The Best Start in Life by Laura Gibson

  • Getting It Right For Every Child
  • Giving children the best start in life
  • Making Scotland the best place to grow up
  • Improving the life chances of children, young people and families at risk
  • Reducing health inequalities

These high level national aspirations underpin much of the work that we, as healthcare professionals, are involved in delivering on a day to day basis. And achieving them does not start with children, the early years, or even pregnancy. It begins before conception. And I thoroughly believe that we are missing an opportunity. An opportunity which is inexpensive, evidence based and highly effective. That opportunity is better promotion of preconception health and care.

What is preconception health?

image1-2There is a clear link between a mother’s health before pregnancy and her baby’s health. We know that healthy women and men are more likely to have healthy babies who grow into healthy children 1. Therefore, thinking about, and improving, your health and wellbeing before conception increases your chances of a safe pregnancy, a thriving baby and a rewarding parenthood. Preconception is the safest and most effective time to prevent harm, promote health and reduce inequalities (pregnancy and birth outcomes are not as good for people living in the highest deprivation).

 
Currently, most people only consider two stages: avoiding pregnancy or being pregnant. With around 40% of all pregnancies being unplanned, the middle stage of preparing for the best possible pregnancy continues to be overlooked; in terms of policy, professional practice and individual thinking across Scotland. Where delaying pregnancy is the norm in Scotland (the average age of giving birth is 29.5 years, and 28 years for first time mothers), taking action to avoid pregnancy is not the same as preparing well for pregnancy.
image2Preconception health is about preparing for pregnancy, whether for your first pregnancy or your next pregnancy. What you do, or don’t do, before the pregnancy test says ‘yes you’re pregnant’ really matters. The choices you make and the actions you take before conception can make a big difference to you and your baby. That is true even if you haven’t given much thought to when you’d like to become a parent.

 
However, preconception health is not just for women, it is important for men too. There are steps that future fathers could take before creating a baby, for the sake of his own health and for that of his partner and their baby.

 
The infographic below, developed by Dr Jonathan Sher, an independent consultant and respected author of numerous published reports and blogs 2, identifies the steps women (and men, where relevant) should take to improve their preconception health:

image3-copy

Why promote preconception health?

Many things that may put your baby’s health at risk, such as smoking, drinking alcohol, taking drugs (prescribed or not), being overweight, being very stressed and some medical conditions, can all make an impact before you even know you are pregnant. That is why planning and preparing for pregnancy are so important.

 
However, not all the negative possibilities of pregnancy are inevitable. Many miscarriages, stillbirths, too early or too small babies, birth defects and other problems may be prevented and the odds of a good outcome can be improved. Good outcomes should not be left to luck alone. Doing what you can to become as healthy and ready as possible, and getting help if required, is hugely beneficial for yourself, your partner and your baby.

 
Traditionally, health promotion for pregnancy begins in the antenatal period, most often from first contact with Maternity Services at around 8 to 12 weeks of pregnancy. Many women are not aware that they are pregnant during the early weeks and months, and unfortunately it is not uncommon for women and men to continue negative health behaviours such as smoking and drinking alcohol through this important stage of early foetal development. Getting ready for pregnancy is as important as getting medical attention once you know you are pregnant.

image4

The concept that “every contact is a health improvement opportunity” demonstrates that all health and social care service providers who have contact with women and men of reproductive age can make a significant impact on optimising the preconception health of their service users. By utilising every opportunity to promote preconception health and to support women and men to make healthy lifestyle choices, the health and wellbeing of women and men who plan a pregnancy, as well as those who find themselves with an unintended pregnancy, can be maximised.

 
How can we incorporate preconception health into our work?

A new Preconception Health Toolkit that has been designed, tested and refined using Early Years Improvement Methodology will soon be available to support staff across all agencies to raise the issue of preconception health with their service users. The Toolkit includes information on risk indicators for adverse pregnancy outcome, health enhancing behaviours, tips for raising the issue and other suggestions for raising awareness.

image5

The Preconception Health Toolkit will be launched next Friday 27th January at an event at the Garroch Training Centre near Dumfries, 10am-11.30am. Dr Jonathan Sher, independent consultant, will deliver an interactive key note address. There are still places available, please contact me at lauragibson1@nhs.net if you’d like to participate.
Following the formal launch, the Toolkit, which has been developed specifically for non-specialist staff, will be available electronically to all staff and volunteers in the statutory and third sectors. Please contact me to request a copy or download it from http://www.sexualhealthdg.co.uk.

Laura Gibson, Health and Wellbeing Specialist, DG Health and Wellbeing, Directorate of Public Health

References

Royal College of Obstetricians and Gynaecology (2008) Standards for Maternity Care Royal College of Obstetricians and Gynaecologists; London

J Sher (2016) Prepared for Pregnancy? NHS Greater Glasgow and Clyde (Public Health)

3 Woods, K (2008) CEL 14 Health Promoting Health Service: Action in Acute Care Settings The Scottish Government: Edinburgh

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