Hackney's "Innovative and Successful" Infant Mortality Programme Claims Early Results

An innovative approach to antenatal care being pioneered in the London Borough of Hackney is already delivering positive results after just one year of operation, according to findings published Friday, October 17.

The report, Reducing Infant Mortality Programme: the First Year, shows that the two-year integrated programme, which contains ten distinct projects within it, has led to more breast feeding, earlier booking and better attendance at antenatal care, fewer emergency admissions for new babies, and fewer women referring themselves too soon to labour wards.

"This project is significant to all of us not only because its overall aim is of such fundamental importance to the population we serve but also because it represents an innovative and highly successful partnership", says Kate Costeloe, Professor of Paediatrics at Queen Mary University of London, in her Preface to the report. "Infant mortality is a complex problem with no single cause and sustained change will take time”.

Hackney's infant mortality rate is higher than the average for London, especially among the Black African and Caribbean communities, where pre-term births are also more common. The Reducing Infant Mortality Programme (RIMP), a two-year programme costing £2.2m, was commissioned in 2007 by Hackney's local strategic partnership, Team Hackney, with the aim of reducing infant mortality in African and Caribbean women, women who sign up late for maternity services, and teenagers.

The programme

The programme is led by a consultant midwife based at the Homerton University Hospital, who co-ordinates services delivered by the Homerton, the City and Hackney Primary Care Trust, the Shoreditch Trust and City University. A so-called “bump buddies” scheme matches pregnant women with experienced local volunteers; a “birth buddy” scheme provides trained volunteer birth partners; Shoreditch Spa provides nutritional advice and cooking courses; and a midwives group practice based in the crypt of a Church in Shoreditch provides continuity of care at home to those most at risk. Bi-lingual maternity support workers offer not only language services but clinical advice and emotional support as well.

A maternity phone helpline staffed by midwives provides instant advice seven days a week from 10am to 8pm. Three research projects are investigating high rates of very preterm birth among Caribbean and West African women in Hackney, updating the study of Fetal and Infant Death in East London (FIDEL Study), and looking into the role of lactobacillus in preventing preterm birth.

The results:

Full findings will not be available for a year or so, but interim findings have shown that:

· Antenatal booking rates within 12 weeks at the Midwives Group Practice are 73% compared to baseline hospital data of 44%

· 80% of women in the group practice are breast feeding at discharge (10-28 days) compared to local average of 69%.

· Only one baby born through the group practice has been readmitted to hospital as an emergency in 2008 compared to 12 in the same area in the first eight months of 2007

· More than 600 women have received language support over one year

· More than 7,000 calls have been made to the maternity helpline – seven times the target – and half of all callers are from black and minority ethnic groups.

· Self-referral antenatal admissions to the Homerton maternity unit are down by 16% in the first months of 2008

· Nearly 50 black and minority ethnic women have been trained as “bump buddies” and have reached more than 200 pregnant women.

· There are 49 “birth buddies” on the roster at the Homerton, who have helped more than 330 women. There is a huge waiting list for those waiting to volunteer.

· Every household in the borough has received the Hackney Women’s Wheel – a device which provides information about health services in Hackney

Women most at risk have been supported by midwives working from two Children’s Centres and from the Sanctuary Practice, a GP practice working with refugees, asylum seekers, homeless people and other vulnerable groups.

Councillor Rita Krishna, Hackney Council’s cabinet member for Children’s Services and Chair of the Team Hackney Children and Young People’s Partnership, said: “These services were especially designed to meet a need, and it is immenselygratifying to see such positive results after just a year of operation. By listening to what women said they needed, by working together with the community, by using imaginative methods of reaching out, we have created a programme which, over time, will reduce health inequalities and will help to prevent one of the worst family tragedies - the loss of a baby.”

Pauline Brown Director of Nursing at Homerton University Hospital NHS Foundation Trust said:
“This innovative programme is already having a considerable impact on planning for maternity services including better access to maternity services, enhanced quality of experience and improvements in the continuity of care provided throughout pregnancy. These important interventions are reaching those who are most at risk of falling through the net.  We now need to ensure that the best parts of the programme are funded and continue so that we can see a reduction in infant mortality over time.”

20.10.2008