Cases

Chapter 11 Public health and health promotion

Case 1: Obesity

A pregnant woman Nneka has attended the antenatal booking community midwifery clinic. Her booking weight is 105 kg and her body mass index is 35 kg/m2. This is her third pregnancy; she has two children aged nine and four. Nneka is keen for a normal birth as with her second child. Her first child was born by forceps delivery and complicated by shoulder dystocia.

Questions

• a) What should the community midwife do to ensure that the BMI calculation is accurate?

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  Correct answer:
  The midwife must personally weigh the woman and measure her height on equipment that is correctly calibrated: women will often underestimate their weight and overestimate their height.

• b) What information will the midwife need to develop a plan of care for Nneka?

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  Correct answer:
  Previous obstetric history including number and type of births. Previous birth weights. How labour began and gestational ages at which previous babies were born. Nneka's current health status (e.g. Is she hypertensive? Does she have gestational diabetes? Therefore, blood pressure determination and a glucose tolerance test or other acceptable methods of blood glucose determination may be required).

• c) What might be the role of a Healthy Lifestyles Midwife (HLM) for Nneka?

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  Correct Ansewer:
  The Healthy Lifestyle midwife (HLM) could offer Nneka regular supportive consultations during pregnancy, discussing how to maintain a healthy balanced diet, monitoring her weight, encouraging her to persevere with healthier eating and moderate activity, finding out whether Nneka is aware of a problem and what strategies she may already have put in place to tackle her obesity. The HLM could discuss the birth plan with Nneka, discussing the various options and the benefits and risks involved. The HLM could also conduct respectful discussions with the consultant obstetrician seeking ways to maintain safety whilst avoiding unnecessary interventions, ensuring that Nneka's wishes are heard and not dismissed.

Case 2: Communicable diseases

It is early January and it is reported in the national news and by the Department of Health that there has been a recent pronounced increase in the numbers of young infants who have contracted whooping cough in the last two years. This includes a number a couple of neonatal deaths. In addition, significantly higher numbers of pregnant women having been hospitalized with flu-virus in the past six months, than in the previous three years.

Questions

• a) What area of public health is concerned with counting populations by their characteristics?

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  Correct answer:
  Demography.

• b) What is the name of the field of study which is concerned with the causes of ill-health and the spread of disease in populations?

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  Correct answer:
  Epidemiology.

• c) What kind of public health and health promotion interventions may be implemented and who might be involved?

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  Correct answer:
  Antenatal clinics offering immunisation of pregnant women against Bordella pertussis and influenza. Education of health professionals about the risks the diseases and preventative strategies. Public awareness campaigns (including advertising in public spaces (hoardings, hospitals doctors surgeries, community clinics, bus shelters, television, radio, internet) advising pregnant women to be vaccinated and warning of the dangers of the disease to their children. Ensuring that staff who come into direct contact with childbearing women, infants and children) are also vaccinated. Community midwives, hospital based midwives, obstetricians, paediatricians, general practitioners (GPs), health visitors, practice nurses, clinical support workers (e.g. in Children's Centres).

• d) Why?

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  Correct answer:
  These campaigns will raise awareness of the need to protect mothers and children against these diseases. The different groups of health professionals may all have direct contact with childbearing women and children, they are trusted to have health information and knowledge and during pregnancy may have regular opportunities to explain these important messages to women and their families. These health professionals may also be involved in performing the vaccinations.

Case 3: Health inequalities

Monika, a 28-year-old Polish woman, who has been living in the UK for three years, is 22 weeks pregnant with her first child. She has had persistent nausea and vomiting, and has a demanding job in a restaurant kitchen. She feels dreadful but is afraid to tell her employer that she needs time off work, because she has noticed that other pregnant employees, from a similar ethnic and national background, have lost their jobs, in the same establishment. The community midwife Jolene feels that Monika needs to take some time off sick.

Reflection questions:

Questions

• a) How might Monika be considered to be experiencing health inequalities?

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  Correct answer:
  Monika could be considered to be low down on the social gradient. She could have poor language abilities in English and she may not know her employment rights and entitlements. She may be working in a low paid industry, and more susceptible to ill-health. Her pregnancy, which is causing ill-health (in this case), may make her vulnerable to unemployment, which may lead to lower income (or no income), which may contribute to poor or poorer housing conditions. The stress may also contribute to poor health in Monika and in the fetus.

• b) How might the midwife act to promote Monika's health and the health of the unborn baby?

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  Correct answer:
  The midwife might use different strategies to support Monika; one of these could be as a behaviour change agent giving Monika advice on how to control her symptoms, or referring her to GP or obstetric care, depending on the severity of her symptoms. The midwife may also act as a strategic practitioner, raising awareness of the plight of young women like Monika who are being exploited by their employers, through organisations like the Maternity Alliance, or the Royal College of Midwives, by consulting the local Member of Parliament. The midwife could be a catalyst for collective empowerment of women in Monika's situation, helping them to initiate support groups and find their own voice against unscrupulous employers.