What Respondents Want to Happen Next

Considering that a significant proportion of respondents do not work with reproductive age clients/patients, it is impressive to see that 49% still “want to improve my [their] knowledge and skills around preconception and interconception care”.

The perspectives shared in the comments section reflect a deep understanding of this critical gap in services and a desire for pre-pregnancy counseling and assistance be added into routine clinical practice.

“Reproductive health mainly only gets discussed when chatting to women re contraception/smears/sexual health etc. I would like to see us be able to offer well man/well woman health care to everyone, instead of just the over 45’s! This would be an opportunity to discuss early on in adulthood.”

“It is vital to be able to support women to be as healthy as they possibly can be prior to and during pregnancy. This will benefit mum, her unborn baby and the family as a whole, now and for the future. In the Healthier Futures Strategy, the Scottish Government states that women should be supported to be in optimal health PRIOR to pregnancy – and, of course, during the pregnancy. This is important too. Workload pressures and lack of knowledge/training around preconception health mean that very often midwives are NOT addressing this as well as they could”.

“It should be on everyone’s agenda to regularly ask our patients. By normalising it, we reduce stigma. We would also be able to offer the right help and support. By avoiding important conversations like this with our patients, we do not give them permission to talk about it. Sexual and reproductive health and desires can still be a difficult topic to talk about and prompts are needing to open up those discussions”.

“I don’t think we give enough preconception health advice. I think we would massively improve health outcomes for women and their babies if more preconception advice was given”.

“I think it is important to empower and activate people to be curious and ask for the appropriate information to allow them to make informed choices. These conversations should be normalised, and doors opened to allow our patients to keep questioning and feel comfortable discussing these choices without judgement.

In question 18, we asked how likely it was that respondents would now make preconception and interconception care a high :

– 15% answered High Chance

– 21% answered Moderate Chance

This is an encouraging response with clear benefits.  If 36% of respondents were to make it a priority within their practice, this key piece of the reproductive health puzzle would be more widely understood, and normalised, across Scotland.

There were an additional 29% who replied that the likelihood of providing pre-pregnancy services were only “Modest”. This group includes community nurses and midwives who say they want/need training before taking this next step, as well as those who identified the difficulty of adding anything new to their role as being a potential barrier.

“I have not had any training in working with families during preconception phase. Throughout my working practice I have learned to have conversations mostly around contraception, but rarely do we become involved in conversations about having a healthy pregnancy”.

“I think there are probably gaps in my knowledge so would always refer to medical staff if a woman wanted more counselling around conception. Generally, the women I see are already pregnant”.

“Our postnatal conversations can be limited at times due to care of patient and newborn”.

“I answer questions when asked but would not initiate conversations about reproductive health or attitudes.”

At the other end of the scale, 35% responded that the chance of making it a priority was or “Slim” or “None”. What is perhaps most striking is that

Considering the impact of COVID, many have been left struggling.  Another 10% called out staff shortages, 3% said it was not a priority in their role, and 3% cited language and cultural barriers to having this conversation effectively.

“In the early postnatal period women often don’t want to discuss contraception as they can’t imagine being sexually active again, it feels too soon to even consider for some.”

“We give women a lot of information after delivery at a time when they are mostly exhausted and trying to adjust to having a new baby. I feel that a discussion at this time may be inappropriate or not retained well.”

“I would need further time allocated to discuss reproductive health and attitudes towards pregnancy. As a community midwife I focus on health during pregnancy”.

“Our postnatal conversations can be limited at times due to care of patient and newborn”.

“Cultural differences can make it more challenging. I do not avoid but I am more sensitive and perhaps frame questions a little different. Language barriers can be challenging as well, even with using an interpreter, or sometimes BECAUSE of using an interpreter (patient ashamed of discussing their sexual and reproductive health, especially when it’s a translator of opposite sex)”.

“I would love to be more involved in this work. However, the only concern I have is that, as we are so stretched in our current role, our management would not consider this a priority. We can only do what is considered ‘essential’. So, a lot of the preventative/public health has sadly gone out of the window”.

We also asked which areas of preconception/interconception health, education and care would be of greatest interest and potential value to respondents. We asked them to rank their priorities for CPD. Their preferences, in rank order, were:

1. Sexual and reproductive health
2. Promoting wellbeing and good health
3. Teratogens (Illnesses, medication, environmental risks)
4. Stress, trauma, intimate partner violence
5. Contraception alternatives
6. Substance misuse and mental health
7. Chronic health conditions
8. Diet, nutrition and healthy weight
9. Role of men/partners/fathers
10. Screening tools and assessment skills

It is worth noting that there was not a huge difference between the highest and lowest ranked topics. This suggests the need for a comprehensive approach to CPD and other learning opportunities. In question 20, the group expressed their preferences for the training being delivered. The top responses were:

1) A series of interactive webinars/discussions

2) Courses with certificate of completion

3) A series of podcasts featuring practitioners and experts

Additional comments offered further encouragement:

“I think that health visitors are in a prime position to have conversations about pre-pregnancy health. We are in the family homes from the birth of a child to age 5 and are often carrying multiple siblings on our caseload”.

“I am interested in this field and would like to see further investment.”

“I think more training is essential and would welcome this.

“I feel it is important to be an all-rounded HCP and think these conversations are important, but the appropriate education should be undertaken in order to initiate these topics of conversation”.

“Really valuable topic to learn more about and educate patients on.  Would be so beneficial to have a template for this topic.”

“I am keen to learn more about this area to provide better care”

“I feel this is such an important area for families and interested in any further reading that is available through this research.

We are thrilled to see so much interest in making visible the too often invisible preconception and interconception period in women’s lives.

The diversity of responses reflects the rich fabric of these practitioners’ own lived experience. The commitment to quality service represented by these community nurses and midwives is quite remarkable. They are well-placed (perhaps even uniquely well positioned) to take this new work forward throughout Scotland.

Not everyone agrees on who should be offering this care, but it is notable that 80% agree that such care should be delivered. There is a significant support for addressing the gap between avoiding pregnancy and being pregnant, i.e., between contraception and conception.

Making it easier and more effective to prepare well for pregnancy is a core purpose of QNIS’ Healthier Pregnancies, Better Lives programme.  Your comments and contributions are welcome at HPBL@qnis.org.uk or @HPBL_Scot.

You can read the other blogs here:

1. 1. Mind the Gap
   2. Preconception Health Risks and Realities
   3. Your Views and Experiences
   4. What Respondents Want to Happen Next (you’re already here)