As registered nurses we are all aware that the population of patients we are caring for are older and sicker, including on in maternity services. Unsurprisingly historically, maternity services have not dealt with medical disorders in pregnancy and midwifery training had not focused on this in great detail.
NHS England have created an improvement plan to support all pregnant women and their babies. A Maternal Medicine Network (MMN) has been created to ensure women with medical conditions have timely access to the best specialist advice and care at all stages of their pregnancy. This includes planning a pregnancy, antenatal, intrapartum, and postnatal care. These MMN cover different footprints across the UK and the aim is that no matter where a woman lives, she can access the same specialist care.
I am currently lucky enough to work within the Northwest MMN. I work as an Advanced Nurse Practitioner within Obstetric Haematology. In my role I care for women within the Merseyside and Cheshire area that have a haematological condition and are pregnant, wanting to get pregnant or are in the postnatal period. These women are reviewed in a specialist haematology clinic and nursing input is an integral part of their care plan.
As nurses we are trained to recognise the deteriorating patient which can be common within this patient group. Our training is focused on recognising the unwell patient rather than normality, recognising that midwives are also educated to recognise deterioration in women in their care, and these skills are vital when caring for these women. In my opinion , this is where specialist nurses and midwives may differ in experience and can make an amazing team. The specialist nurse can focus on the woman from a medical disorder point of view and the midwife is able to focus on the pregnancy and ensure that the women is benefiting from their specialist skills.
Another benefit of having a nurse involved in caring for these women with medical disorders is that the patient journey is more streamlined and greater continuity of care. In my experience the woman is also more likely to adhere to her postnatal care plan if the same specialist nurse can follow her up once discharged from maternity services. Relating this to my own practice, I am often involved in pre-pregnancy counselling and then often I am the first port of call when a woman finds out she is pregnant. I can initiate or modify treatment for their haematology diagnosis and make a referral to the MMN. I am then able to be present in the antenatal care, formulation of intrapartum and postnatal plan, with the woman and her midwife. Post delivery the women are then able to be followed up by myself before referring back to their original team prior to pregnancy.
Specialist nurses are available to provide education within maternity services, as part of continuing professional development for all maternity staff. Teaching sessions as part of the pre-registration midwifery programmes is something that has also been greatly received, and specialist haematology teaching has also spanned into the MMN.
Specialist registered nurses possess a specialist skill set that should be acknowledged and valued. These skills will add to the specialist care we are providing to these women with medical disorders whilst pregnant.
