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Key role of OTs in maternity pathway outlined in new report

New maternity care pathway highlights key areas that occupational therapists can help to support expectant and new mothers.

Published on 8th July 2019

A maternity care pathway outlining the key role that occupational therapists can play in maternity services has been published by Health Education England.

Dr Sally Payne, Professional Adviser of Children, Young People and Families at the Royal College of Occupational Therapists, said that occupational therapists have an important contribution to make to the health and well-being of women during pregnancy and in the postnatal period.

"A small (but growing) number of occupational therapists work in specialist services for women who experience mental health issues during or after pregnancy. Elsewhere occupational therapists support new and expectant mums with physical disabilities and long-term physical or mental health problems, and parents whose babies are premature, disabled or unwell," said Dr payne.

"The role of occupational therapy in the maternity care pathway is, however, not well recognised or understood," she added.

Dr Payne edplained that in May 2018, she was asked to contribute to a project to understand the contribution that Allied Health Professionals (AHPs) and psychologists make to the maternity care pathway.

The AHP project was driven by the recognition that “there is limited awareness, understanding and visibility of the roles of AHPs and psychologists working across the maternity care pathway. These professional groups are seldom referred to in local maternity workforce plans, with the exception of paramedics in the antenatal stage, operating department practitioners during the intrapartum phase and physiotherapists during post-natal care”.

The pathway explains that during the pre-conception period, OTs working in hospital outpatient clinics, community clinics, patients’ homes and children’s centres, can be involved with the following:

- Providing counselling and advice to help women consider the implications of any known medical/physical/sensory impairment/mental illness (including medication) on pregnancy.

- Providing advice about role/lifestyle changes for women living with illness and/or disability to support a healthy pregnancy including referring for a medication review where appropriate.

- Supporting women who do not conceive, helping them to re-imagine their roles and identities as ‘not a mother’.

- Offering advice upon the importance of meaningful occupation as part of a positive physical and mental health.

- Supporting women to access opportunities and support for social inclusion.

During the antenatal period, OTs can support patients by:

- Providing strategies (including pain and fatigue management, pacing, anxiety management), organising equipment, adapting activities and modifying the environment to reduce the risk of antenatal hospital admissions and to ensure the health and well-being of mothers living with illness and disability as the pregnancy progresses.

- Helping women prepare for a change in role, routines and occupations and manage their expectations of birth and motherhood.

- Helping women whose functional performance has been eroded as a consequence of their physical or mental illness to plan and make practical preparations for their new baby e.g. shopping for equipment, adapting their home environment, planning routines for herself and her family.

- Exploring strategies and arranging adaptations and equipment to enable parents (and other family carers) living with illness or disability to manage their new baby at home as independently as possible e.g. adapted changing tables, cots, pushchairs and organising bespoke adaptations (e.g. for wheelchair/buggy) if required.

- Working with parents/carers living with illness or disability to identify baby care activities that might present a challenge and practising techniques.

- Identifying the support required for mothers to care for an older child with additional needs whilst pregnant and when the new baby arrives (contributing to a Carers Assessment where appropriate). This may include providing equipment such as an adapted buggy to accommodate the sibling and new baby.

- Improving safety at home for expectant mothers with an older child who displays challenging behaviour by facilitating home adaptations.

- Liaising with other agencies (e.g. social workers, housing and benefits agency, health visitors) to ensure appropriate support is in place to enable mothers to meet their baby’s physical and emotional needs.

- Providing counselling/support to help women cope with possible negative attitudes and scepticism of others regarding their abilities as a mother living with illness or disability.

The pathway continues that during intrapartum, from labour through to delivery, occupational therapists can undertake relaxation and mindfulness therapy for expectant mothers with anxiety and fear of birth (tokophobia), can advocate on behalf of women to ensure their mental health, physical and learning needs are understood and supported during delivery and liaise with the midwifery team to ensure necessary equipment/adaptations are in place for a safe and dignified delivery e.g. hoist, adapted bed, wheel-chair accessible bathroom, communication aids.

Post partum, occupational therapists can support their patients through:

- Adapting activities and providing equipment for women with physical needs to enable them to carry out personal care activities.

- Providing equipment, information and support to ensure women living with illness or disability have the confidence, equipment and skills to care for their baby, themselves and family members as safely and independently as possible.

- Supporting new mothers to structure their days/weeks and develop healthy routines for themselves, their baby and family that balance mothering occupations with mothers’ own self-care/nurturing needs.

- Fostering parent/infant attachment in neonatal settings by promoting skin-to-skin contact and helping parents read infant cues and use positive handling approaches.

- Enabling parents of infants who are premature, disabled or unwell to support the baby’s self-regulation, physical and sensory development by giving guidance on positioning and adapting the environment to modify sensory input and minimise baby’s stress.

- Promoting bonding/attachment/positive interactions between mothers living with illness and disability and their baby.

- Contributing to risk and safeguarding assessments to ensure the safety and well-being of mother, baby and other family members.

- Supporting the transition from hospital to home.

Furthermore, the occupational therapist's role continues up until a year after birth. during thsi first year, occup[ational therapists may provide individual and group therapeutic interventions to promote mothers’ physical health, mental health, confidence and skills. They may signpost mothers to sources of community support and help facilitate networks for mothers with similar needs and experiences for ongoing support.

OTs may also provide guidance and support to enable parents to support the motor, sensory and cognitive development of infants who are premature, disabled or unwell through play opportunities that are appropriate for their individual needs. They may even become involved with providing support for returning to work including childcare, housing and financial arrangements, adjustment to new/additional roles, help to balance new routines and develop a positive sense of identity as a mother and worker.

Dr Payne concluded: "RCOT and the report authors hope that the guide will raise the profile of the role (and potential role) of occupational therapy in the maternity care pathway. The guide should also inform local maternity workforce plans and the improvement of maternity services so that women, particularly those with additional physical, learning and mental health needs receive support to fulfil their parenting roles and to optimise outcomes for them, their babies and families."

The report, which includes eight occupational therapy case studies illustrating the diversity and value of the occupational therapist role across the maternity care pathway, is available here:
The engagement of Allied Health Professionals and Psychologists in the maternity care pathway

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