We have been working with pregnant women in Birmingham over a number of years. Many have difficult and complicated lives and while we primarily want to support them, we also want to help people understand how systems and services can let them down at times. In particular we want to urge commissioners, policy and decision makers to examine if their services really support people who have greatest need.
The Pregnancy Outreach Worker service is increasingly showing us where there are gaps in services, these gaps lead to exclusion, inequality and injustice. The picture we see is in contrast to the Troubled Families Unit report – which was compiled after talking to 16 families in poverty. This report does not challenge services but does seem to lay blame firmly at the door of the poor.
I reviewed the case of a current client we are working with, her circumstances prompt a number of questions about the way support services are structured :
Jodie was referred to us when she was 14 weeks pregnant, 22 years old, living in a hostel, an unplanned pregnancy, the father unwilling to be involved. Jodie suffers from depression and self-harms, she has debts and is on medication. Her baby is due in December – her life is chaotic.
Jodie was referred to mental health support service by her GP, however she did not turn up for several appointments and so was discharged from their service. She has not seen her named Midwife in 4 months.
Jodie has mental capacity and therefore does not meet the definition of a Vulnerable Adult, which would entitle her to support from Adult Social Care.
Jodie’s baby is unborn and does not have a Social Worker involved – the baby, when it is born, may generate Social Worker involvement.
Jodie has been re-housed but does not have any money for food – she is in receipt of food parcels
Jodie’s chaotic lifestyle did not start when she became pregnant and will not end when the baby is born – It appears that statutory support services will begin when the baby is born and considered at risk or in need. The work we are doing with Jodie is to prepare her for parenting and being able to support a child, but crucially to understand causes of her chaotic life. We are examining the gap with what is available to her and why she is not engaging with services.
We believe that investing time in her may prevent her child becoming at risk or in need. Our aim ultimately is that Jodie and her child will be able to function well as a family unit. – Jodie is one of over 200 pregnant women we are currently supporting in Birmingham
(names have been changed)
Photo by Nina Matthews Photography
She should be eligible for Healthy Start, surely, which would give her food vouchers? Midwives should check this and sign women up at booking appointment, although changes of address may be a barrier. She can definitely have vitamns, and we could set POWs up to give them out if that would help. Also, my understanding is that a pre- CAF should be done at booking, and I would expect that to trigger some kind of involvement with Social Services during pregnancy for someone with a history of self harm. I presume the POW involved has offered to accompany her to appointments, as her own and the baby’s physical health need checking by a midwife. I thought Mental Health had a service for pregnant women with a history of mental health problems. While I am sure a POW makes a difference, getting her to engage with services is crucial. There seme to be two categories of issue here: lack of engagement with services, and lack of clarity about whether the serivces are avaible to her during pregnancy. I think they are, but not necesarily easily accessed by someone in such need- an issue to highlight in itself.
Jodie is just one of the many complex cases seen by the Pows, that is why a tailored one to one support is beneficial for women in the vulnerable state of pregnancy. In my opinion these evidence suggest her vulnerability as a self harmer, prone to depression is currently on medication, no stable abode, a hostel is temporary, she has no finance and is a young adult who is pregnant, her chaotic life proves she is vulnerable so who decides she is not and deny her social services assistance. On a different note, it seems likely she would have a mental health keyworker who is responsible to work her care plan with multi-agency support to meet her needs.
You are right Eleanor,she is entitled to Healthy Start vouchers as she is in receipt of benefits. However the vouchers are worth (one £3.10 voucher per week) (see website Healthy Start). Which in reality does not go very far. Nevertheless POW’s have their own food bank scheme, which is fantastic in providing food items to this lady.
What really needs to be taken into consideration and in very much agreement to yourself is that there are issues that need to be tackled, the main one is for other professionals in organisations and agencies, to work together in partnership and try to reduce to alleviate the issues this lady is facing. The POWs can support this lady through her pregnancy and up until 8 weeks after the delivery of her baby, however it becomes even more important to leave this lady after the delivery of her baby in safe and supportive hands. It is very important for Social workers to come on board as soon as possible and they can be involved during a pregnancy. The question is how effective is that. I believe working together in partnership with other service providers can help us to help others tackle their issues
It is easy to say that vulnerable women don’t access services when the barriers facing them are quite clear. One barrier is the benefit system where payments can be seized due to changing over to another benefit, leaving women without money for up to 6 weeks. Claiming benefits are now made over the phone which is a very long process of which can be a very frustrating experience for any individual. The POW service supports with this process and advocates on individuals behalf’s if necessary. This is when food parcels are needed to ensure women have the basics and can eat.
POW, s are also there to offer a monitoring service for other agencies like social services, which can at times lead to less involvement on their part, leading to a vital gap in services. Social services have set guidelines to follow and required monitoring systems for a reason and if they are not followed pregnant women can be let down by the system.
Interagency working can work, but building relationships and trust with women is key to ensure better outcomes. The POW service provide this service and through my own experience have changed women’s outcomes and views on services in general.
It is everyone’s responsibility to ensure the wellbeing and safety of all vulnerable groups and to simplify systems to make them more accessible.
is she linked into a health visitor yet as mentioned above a pre caf should have been done and her HV contacted. Although Antenatal has slipped in Bham due to capacity she is someone who is vulnerable and should be a priority.
Hi Julia, You are right in what you say, however the realities are different. This is what Gateway are trying to highlight, we are trying to bring to people’s attention the real experiences that our clients have, and although there are systems they are not always implemented. I have asked the Pregnancy Outreach Workers about the pre-CAF at booking and they fed-back that this does not happen in their experience. Normally the the Health Visitor is not involved pre-birth, although we have known it occasionally, often this is because the clients are moved around the city an awful lot.
If she has domestic abuse issues she would have a social worker due to protection of the unborn child. Surely this is an unborn child that needs protecting from poverty and malnutrition. It seem stupid that Social Services won’t come on board until the baby is born, adding more pressure to services that are stretched to the hilt as it is. With the right intervention she could move forward, ultimately costing a lot less in the long run.
FAO Justine Ennis
Hi Justine. We met when you attended the Register Office to discuss appointments for birth registrations.
I note from your website that Gateway supports families by supplying food parcels. I am looking at a xmas charity for the staff this year and wondered if we could “use” you as our charity for any tins of food collected.
Happy to discuss with you.
This is great news. We’d definitely put your donations to good use. Thanks to all at the Registry.