East Sussex Healthcare Trust established the Lighthouse Team, providing continuity of care and an enhanced service for young parents under 20 and those aged 20 to 22 with additional vulnerabilities.
Following the publication of The Better Birth Maternity review in 2016, East Sussex Healthcare Trust established the Lighthouse Team. This decision was prompted by the high under-18 maternity rate in Hastings, which in 2017 was 68 per cent higher than the England average (Office for National Statistics, 2019). Hastings is the 13th most deprived local area in England which contributes to the vulnerability of young parents and their children with regards to financial difficulties, domestic abuse, substance misuse and smoking, mental health difficulties and safeguarding concerns.
As young parents often find accessing care difficult for several social, emotional, or financial reasons, the Lighthouse Team provides ante and postnatal support in various settings to suit the family. This is usually in their home which provides a more relaxed setting for the team to offer their holistic care approach. This has resulted in a low rate of missed appointments, more consistent monitoring and better maternal and infant outcomes including lower rates of small for gestational age babies. Depending on individual need the team can offer extra antenatal appointments and additional support with emotional wellbeing and mental health issues, and any safeguarding concerns. Working closely with other services, the team signposts and supports young parents to access antenatal education, and specialist advice on benefits and housing and healthy pregnancy support for smoking cessation, substance misuse, nutrition, and exercise.
In the postnatal period families are seen for 28 days on an individualised care basis for clinical checks, feeding support, emotional support, and parenting advice. Discussion about their preferred method of post-partum contraception starts in the 28thweek of pregnancy with the midwifery team able to provide three months of contraceptive pills, the contraceptive injection or implant. Alternatively, they are referred to local sexual and reproductive health outreach services for further contraception needs.
Funded from the Trust’s maternity budget the Lighthouse Team is made up of seven full time equivalent midwives and is led by the specialist midwife for young parents. Each midwife has a caseload of up to 28 per year and they provide 24/7 cover for intrapartum care with the families followed to the obstetric unit or supported for home births. Regular ‘meet the team’ events occur to invite the caseload to meet each other for support and to meet the team midwives in preparation for labour. Some additional funding from the Local Maternity System has increased midwifery hours and enabled the appointment of a care coordinator/administrator to assist the team.
To support young parents in the transition from the Lighthouse Team to health visiting services and other community support, a Young Parents Forum has been established, comprising the Health Visiting service leads, the Child Health Commissioner, and the Young Parents Specialist Midwife. Together they have developed a care pathway with the specialist midwife introducing young parents to their health visitor and to the local baby groups run by Early Help Practitioners and Nursery Nurses. Young parents are typically reluctant to engage with new support groups and often become isolated which can impact on their emotional wellbeing. Making the first visit with their trusted midwife aims to build their confidence and integration into wider community support.
A Perinatal Mental Health midwife is now being employed to link with the mental health and the Enhanced Continuity of Carer (ECoC) teams to support vulnerable parents to access mental health support. Liaison with the named midwife and the young parents will help ensure individualised management plans are in place, identifying specific needs relating to mental health, learning needs and neurodiversity. They provide the Multi-Disciplinary Team with information to ensure trauma informed care and communication and learning styles are taken into account. This will be funded by the Enhanced Maternity Continuity of Carer budget.
Lessons learned
- An understanding of the lived experience of young parents is key to providing sensitive and effective support.
- A specialist team of midwives provides the expertise and communication skill needed to build the trust of young parents and address their complex needs and vulnerabilities.
- Knowledge of and collaboration with other agencies providing support is essential for a coordinated care pathway for young parents.
- The Enhanced Continuity of Carer needs for young parents is the same for many of those into their early 20s with pre-existing vulnerabilities.
- The Lighthouse team covers a large geographical area covering two large towns, two hospitals and the surrounding rural areas. To meet the need, ideally a team on both sites with increased capacity to facilitate ECoC to all those under 21 with additional young parents up to 25 with vulnerabilities requiring enhanced care.