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围产期保健服务中面临儿童社会关怀介入风险的妇女:英格兰专业人员的定性调查。

Perinatal healthcare for women at risk of children's social care involvement: a qualitative survey of professionals in England.

机构信息

Department of Epidemiology and Public Health, University College London Institute of Epidemiology and Health Care, London, UK

Homerton Healthcare NHS Foundation Trust, London, UK.

出版信息

BMJ Open. 2024 Mar 5;14(3):e082914. doi: 10.1136/bmjopen-2023-082914.

Abstract

BACKGROUND

Women with complex health needs are more at risk of having children's social care involvement with their newborns than other mothers. Around the time of pregnancy, there are opportunities for health services to support women with these needs and mitigate the risk of mother-baby separation. Yet little is known about healthcare professionals' experiences of providing this support.

METHODS

We administered an online survey to perinatal healthcare professionals across England (n=70 responders), including midwives, obstetricians, perinatal psychologists/psychiatrists and health visitors. We asked about their experiences of providing care for pregnant women with chronic physical conditions, mental health needs, intellectual/developmental disabilities and substance use disorders, who might be at risk of children's social care involvement. We conducted a framework analysis.

RESULTS

We constructed five themes from participant data. These include (1) inaccessible healthcare for women with complex needs, (2) the challenges and importance of restoring trust, (3) services focusing on individuals, not families, (4) the necessity and caution around multidisciplinary support and (5) underfunded services inhibiting good practice.

CONCLUSIONS

Women who are at risk of children's social care involvement will likely experience perinatal healthcare inequities. Our findings suggest that current perinatal healthcare provision for this population is inadequate and national guidelines need updated to inform support.

摘要

背景

与其他母亲相比,有复杂健康需求的女性更有可能让新生儿接受儿童社会关怀。在怀孕前后,卫生服务机构有机会为有这些需求的妇女提供支持,降低母婴分离的风险。然而,人们对医疗保健专业人员提供这种支持的经验知之甚少。

方法

我们向英格兰的围产期保健专业人员(70 名应答者,包括助产士、产科医生、围产期心理学家/精神科医生和保健访视员)进行了在线调查。我们询问了他们为可能面临儿童社会关怀介入风险的患有慢性身体疾病、心理健康问题、智力/发育障碍和药物使用障碍的孕妇提供护理的经验。我们进行了框架分析。

结果

我们从参与者的数据中构建了五个主题。这些主题包括(1)为有复杂需求的妇女提供难以获得的医疗保健服务,(2)重建信任的挑战和重要性,(3)专注于个体而非家庭的服务,(4)多学科支持的必要性和谨慎性,以及(5)服务资金不足妨碍了良好实践。

结论

可能面临儿童社会关怀介入的妇女可能会经历围产期医疗保健方面的不平等。我们的研究结果表明,目前针对这一人群的围产期医疗保健服务不足,需要更新国家指南以提供支持。

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