A Refreshed Framework for Maternity Care in Scotland: The Maternity Services Action Group

1. INTRODUCTION

This refreshed framework is concerned with maternity care from conception until the postnatal period. Getting maternity care right for every woman and baby is the cornerstone of family health - it is an essential element of giving all Scotland's children the best possible start in life. We know however that not all of our children have that start in life, for whilst maternity care in Scotland is amongst the safest and of the highest quality in the world, significant inequalities exist in maternal and infant health outcomes ⁴.

"A Framework for Maternity Services in Scotland" was published in 2001. Since then, evidence has been gathering about the importance of maternal lifestyle and chronic stress on the developing fetal brain and stress regulatory system. We now understand that maternal physical, emotional and social wellbeing in pregnancy and in the early weeks of an infant's life are important ingredients for improved outcomes at birth and across the life course.

Strengthening the role of maternity care services in promoting and supporting improvements in maternal and infant wellbeing is the key aim of this framework However, we know that improvements in maternal health and wellbeing need to happen before pregnancy begins and maternity care is needed. The Centre for Maternal and Child Confidential Enquiries ⁵, highlight that maternal obesity, poor maternal nutrition, maternal mental health, gender based violence, use of toxic substances such as tobacco, alcohol and drugs, are all indirect ⁶ causes of maternal and infant death or illness.

Improving the general health and wellbeing of prospective parents and families is a key precursor to improving maternity care and central to improving outcomes for children. The important role of the General Practitioner and the Public Health Nurse in caring for the whole family's health is therefore a vital component of both preconceptual care, and safe and effective maternity care. General Practitioners also have a crucial role in continuing care for women with underlying medical conditions throughout the pregnancy journey and beyond.

Other public services have a key role to play in preconceptual health including reproductive and sexual health care services through supporting women plan their pregnancies as detailed in the Sexual Health Strategy for Scotland -Respect and Responsibility, the Teenage Pregnancy toolkit and the HIV Action Plan. ⁷ Education services also have a key role through the delivery of the personal, social and health education elements of the Curriculum for Excellence ⁸.

This refreshed framework for maternity services should therefore be seen as one part of a wider landscape of health improvement activity.