ASM 2015 Programme Notes

Combined meeting NES / BSBOG 4 Dec 2015- the BSBOG Annual Scientific Meeting  - NICE, KCND and NES.

The idea for this meeting came about at the combined BSPOGA/ RCOG launch of the NICE 110 Guideline, Pregnancy and Complex Social Factors in March 2012 .  Dr  Mary Hepburn (OBE) recognised  the impact of poverty on lifestyle  choices, health and attainment outcomes decades before inequalities  and complex psychosocial factors were officially recognised as a direct cause of maternal mortality and  she devoted her working life to this.  This meeting is therefore seen as a tribute to the work she has done in Glasgow, Scotland and worldwide, and also a celebration of the National Collaborative Approach adopted by the Scottish Government.

Confidential enquiries into maternal deaths began in 1952, however, the history of smaller, local enquiries dates back to 1917 in Aberdeen. Maternal deaths during this period were particularly prevalent in poor, working-class families, thus a large part of these early local enquiries was focused on the social backgrounds of the women who died. Further emphasis was placed on educating women and their families on the importance of maternity care as well as an understanding of the warning signs of complications and the importance of seeking help. Society has changed in Scotland and the UK, maternal mortality has plummeted, health care has become safer, however inequalities remain.

 It was not possible for many people to travel from Scotland for this one day event in 2012 , and  as Secretary of BSPOGA , I pledged to host an affordable meeting in Scotland - to raise awareness of complex social factors affecting mothers, babies, families and society, and ways to support those providing the care. Since then, various Scottish Initiatives have arisen following what had  already been established  in 2009 with KCND , Keeping Childbirth Natural and Dynamic (known affectionately as KIND), namely the Scottish Patient Safety Programme  ( SPSP) , Maternity and Childrens Quality Improvement Collaborative , MCQIC, Early Years Collaborative, EYC  and Person Centred Care Collaborative  . All of these collaboratives bring together people from every Board area in Scotland and could be seen as models of relationship based care, a model of care that places personal relationships between caregivers, patients and families at the centre of care delivery. In a relationship based care culture, clinicians get reconnected with the purpose and meaning of their work, teamwork is based on deep commitment rather than surface-level compliance, and patients and their families feel safe and cared for as clinicians commit themselves to making authentic human connections with the people in their care.

Relationships are crucial to human development, and the period  from conception  to birth and the early years can be formative for babies and parents, and tend to establish patterns of intimacy and sociality for life, and origins of adult health.  This includes psychosocial and environmental conditions that affect  both prenatal development in the nine months of pregnancy including conception and also the perinatal period, seen as the short but crucial period of hours including labour, birth and establishment of breastfeeding.

The Lancet series of midwifery  identified more than 50 outcomes that could be improved by care within the scope of midwifery by meeting the essential needs of childbearing women in all countries, and of their babies and families reduced maternal and neonatal mortality and morbidity, reduced stillbirth and preterm birth, decreased number of unnecessary interventions, and improved psychosocial and public health outcomes. The Series provided a framework for quality maternal and newborn care that             firmly places the needs of women and their newborn infants at its centre. It is based on a definition of midwifery that takes account of skills, attitudes and behaviours rather than specific professional roles. The findings of this Series support a shift from fragmented maternal and newborn care provision that is focussed on identification and treatment of pathology to a whole-system approach that provides skilled care for all.  Childbearing women need and want for themselves and their newborn infants: to be healthy, safe, supported, respected and to give birth to a healthy baby that can thrive, after a positive and life-   enhancing pregnancy birth experience, whatever complications they may experience. This is also most likely to promote effective attachment, and longer term survival and wellbeing for the infant.

KCND - a Scottish National Model

KCND (Keeping Childbirth Natural and Dynamic) is a  national  programme to ensure all women have a robust assessment of their needs  in early pregnancy,  with timely intervention for those women and their families with additional medical or social need, and that care is provided by the most appropriately skilled maternity professional.

What happens in Scotland with KCND (aka KIND) ?

Midwives carry out a quality social needs assessment including information on sensitive issues such as gender-based violence and therefore it is essential that they receive the correct level of support and training to develop these skills. The NES (NHS Education for Scotland) resources which will be discussed at this meeting, ( One out of Four Resource   and Maternal Mental Health Resource ) were  produced to support professionals to deliver sensitive and  appropriate care to these women, by multi-professional and multi-disciplinary collaboration.  Women experiencing high risk pregnancies, who would therefore benefit most from early contact with maternity services, may be in contact with other services such as drug or alcohol addiction, housing or social work.  It is important that professionals working in these services signpost women to the support delivered by maternity services at the earliest possible stage.

What has happened in Scotland since KCND was introduced and since NICE 110 ?

A lot has happened.......

The initiatives  from KCND were strengthened by the Refreshed Maternity Framework which was published in 2011 and the Scottish Patient Safety Programme - seen as key to delivering the NHS Scotland Health Quality Strategy and Quality Ambitions of Safe, effective and Person-Centred care, both of which support The Scottish Governments 2020 vision to provide safe, high quality care whenever and wherever care is delivered.

The Early Year’s Collaborative  (EYC) was launched in October 2012 and is the world's first multi-agency, bottom up quality improvement programme to support the transformation of early years. Bringing together all those involved in the lives of babies and children from birth onwards to ensure there are positive opportunities for children to get the start in life that will give them a strong platform for healthy growth, development and attainment.

Getting it right for every child  (GIRFEC) National Practice Model is seen as a  a consistent way for people to work with all children and young people and the bedrock for all children’s services and professionals in adult services who work with parents or carers

The Maternity and Children Quality Improvement Collaborative (MCQIC) launched  in March 2013 and is a unique National Initiative with the overall aim to improve outcomes and reduce inequalities in outcome by providing a safe, high quality care experience for all women, babies and families in Scotland.

Person Centred Care Collaborative  takes a humans rights based approach to health and care that respects the personal experiences of the individual by five must do with me areas to ensure that all of the interactions between people using services and the staff delivering them are characterised by listening, dignity, compassion and respect.

........Which is why we called the meeting NICE and KIND with NESsie- We hope you enjoy the day!


Sources and Informational Links


Mary Hepburn (OBE)  BSc MD MRCGP FRCOG

Consultant obstetrician and gynaecologist

Senior lecturer in women’s health / Consultant obstetrician and gynaecologist- recently retired from the NHS

Mary Hepburn trained first as a general practitioner and then as an obstetrician and gynaecologist. Her main interest is in the effects of poverty and inequality on health and access to services. She established and, until her retirement from clinical practice in July 2014, was consultant in charge of the Glasgow Women’s Reproductive Health Service for women with social problems (now the Glasgow Special Needs in Pregnancy Service). Dr Hepburn continues to contribute to the undergraduate and postgraduate training for medical and non medical professionals nationally and internationally. She has provided training and support with service development nationally and internationally and continues to work as a consultant for WHO and other NGOs in developing and /or resource poor countries.

  1. BSPOGA - who are we ?
  2. NES NHS Education for Scotland
  3. NICE 110  Guidance - Pregnancy and Complex Social Factors
  4. KCND - Keeping Childbirth Natural and Dynamic,_maternal_child/programme_resources/keeping_childbirth_natural.aspx
  5. Scottish Patient Safety Programme 
  6. Maternity and Children Quality Improvement Collaborative
  7. Early Year’s Collaborative
  9. Person Centred Care Collaborative
  10. Relationship Based Care
  11. Lancet Series  MidwiferyThe Lancet Published: June 23, 2014
  12. One out of Four Learning -
  13. Maternal Mental Health Resource -
  14. Refreshed Maternity Framework
  15. NHS Scotland health Quality Strategy