Blog by Jennifer Pountain

Midwifery is a unique profession, straddling many aspects of the medical model, but also the concepts of health and wellbeing in a population, in short, population health.

Midwives don’t just ‘catch’ babies, midwives signpost, educate, and nurture optimal health and wellbeing in the pregnant, postnatal population and early years foundations. Yet, given the current health service climate — whereby acute services are heavily weighted in terms of investment over population health — I felt compelled to thrust my profession into the population health limelight, to educate the maternity system about why population health matters for optimal maternal health and wellbeing.

As a community midwife in Greater Manchester, I also have a master’s in public health and global health, so the National Population Health Fellowship gave me the opportunity to put public health theory and knowledge to practice. My fellowship project was very much my own development; I was seconded to work with the Greater Manchester Integrated Care Partnership population health team, focusing on the Greater Manchester and East Cheshire (GMEC) Local Maternity and Neonatal Systems (LMNS) Equity and Equality Action Plan 2022-2027 for maternity services in GMEC. A national incentive derived from NHS England 2021 guidance for local maternity systems to improve equity and equality in maternity care. My project has enabled me to benefit from co-production with the local community, voluntary and charitable sectors (VCSE) and social and cultural groups who provide vital links to vulnerable communities.

I decided to conduct some insightful work to develop a quality improvement project, to increase early access to antenatal care for women from GMEC ethnic minority backgrounds given that 40% of women did not book into the maternity care system by the recommended National Institute for Health and Care Excellence (NICE) guidance of 10 weeks of pregnancy. Early access care is proven to reduce suboptimal maternal and neonatal health, reduce the risk of maternal and neonatal mortality rates, increase vaccination in pregnancy consent, screening for infectious diseases, and inherited haemoglobinopathies in pregnancy to name only a few. Moreover, cementing relational continuity of care early on in pregnancy increases health empowerment. For me, this is the biggest factor that has yet to be increased across the whole of our health system: the concept of health literacy. This is not isolated to maternity care; there is evidence to suggest those who do not possess the knowledge and confidence to take control of their health and wellbeing will always have reduced optimal healthy outcomes. This is where population health management can really make a difference: acknowledging the social determinants of health whilst addressing the nation’s health from a protection of health and wellbeing perspective (instead of the pathogenic paradigm).

I do not want my fellowship to end! I have made some fabulous connections; I am now part of population health steering groups and have felt empowered and confident that my clinical knowledge and experience has made a difference to developing population health guidance to increase good health and wellbeing in GMEC.