Quitting smoking in pregnancy and following childbirth

The National Institute for Health and Clinical Excellence (NICE) has launched a consultation regarding quitting smoking in pregnancy.

The Department of Health asked NICE to develop guidance on how to stop smoking in pregnancy and following childbirth. Comments are now invited on the draft scope. The scope addresses women who are planning a pregnancy, are pregnant, or have an infant aged less than 12 months. To address health inequalities, particular focus will be given to women from groups where smoking rates are high.

The consultation includes interventions aimed at encouraging women to quit smoking, and interventions to help their partners support their attempt to quit. It also considers eliminating foetal and infant exposure to tobacco smoke in the home.

The consultation closes on November 22 2009.

Family Nurse Partnership improving outcomes for vulnerable families

Young first time mothers are being helped to improve the life chances of their babies and fathers are more involved in the early years of their children’s lives thanks to the Family Nurse Partnership (FNP) programme, independent research published today has found

The second year evaluation report of the Family Nurse Partnership programme by University of London, Birbeck, which is joint between the Department for Children, Schools and Families and the Department of Health, found that:

· Effective delivery is having a positive impact on some of the most vulnerable young families in society;

· There are early signs that the programme is having a positive effect on reducing smoking during pregnancy and increasing rates of breastfeeding;

· Mothers value the programme and believe it has made a positive difference to how they care for their baby and their own aspirations for the future;

· Fathers involvement is especially high with more than half of Fathers present for at least one pregnancy visit;

· A strong nurse-client relationship is key to its success – and clients are overwhelmingly positive about their family nurses, rating them on average 9 out of 10; and

· Nurses have reported that their clients are more confident as parents, were playing with their children more, wanted to learn and had aspirations for the future.

British Pregnancy Advisory Service comment on media discussion of abortion, low birth weight and prematurity

BPAS’ Medical Director Patricia Lohr said of a research review published in BJOG, the International Journal of Obstetrics and Gynaecology, which has been the subject of media discussion:

‘As the study’s authors point out, a causal relationship between abortion and adverse pregnancy outcomes cannot be determined from this paper. There are multiple confounding factors affecting low birth weight and premature births that were not examined in many of the previously published studies which were assessed in this paper.

‘We know from other research that adverse pregnancy outcomes often involve other risk factors to health: being poor, unemployed, or the effects of alcohol use and smoking. These risk factors can be difficult to separate from a woman’s previous history of abortion or miscarriage.

‘It’s a central principle for BPAS that women are informed of relevant health information if they are considering an abortion. On the basis of the evidence to date however, it would inappropriate for doctors advise women that there has been anything more than an association made between abortion and adverse pregnancy outcomes. We already do this in our patient literature. This study sheds no light on the contributory effect of one abortion procedure over another.’

Health visitors crisis is ‘a national scandal’ – PM’s nursing commission told

The dramatic fall in the number of health visitors since 2004 is ‘a national scandal’, Unite, the largest union in the country, has said.

Unite, in its response to Prime Minister’s Commission on the Future of Nursing and Midwifery, has called for ‘a new fast track into health visiting’ to reverse the profession’s decline.

Unite is equally critical of the state of school nursing which has fewer than 900 whole-time equivalent (WTE) qualified school nurses employed by the NHS, and as a result many schools ‘rarely’ see a school nurse. One way to overcome this would be to encourage more men to become school nurses, with the job role more clearly defined.

Unite said: ‘The fall in new health visitor registrants from 717 in 2004 to 253 in 2008 should be seen as a national scandal.’

Unite said that there been a nearly 13% drop in WTE health visitors since 1998, but the number of live births has increased by 8.5% and the population of the UK by 4.6% during the same period.

‘Allowing this to happen has been a social experiment that will have affected a whole generation of children’s lives. Furthermore it will cost the total economy, from health expenditure, criminal justice and unemployment, billions of pounds in the future.’

It is essential that the Commission supports a new fast track route into health visiting which reduces the requirement to spend three years training as a nurse, when the ambition is to be a health visitor. This would appeal to mature entrants, and to those with degrees in subjects, such as psychology and life sciences.

Unite urged the Commission to recommend that ‘health visiting’ is once again legally defined in statute, as it was between 1909 and 2004. This would stop less qualified health professionals doing the ‘health visitor’ job and strengthen the public’s confidence in the profession.

The fact that Unite, the third largest NHS union, which embraces the Community Practitioner’ and Health Visitors’ Association, was not represented on the commission was described as ‘unfortunate’.

Unite Lead Professional Officer for Policy and External Affairs, Obi Amadi said: ‘The picture is bleak. However, we have put forward a number of positive recommendations that would revitalise the health visiting and school nurse professions, at a time when the public is rightly concerned about child protection issues in the aftermath of the tragic case of Baby P.’

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The Downs Syndrome Association launches an all party parliamentary group

An All Party Parliamentary Group (APPG) on Down’s syndrome has been launched to inform MPs and Lords about many of the issues facing people with Down’s syndrome and their families, and ways in which policy changes can improve their quality of life.

One of the DSA’s parent members, Tony Greaves, worked with his local MP and with the DSA to seek the support of 25 other MPs to create a new Parliamentary Group, some of whom met for the first time at the end of June. Down Syndrome Education International (DownsEd) is also supporting the Group.

At the inaugural meeting, we heard about MP interest in Down’s syndrome, about the work of our organisation and that of DownsEd. We also heard from Professor John Hardy, a researcher in genetic and neuro-science from UCL who believes that there is so much to learn about Down’s syndrome and much that could be gained from pursuing a research programme that focuses specifically on various aspects of Down’s syndrome.

The APPG has already agreed to support our Tell it Right (http://petitions.number10.gov.uk/TellItRight/) campaign to ensure that high quality support is given to parents after a diagnosis of Down’s syndrome. The Group will seek to improve, through legislation, the quality of information provided to parents throughout the prenatal screening process, and to those with a post-natal diagnosis.

As well as establishing current public funding for research (medical, social and educational) the Group have also agreed to work to establish two National Working Groups, the first to develop a multi-disciplinary, co-ordinated research strategy for Down’s syndrome, and the second on Best Practice Standards in health and medical care, early development, education (including adults), adult social care and employment support.

The DSA is very pleased by the expressions of support from all the political parties and from members of the Lords. The Group will meet again in the autumn – we will keep you posted!

Women being denied labour beds to give birth

Last year, almost 4,000 women in England gave birth in a location other than a designated labour bed in a hospital.

Hospitals also gave examples of babies being born in midwife offices, lifts, toilets and a caravan. Some of these births will have been genuine emergencies and unavoidable, but many are because services are overstretched.

“New mothers should not be being put through the trauma of having to give birth in such inappropriate places”, Shadow Health Secretary Andrew Lansley said. “It is extremely distressing for them and their families to be denied a labour bed because their maternity unit is full”.

Lansley added that the fact that mothers are getting this sort of sub-standard treatment despite Gordon Brown’s tripling of spending on the NHS reflects the incredible waste of resources in recent years.

He also pledged that under a Conservative Government would make sure every woman who wants a single hospital room will get one, and also that it would make sure the money follows the patient “so that if more women are giving birth then more money is available”.

Infant and perinatal mortality 2008: Health areas, England and Wales

This week data has been released by the Office for National Statistics on infant and perinatal mortality showing a decrease in stillbirth and neonatal mortality rates. There were 3,369 infant deaths (deaths under 1 year) registered in England and Wales in 2008, giving an infant mortality rate of 4.8 per thousand live births.

In 2008, there were 3,617 stillbirths and 1,763 deaths at ages under seven days registered in England and Wales giving a total of 5,380 perinatal deaths.

The neonatal mortality rate (deaths under 28 days) decreased to 3.2 per thousand live births in 2008, from 3.3 in 2007. The postneonatal mortality rate (deaths between 28 days and one year) remained at 1.5 per thousand live births.

The data presented here include statistics on infant deaths registered in 2008, and live births and stillbirths occurring in 2008, in England and Wales, for residents of each Government Office Region (GOR) and Strategic Health Authority (SHA) in England and Local Health Board (LHB) in Wales.

The stillbirth rate decreased from 5.2 per thousand live births and stillbirths in 2007 to 5.1 per thousand live births and stillbirths in 2008. The perinatal mortality rate also decreased from 7.7 per thousand live births and stillbirths in 2007 to 7.6 per thousand live births and stillbirths in 2008 (Table 1).

To view the full statistical release can be found here- Infant and perinatal mortality 2008: health areas, England and Wales

NCT response to Swansea University research relating to drugs in labour and breastfeeding

A study published in the British Journal of Obstetrics and Gynaecology suggests that there may be an association between drugs used during the third stage of labour and a reduction in breastfeeding at 48 hours after birth.*

This study suggests that injected synthetic oxytoxin alone or with ergometrine (e.g. Syntometrine), which is given to speed the delivery of the placenta and prevent haemorrhage after the birth, could also make breastfeeding more difficult. It is already known that pethidine and similar opioid drugs can have an impact on babies’ ability to start breastfeeding in the early days.

For more information about oxytocin, the third stage of labour or drugs that may be offered to women during labour, please visit the NCT info centre

Should the Child Trust Fund be abolished?

IFS Observation – Should the Child Trust Fund be abolished?

The oldest children to receive a Child Trust Fund from the Government today celebrate their seventh birthdays. Alongside their other presents, the Government is making a further contribution to their accounts – those in families receiving a full Child Tax Credit award get £500 while everyone else will get £250. These are the first contributions that these children will have received from the Government since equivalent amounts were paid in when the account were opened, at which point thirty per cent qualified for the more generous award. The money is invested and, under normal circumstances, is locked away until the child reaches age 18.

The need, in the medium-term, to reduce public borrowing makes it natural to try to identify the areas of public spending that could be cut with the least pain. Might the Child Trust Fund be a potential candidate? Each year around 800,000 newborns receive an account at a cost – including the top-ups at age seven – of around £½ billion to the taxpayer. Abolishing it would make a small, but not insignificant, contribution to the total £26 billion spending cut estimated to be needed by 2013-14 under the Government’s spending plans.

There are two benefits from the Child Trust Fund. First, most eighteen year olds will have no financial assets so even a modest amount – such as £500 – can have a major impact on the distribution of wealth at that age. For those individuals unable to access credit it could increase opportunities, such as to continue in education, to purchase a car, to become self-employed or to go travelling. Second, children could benefit from seeing their Child Trust Fund accruing over time and learning about the advantages – and costs – of investing in riskier and safer financial products. The FTSE-100 index is currently around the level it was at the start of 2005 when the first Child Trust Fund vouchers were issued having first risen steadily, then fallen sharply and then risen again during the intervening period. Proponents of the policy therefore argue that the Child Trust Fund complements existing spending on schools and cash transfers to families with children, and that it could help improve life chances by bringing about a stronger saving culture.

Abolishing the Child Trust Fund would make newborns worse off in eighteen years time. But spending cuts in other areas might leave them worse off. Cuts to benefits or tax credits would reduce the amount that their parents have available to spend on them during their childhood. Cutting spending on public-services – such as pre-school education – could reduce the quality and quantity of the services provided. Both could reduce the quality of life and the future life chances of children by more than the abolition of the Child Trust Fund. The now increased focus on personal financial education within schools might be a more cost-effective way of helping children to make appropriate saving decisions in the future. When the time for tough choices about public spending arrives abolishing the Child Trust Fund could be one of the less unattractive options.