A Pathway of Care for Vulnerable Families (0-3)

There is currently no universal approach to managing pre-conceptual health. However, Improving Maternal and Infant Nutrition - a Framework for Action¹⁸ and A Refreshed Framework for Maternity Care in Scotland¹⁹ highlight areas of concern that can contribute to poor health outcomes for mother and baby, such as poor nutrition and obesity.

• Sensitive enquiry as to whether or not the woman is accessing any other services such as substance misuse, social work and psychiatric services, and any history of domestic violence.
• Information provided, scheduling of screening tests ²⁰ and contacts, parent education sessions, locally available services to support pregnancy, birth and postnatal care and specialist services to support healthy lifestyle choices.
• Families who wish termination of pregnancy are offered appropriate information and counselling.

• Maternity record updated (Scottish Women-Held Maternity Record ( SWHMR)).
• Care is planned with named midwife to meet identified needs.
• Information given: Ready Steady Baby. ²¹
• The named midwife undertakes to support the maternal and family journey throughout the antenatal period using guidance from the KCNDPathways for Maternity Care. ²²

• Maternity record updated, refreshed and needs are recorded.
• Consider engaging with the public health nurse/health visitor, family and other key professionals to allocate the Health Plan Indicator ( HPI) antenatally. ²³

• Fetal anomaly scan.

• Maternity record is refreshed and needs are recorded.
• Screening tests for height of uterus, blood pressure and urinalysis, oedema, fetal heartbeat, fetal movement and emotional well-being discussed and documented.

• Maternity record is refreshed and identified needs are recorded to reflect needs of parent and baby using guidance from Pathways for Maternity Care in relation to physical/mental health and well-being, including emotional attachment.
• Infant feeding support is initiated and information on general care of baby is discussed.
• Full neonatal examination is performed within 72 hours.
• Within three days, screening tests of mother's mental health and well-being, blood pressure, temperature, respiratory rate, bladder and bowel function, perineum and pelvic examination/exercise are performed.
• If appropriate, anti-D and any relevant blood tests are performed.

• The antenatal assessment and care plan, alongside what antenatal pathway of support has been followed, is discussed between the named midwife and the named public health nurse/health visitor.
  The first visit (notification visit) is conducted by the public health nurse/health visitor, assessment of child and family circumstances is refreshed and the care plan updated.
• Information is provided on registration of the child with a GP, general child health surveillance and immunisation programmes and locally available services.
• The personal child health record ²⁴ is given to the family, if it has not already been issued.
• The child is weighed.
• Newborn hearing screening test is performed.

• The public health nurse/health visitor record is refreshed and care plan updated.
• The first physical health and development check, including weight for child, is performed.
• The Edinburgh Postnatal Depression Score for maternal mental well-being is calculated.

• "Childsmile" dental assessment is conducted.
• Weight check and immunisation performed.
• The Health Plan indicator ( HPI) ²⁵ is allocated by the public health nurse/health visitor.

• The 24-30 month review should cover the following as a minimum and may need to be expanded, depending on child and family circumstances and professional concerns: ²⁶
• speech, language and communication
• personal, social and emotional development (including behavioural issues)
• nutrition, growth and weight
• immunisations
• parental concerns and issues
• vision, hearing and oral health
• physical activity and play.