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Pregnancy and complex social factors

About

What is covered

This pathway covers service provision for pregnant women with complex social factors.
The NICE Pathway on antenatal care for uncomplicated pregnancies outlines the care that women should be offered during pregnancy. However, pregnant women with complex social factors may have additional needs. This pathway sets out what healthcare professionals as individuals, and antenatal services as a whole, can do to address these needs and improve pregnancy outcomes in this group of women. This pathway has been developed in collaboration with the Social Care Institute for Excellence and will also be of relevance to professionals working in social services and education/childcare.
The pathway applies to all pregnant women with complex social factors and contains a number of recommendations on standards of care for this population as a whole. However, four groups of pregnant women were identified as exemplars:
  • women who misuse substances (alcohol and/or drugs)
  • women who are recent migrants, asylum seekers or refugees, or who have difficulty reading or speaking English
  • young women aged under 20 years
  • women who experience domestic abuse.
Because there are differences in the barriers to care and particular needs of these four groups, specific recommendations have been made for each group. Specific issues addressed in the pathway include:
  • the most appropriate healthcare setting for antenatal care provision
  • practice models for overcoming barriers and facilitating access, including access to interpreting services and all necessary care
  • ways of communicating information to women so that they can make appropriate choices
  • optimisation of resources.

Updates

Professional responsibilities

The recommendations in this pathway represent the view of NICE, arrived at after careful consideration of the evidence available. When exercising their judgement, professionals are expected to take these recommendations fully into account, alongside the individual needs, preferences and values of their patients or service users. Applying the recommendations in this pathway is at the discretion of health and care professionals and their individual patients or service users and does not override the responsibility of health and care professionals to make decisions appropriate to the circumstances of the individual, in consultation with them and/or their carer or guardian.
Commissioners and/or providers have a responsibility to enable the recommendations to be applied (and to provide funding required for technology appraisal guidance) when individual health and care professionals and their patients or service users wish to use them. They should do so in the context of local and national priorities for funding and developing services, and in light of their duties to have due regard to the need to eliminate unlawful discrimination, to advance equality of opportunity and to reduce health inequalities. Nothing in this pathway should be interpreted in a way that would be inconsistent with compliance with those duties.

Person-centred care

People have the right to be involved in discussions and make informed decisions about their care, as described in your care.
Making decisions using NICE guidelines explains how we use words to show the strength (or certainty) of our recommendations, and has information about prescribing medicines (including off label use), professional guidelines, standards and laws (including on consent and mental capacity), and safeguarding.

Short Text

Everything NICE has said on service provision for pregnant women with complex social factors in an interactive flowchart

What is covered

This pathway covers service provision for pregnant women with complex social factors.
The NICE Pathway on antenatal care for uncomplicated pregnancies outlines the care that women should be offered during pregnancy. However, pregnant women with complex social factors may have additional needs. This pathway sets out what healthcare professionals as individuals, and antenatal services as a whole, can do to address these needs and improve pregnancy outcomes in this group of women. This pathway has been developed in collaboration with the Social Care Institute for Excellence and will also be of relevance to professionals working in social services and education/childcare.
The pathway applies to all pregnant women with complex social factors and contains a number of recommendations on standards of care for this population as a whole. However, four groups of pregnant women were identified as exemplars:
  • women who misuse substances (alcohol and/or drugs)
  • women who are recent migrants, asylum seekers or refugees, or who have difficulty reading or speaking English
  • young women aged under 20 years
  • women who experience domestic abuse.
Because there are differences in the barriers to care and particular needs of these four groups, specific recommendations have been made for each group. Specific issues addressed in the pathway include:
  • the most appropriate healthcare setting for antenatal care provision
  • practice models for overcoming barriers and facilitating access, including access to interpreting services and all necessary care
  • ways of communicating information to women so that they can make appropriate choices
  • optimisation of resources.

Sources

NICE guidance and other sources used to create this pathway.

Quality standards

Quality statements

Effective interventions library

Effective interventions library

Successful effective interventions library details

Implementation

Information for the public

NICE produces information for the public that summarises, in plain English, the recommendations that NICE makes to healthcare and other professionals.
NICE has written information for the public explaining its guidance on each of the following topics.

Pathway information

Professional responsibilities

The recommendations in this pathway represent the view of NICE, arrived at after careful consideration of the evidence available. When exercising their judgement, professionals are expected to take these recommendations fully into account, alongside the individual needs, preferences and values of their patients or service users. Applying the recommendations in this pathway is at the discretion of health and care professionals and their individual patients or service users and does not override the responsibility of health and care professionals to make decisions appropriate to the circumstances of the individual, in consultation with them and/or their carer or guardian.
Commissioners and/or providers have a responsibility to enable the recommendations to be applied (and to provide funding required for technology appraisal guidance) when individual health and care professionals and their patients or service users wish to use them. They should do so in the context of local and national priorities for funding and developing services, and in light of their duties to have due regard to the need to eliminate unlawful discrimination, to advance equality of opportunity and to reduce health inequalities. Nothing in this pathway should be interpreted in a way that would be inconsistent with compliance with those duties.

Person-centred care

People have the right to be involved in discussions and make informed decisions about their care, as described in your care.
Making decisions using NICE guidelines explains how we use words to show the strength (or certainty) of our recommendations, and has information about prescribing medicines (including off label use), professional guidelines, standards and laws (including on consent and mental capacity), and safeguarding.

Supporting information

Glossary

examples of complex social factors in pregnancy include: poverty; homelessness; substance misuse; recent arrival as a migrant; asylum seeker or refugee status; difficulty speaking or understanding English; age under 20; domestic abuse. Complex social factors may vary, in both type and prevalence, across different local populations
an incident of threatening behaviour, violence or abuse (psychological, physical, sexual, financial or emotional) between adults who are or have been intimate partners or family members, regardless of gender or sexuality. It can also include forced marriage, female genital mutilation and 'honour violence'
women who moved to the UK within the previous 12 months
morbidity that has a lasting impact on either the woman or the child
regular use of recreational drugs, misuse of over-the-counter medications, misuse of prescription medications, misuse of alcohol or misuse of volatile substances (such as solvents or inhalants) to an extent where physical dependence or harm is a risk (to the woman and/or her unborn baby)

Paths in this pathway

Pathway created: March 2012 Last updated: November 2016

© NICE 2016

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