Ensuring positive pregnancies with the Lambeth Early Action Partnership

LEAP is one of five local partnerships which make up A Better Start, a national ten-year programme funded by the National Lottery Community Fund that aims to improve the life chances of babies, very young children, and families.

The programme has funded and improved more than 20 local services to meet the needs of families through pregnancy and the early years of childhood. It works across a range of children, families, practitioners and organisations to give thousands of children across Lambeth aged 0 – 3 a better start in life.

Up until last year, a small team of midwives worked across the community to assist women and birthing people at risk of health inequalities with their pregnancy. The service, which has since been absorbed by Guy’s and St Thomas’ Hospital, provided continuity of midwifery care, meaning the same midwife would care for a woman throughout the antenatal, intrapartum and postnatal periods of her pregnancy.

The team of six midwives, looking after up to 200 women and birthing people per year in the Lambeth areas of Vassal, Coldharbour, Stockwell and Tulse Hill, was led by midwife Rachel Smith. 

Their work focused on those most at risk of health inequalities, aiming to provide equity within maternity care for people of Black or Brown ethnicity or those who live in areas of deprivation.

Traditionally, most pregnant women and birthing people are seen by a number of different midwives, depending on availability, meaning that at each contact they may be meeting, and trying to build trust with, someone they have never met before.

Instead, the LEAP team provided continuity of care, which has been demonstrated to improve clinical outcomes, for example reduced risk of pre-term birth and caesarean section.

Clients were allocated a named midwife who they saw throughout their pregnancy and postnatal period. When they went into labour, a member of this small team would also provide their care.

Many of the families looked after by the LEAP team expressed feeling much more satisfied emotionally, as this continuity enabled them to build a stronger bond with their midwife. The familiarity with the midwife also meant that women and birthing people were more likely to disclose difficulties they may be experiencing. Support could then be offered with a referral to one of LEAP’s other services if necessary.

Zahra Khan: How research could help inform policy

I am a midwife, educator, and researcher with a specific interest in ethnicity-based health inequalities and have been a part of the King’s community since 2016. I am currently in my final year of a PhD, evaluating LEAP as a community-based model of midwifery continuity of care in an area of high ethnic diversity and social deprivation.

I am part of the NIHR ARC South London Maternal and Perinatal Mental Health Theme research group led by Prof Jane Sandall, based in the department of women and children’s health. Alongside my colleagues Dr Cristina Fernandez-Turienzo and Zoe Vowles, we are evaluating the pregnancy and maternal aspect of the LEAP programme. The evaluation includes four components:

• Qualitative longitudinal interviews with 15 women receiving continuity from LEAP
• Qualitative interviews with 24 stakeholders about the implementation, delivery and scalability of the programme
• Exploring clinical outcomes between different models of care using the Elixir dataset

My PhD research focuses on the qualitative longitudinal interviews with 15 local women who have received care from the LEAP midwife team. Women are interviewed at three timepoints: the third trimester, 0-3 months postnatal, 9-12 months postnatal. The premise of this research is to understand the impact and experiences of community-based care and care from a named midwife (continuity of carer), as we know that midwifery models of care and community-centred services have the potential to make positive changes in disadvantaged population groups.

Currently there is little evidence to inform policy about these interventions specifically for ethnic minority and/or socially disadvantaged women, despite being a vulnerable population experiencing starkly worse clinical outcomes (women and infants) and reporting poorer experiences of care.

Currently there is little evidence to inform policy about these interventions specifically for ethnic minority and/or socially disadvantaged women, despite being a vulnerable population experiencing starkly worse clinical outcomes (women and infants) and reporting poorer experiences of care.

The sample is representative of Lambeth’s population and includes a mix of ethnicities and social backgrounds. I feel strongly that research should engage with local communities to better understand their context and health needs and make an active effort to collaborate with typically underrepresented ethnic and social groups. By doing so we can tailor services to help reduce health inequalities, improve engagement with health services, identify research gaps and priorities.

The evaluation of this LEAP service is ongoing and I am currently working on analysing the results of the qualitative longitudinal interviews with women. Preliminary results demonstrate overall positive experiences of LEAP and community-based midwifery continuity of care. We hope to publish results later in 2024.