According to The Lancet, one of the best investments in public health is maternity. The right care in the perinatal period can change the health trajectory of entire generations
Good midwifery care is the front door of the NHS for hundreds of thousands of women, many of whom won’t have had much experience of the NHS before,” says the RCM’s CEO Gill Walton. “As maternity support workers [MSWs] and midwives, you can signpost them to support to stop smoking or manage their weight, or give advice about vaccination or even accessing the right benefits. Any one of these could have a massive impact not just on that woman, or her baby, but her wider family too. That ripple effect cannot be underestimated.”
Healthy beginnings, hopeful futures
Maternity services in the UK play a vital role in providing public health advice and support. On World Health Day in April, the World Health Organization (WHO) launched a year-long campaign called ‘Healthy beginnings, hopeful futures’. This urges governments and healthcare professionals to prioritise the health of mothers and babies to achieve long-term health benefits.
When the campaign launched, the RCM called on the UK’s four governments to heed WHO’s advice by investing in maternity services. “Our members provide comprehensive care throughout pregnancy, labour, birth and the postpartum period – and that care should receive proper investment,” says Gill. “If we can get this care right, we have a huge opportunity to change the health trajectory of communities across the UK and in the long run save the NHS millions of pounds.”
Clare Livingstone, head of professional policy and practice at the RCM, agrees. “Midwives and MSWs have a unique relationship with women and their families. They are trusted, which means they are in a strong position to provide public health advice and support.”
An example of this is the RSV vaccination that was rolled out by maternity services in autumn 2024. Clare says: “Midwives and MSWs quickly responded to this call to protect women and their babies.”
For more on this read Thank you – RSV vaccination rollout).
All in a day’s work
Emily Clews is an MSW at The Princess Royal Hospital in Telford, with 12 years of experience in maternity care as a women’s services assistant and MSW.
“I work predominantly on the postnatal ward, and giving public health advice is definitely part of the daily role: infant feeding, safe sleep, post-partum recovery, mental health. Most of the time we’re not even aware we’re doing it – it’s second nature.
“You can reel off 30 different things about safe sleeping or infant feeding, but I don’t think people would take it in, especially just after having a baby. As MSWs, we provide that drip, drip of information. It might be taking a teddy out of a cot and explaining it’s safer for cots to be clear, or suggesting they take a layer off baby when it’s warm. We always point to a source of more information – The Lullaby Trust for safe sleep advice, for example.”
Emily notes that MSWs and midwives dovetail in their care. “Women might see more of their support workers than their midwives, who can be so busy clinically, especially postnatally – so we get a lot of ‘can I just ask’ moments. Signposting, referrals or escalating to midwives is a big part of my role. If I don’t know something, one of the team always will,” she says.
Social care
Clare says that as well as providing pregnant women with public health information – such as infant feeding, nutrition and vaccines – midwives and MSWs are trained to support women with wider issues including housing and food security. These issues can also affect someone’s pregnancy and health.
This is supported by an RCM toolkit that assesses women’s needs. MatDAT looks at all aspects of a person’s life. Clare says: “The toolkit helps to make sure maternity services are meeting people’s needs holistically. By looking at different areas of someone’s life, we can join up services and support women throughout their pregnancy.” (More information on how to use the MatDat tool.)
Emily notes that this vital support is done intuitively by midwives and MSWs. “Working postnatally, I remind women to care for themselves – again, almost subconsciously. From my own experience, I know new mums put themselves last, so I’ll check in and encourage a woman to shower and eat. I always say, ‘If you’re struggling, don’t be afraid to ask for help.’
“I know not everyone has a support network, so I’ll share information about our local breastfeeding support group or encourage them to try a baby and toddler group and make connections.”
Little things, big difference
Emily continues: “I think of my role as helping inspire confidence in parents to make decisions and care for their families – and if they don’t feel confident, to find a way to help them get there. You don’t realise at the time, but little things make a big difference, like showing new parents how to safely bathe their baby. It’s not until you see them again when they have a second or third baby and they tell you, ‘That was the moment I knew we could do it.’
“Midwifery care provides so much information and support over such a short time, which can impact the longer-term health of the mum, baby and whole family. I feel like the maternity team is the foundation – and if that’s solid, other public health services and interventions can be built on top.”
Smoking cessation
When Heidi Croucher, lead midwife for treating tobacco dependency, started working at University Hospitals Dorset (UHD) Foundation Trust in 2015, there were high smoking prevalence rates in pregnancy in the county.
“Part of my role was to set up a smoking cessation service,” says Heidi. “The goal was to support women to become smoke free by 15 weeks of pregnancy. This was successful and we halved the smoking rates in the first year of the service running.”
Heidi visited people at their homes so she could better understand their situations. “Quite often with people who smoke, there are other things going on such as safeguarding issues or lifestyle concerns such as drinking and being inactive.”
After the initial drop, the smoking rates in pregnant women in Dorset became static, so Heidi looked at what else the Trust could do to reduce them. “I managed to source some funding to extend the smoking cessation service to people who live within the home, such as a partner or family member. We know that one of the biggest barriers to a pregnant woman stopping smoking is people around her smoking.”
Sharing knowledge
In 2023, Heidi took on an expert role with NHS England Prevention Team to support hospitals across England with similar implementation and sustainability of in-house tobacco dependency services. “We know that when smoking cessation is offered within maternity services, it’s much more effective than when a pregnant woman is referred to an external service. This is because all maternity healthcare professionals will provide a consistent message about why it’s important to try and be smoke free. ”
In England alone, 95% of maternity services are now running in-house smoking cessation services. As a result, in 2024-2025 smoking rates in pregnant women and birthing people at the time of birth reduced to 6.1% from 7.4% the year before, according to NHS Digital stats from this year.
Time to talk
Advice and support are an enormous part of the role. MSW Lee Barrett, who works for the South Eastern Health and Social Care Trust in Northern Ireland, says that when an MSW carries out routine tests they have time to speak to pregnant women and answer their questions.
“When I’m taking blood, checking blood pressure or doing a urinalysis, I speak to women about topics like infant feeding and vaccines,” she explains. “It’s about giving women the relevant information they need so they can make informed choices for them and their babies. If they ask me questions that I can’t answer, then I would ask a midwife to come and speak to them.”
Lee also does carbon monoxide testing for both pregnant women who smoke and those who don’t. “An MSW is trained to do the tests and understand the readings. I always explain to women that if there is a high reading and they don’t smoke, then the gas appliances in a house can contribute to a high reading, as well as car emissions. I give someone the basic information and then pass it over to a midwife.”
Source of information
Lee adds that midwives and MSWs need to understand, and keep up to date with, clinical information and data. She explains: “Before COVID-19, a woman would go to her GP, who would refer her to a maternity service. Now women are referring themselves straight to us. So, maternity services are working hard to make sure women have the information they need and that they can signpost them to different support services.”
The RCM has long said pregnancy should be viewed as a prime opportunity to make public health interventions. As Gill says: “Good midwifery care sets the foundations. The care and support midwives and MSWs can offer women during pregnancy can have a profound and positive impact on the next generation, who will grow up healthier and happier as a result.”
Post pregnancy contraception
The fact that women are more fertile just after birth is often not known and can result in another pregnancy at an already overwhelming time. However, post pregnancy contraception (PPC) provision isn’t consistent across the UK. Women in some areas have greater access to information about PPC than others.
The Faculty of Sexual and Reproductive Healthcare is publishing a report about PPC in September. This will include contributions from healthcare professionals – such as midwives and obstetricians – and women with lived experience to show how PPC is currently provided across the UK.
The report will set out recommendations to government, integrated care boards and healthcare professionals for how they can support universal access to PPC services across the UK.
