
  ante natal consultation and her data are being
  send to the Midwifery clinic and to the Antenatal
  outpatient clinic at the hospital.
• The visitating Midwife refers, within the
  criteria for vulnerable pregnant women, the
  pregnant woman to the visitating Health Visitor
  in the municipality.

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Methodology

• Meddelelse til sundhedsplejen / Dalum
  områdekontor
•  
• Udfyldes og afsendes i forbindelse med første
  jordemoderkonsultation.
•  
• Navn Telefon. Mobiltelefon
•  
• Adresse
•  
• Cpr. nr.
•  
• Tidligere graviditeter / fødsler /
•  
• Gestationsalder uge Termin d. /
  200......
•  
• Besøg af sundhedsplejerske i andet trimester
  graviditeten ønskes på følgende baggrund
• ? Behov for vejledning vedrørende livsstil
• ? Behov for kontakt på baggrund af sociale
  forhold
• ? Behov for kontakt på baggrund af
  følelsesmæssige forhold

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Interdiciplinary Collaberation

• When the pregnant woman is in the high risk
  group of, for example diabetes, high
  bloodpressure, drug treated depression she will
  be refered directly from the GP and the Midwife
  to the outpatient Antenatal clinic at the
  hospital.

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Field work

• 2 home visits by the Health Visitor during
  pregnancy. Following the normal Health Visiting
  programme after the birth.
• Participation in group sessions with other
  vulnerable pregnant women in the project.

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Field Work

• Home visits. The Health Visitors brought up
  issues such as
• Expectations to motherhood. How do you see
  yourself as a mother?
• Relationship to own mother/ childhood.
• How to prepare yourself to motherhood/parenting.

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Groupsessions

• Invitation to participate
• Meeting neutral place
• The filosofi that the group can mend itself. No
  age or social barrier
• Participation of a coach and a co-coach (Health
  Visitor and Midwife)
• Meeting every 2-3 weeks untill everybody had
  delivered their baby

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Findings

• Generally the women had relational problems
• Very young mothers to be
• Older mothers to be 38
• Signs of pre natal maternity blues
• Women who had been in contact with the social
  system in one way or the other.

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Findings

• The group of women we found were at risk of
  developing relational problems were the pregnant
  women who had
• A high BMI
• Had been left by their partner during pregnancy

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Mind the gap

• The gap in this project, was collaberation
  with
• The GP, know more about the pregnant womans pre
  medical story than he documents to the midwifery
  centre.
• The obstetricians at the hospital who could be
  more aware of the vulnerable pregnant women and
  refer them to the Midwife, Health Visitor or the
  Family centre at the Ante natal clinic so early
  intervention can take place.

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• Vulnerability is more than
• poverty
• and low social status

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Closure