Midwives have a specific responsibility for the continuity and coordination of care, providing ongoing midwifery care as part of the interdisciplinary team and acting as an advocate for women and newborn infants to ensure they are always the focus of care.
This care includes women who come to maternity journey with additional needs, such as a learning disability.
In this case scenario, we have described an example of positive collaboration between a midwifery student and a learning disabilities nursing student to enhance the care of a woman and her partner with learning disabilities.
Sharon is a student midwife in her second year. She meets Maisie and her partner Dean in the community antenatal booking clinic.
Both Maisie and Dan have learning disabilities. They live together in supported accommodation and are delighted about the pregnancy.
Sharon remembers that she had recently met Alana, a learning disabilities third-year student nurse who was looking at the evidence around maternity care and learning disability for her thesis. Alana had found that women with learning disabilities were particularly vulnerable when they were pregnant, giving birth or in the early postnatal period. This made Alana question what was is in place in the maternity service to support these women.
Sharon and Alana looked together at the evidence to find out what was in place to support Maisie and Dean.
What did Alana and Sharon consider?
- During her maternity placement, Alana had liaised with the safeguarding midwife. She highlighted that there were limited resources for ways to support mothers with learning disabilities and their potential vulnerabilities.
- The literature showed that women with learning disabilities are often not expected to be mothers, or they’re told they wouldn’t be ‘good enough’.
- Alana and Sharon found that stereotypes and negative perceptions can make a woman with learning disabilities feel devalued. As a consequence, this may impact the relationship between herself and the maternity services.
What did Student Midwife Sharon do?
Sharon worked with her practice supervisor, Maisie and Dean and their support network (which included their families and their social workers), to plan, assess, implement and evaluate the best way of supporting them through their pregnancy and once they were at home with their baby.
Alana had developed a tool, as part of her thesis, aimed at building awareness around supporting women with learning disabilities. It aimed to help by supporting them build key therapeutic relationships with midwives to make sure that their holistic needs are met.
How does this align to the Standards of proficiency for midwives (2019)?
The standards are grouped under six domains and Domain 4 is specifically about the care of women and newborn infants with additional needs.
The midwife is responsible for ensuring timely collaboration with and referral to interdisciplinary and multiagency colleagues. The midwife has specific responsibility for continuity and coordination of care, providing ongoing midwifery care as part of the interdisciplinary team, and acting as an advocate for women and newborn infants to ensure that they are always the focus of care.
6.69 says that midwives must:
"recognise, assess, plan, and respond to pre-existing and emerging complications and additional care needs for women and newborn infants, collaborating with, consulting and referring to the interdisciplinary and multiagency team as appropriate". This includes learning disabilities.
If you were looking after Maisie and Dean, you could demonstrate your proficiency by recognising their needs and listening to their concerns. You could also make sure that Maisie has the opportunity to understand how midwifery continuity of care can support her as well as other healthcare professionals who might be supporting her and Dean.
Using clear language and appropriate resources to respond to Maisie and Dean’s questions will demonstrate kindness and avoiding discriminatory behaviour and unconscious bias. Domain 6, particularly 6.1, describes how the midwife must be able to effectively communicate, share information and manage relationships.
You can also demonstrate the values in the Code by knowing the relevant laws and policies about protecting and caring for vulnerable people. You would be treating Maisie as an individual, upholding her dignity, listening and responding to her preferences and concerns. By being inclusive you will make sure Maisie's physical, social and psychological needs are assessed and responded to.
The work that Sharon and Alana did in collaboration demonstrated that they were incorporating up-to-date evidence in daily practice, sharing and disseminating evidence-informed practice and working innovatively.
Throughout Maisie's maternity journey the co-ordination of care will ensure that her mental, physical, psychological, social and spiritual care needs are met from the midwifery team and other health and social care professionals who are contributing and helping with care and support.
Domain 2.11 requires that a midwife "demonstrates the ability to be the coordinator of care within the wider interdisciplinary and multiagency teams, arranging a seamless transfer of care when midwifery care is complete."
You're also demonstrating the responsibility outlined in Domain 4:
"The midwife has specific responsibility for continuity and coordination of care, providing ongoing midwifery care as part of the interdisciplinary team, and acting as an advocate for women and newborn infants to ensure that they are always the focus of care."
Maisie and Dean might share some concerns about the forthcoming birth:
- They have seen a waterbirth on TV and thought it was beautiful, but Maisie's mum wasn't keen on the idea.
- Dean is confused about feeding the baby, and which way is better, as some of his friends and his family have told them different things.
You'll be able to support Maisie and Dean in a number of ways during her pregnancy to plan for both birth and afterwards with their baby. This planning could include using a range of resources and evidence to talk through a birth plan, consent and options.
If any concerns arise for either Maisie or the baby, you can arrange for Maisie and Dean to get the support they need to understand the implications and work with them to see if they'll need any adjustments to their birth plan or not.
You're demonstrating that you're following Domain 6.10, to consistently plan, implement, and evaluate care that considers the needs of women and newborn infants together.
You can also demonstrate Domain 6.13, to inform and update interdisciplinary and multiagency colleagues (for example, this would be Masie's GP, social worker and consultant) about changes in care needs and care planning, and update Maisie's records accordingly.
When Maisie's care is transferred to her community midwife, along with the GP, health visitor and social worker, that will be demonstrating Domain 6.12 :
'arrange for effective transfer of care for the woman and newborn infant, as needed, and when midwifery care is complete.
Test your understanding
- What resources are available for pregnant women with learning disabilities?
- How will you approach building relationships and sharing information with women, their partners and families in a way that ensures that women’s needs, views, preferences, and decisions can be supported in all circumstances?
- How do you demonstrate skills of effective challenge when discrimination is displayed?
- Consider how you would communicate complex information to a woman and her partner with learning disabilities.
If you are a midwife, you may wish to use this scenario and your reading as part of your continuing professional development (CPD) for your revalidation.
With thanks to Elizabeth Maushe, Learning Disability Nurse for sharing her work that led to this case scenario.