Dilemmas in Practice
A woman that the midwife meets for the first time is an individual who is often very excited about being pregnant. She also usually has a number of anxieties but not necessarily any which may have been mentioned in public health documents that the midwife has read. Nor has she the sort of knowledge which many maternity service consumer activists would like to alert women to as soon as possible. Most of the women on an average community midwife’s caseload of 100 to 150 a year, whatever their circumstances or health inequalities factors, will enjoy a fairly healthy pregnancy with a live healthy baby at the end of it.

The midwife in any situation needs to use her skills to try and form a meaningful, helpful, classless, trusting and affirming professional relationship with the woman whomever and however she is. Honesty and humour is certainly a good starting point. As the relationship grows a midwife tries to work with women with individual issues around nutrition, stopping smoking, drugs, housing, debt, domestic violence, social exclusion, learning difficulties, stress, access, language and communication barriers.

So, in terms of addressing health inequalities and premature birth, at what point do you explain to a woman in socio-deprived circumstances that she has a certain statistical chance of something going terribly wrong? And how do you tell a mother that her chances of a healthy pregnancy will be increased if those around her cut down their drinking, smoking and junk food, thereby making it easier for her to change her own lifestyle habits?

Education and awareness-raising is thought to be the key to this but what works and whether it will take on-going individual or social solutions, reforms or a revolution is unclear. Pregnant women can be highly motivated for a short period of time to make some individual changes but cultural norms often have more influence, especially if women have plenty of friends with the same lifestyle habits where nothing has gone wrong with their babies! What the midwife or doctor cannot do is look any woman in the eye and say if you do or don’t do something in particular you will definitely avoid a premature birth.

Relationship between Premature Birth and Disadvantage
Before the huge reliance on dating scans, a baby’s maturity was assessed more carefully by a number of physical and behavioural features that attracted a score which indicated the level of prematurity, These charts still help midwifery and neo-natal staff today.

Categories used are:

1. Extremely premature: born between 24 and 28 weeks,
2. Very premature babies; born between 29 and 34 weeks,
3. Moderately premature: born between 35 and 37 weeks.

Birth statistic collection is an expensive activity and practitioners would hope that they would reveal inequality links that would help to determine best practice. However, they don’t! What is known is that around seven per cent of babies born in the UK are premature. Some Scottish figures illustrate that the disadvantage link may be more than twice as many premature babies are born to the most deprived groups. This has huge social and economic implications for the families themselves as well as for the NHS and Departments of Education. Even mildly premature babies may have physical and learning challenges which require extra resources to achieve the aim that all UK children are given access to opportunities to fulfil their potential. If resources aren’t available then the infant is doubly disadvantaged.

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