1. Maternity Services Text message service to increase attendance at antenatal clinics

2. Context  “There is a clear correlation between poorer pregnancy outcomes... in women who book later for antenatal care, attended infrequently or never attend for care.  At present in Scotland, women and babies who are at the greatest risk of poor health outcomes are the least likely to access and/or benefit from the antenatal health care that they need.” (A Refreshed Framework for Maternity services 2011).

3.  Ensure that women experience positive pregnancies which result in the birth of more healthy babies as evidenced by a reduction of 15% in the rates of: stillbirths (from 4.9 per 1000 births in 2010 to 4.3 per 1000 births in 2015) infant mortality (from 3.7 per 1000 live births in 2010 to 3.1 per 1000 live births in 2015) Context

4.  Promote enhanced interactions between parents and their unborn baby, resulting in improved attachment as well as strengthening engagement with maternity services.  *Resulting in a decrease in Do Not Attend rates at antenatal appointments in the Wishaw locality by March 2015.  *Resulting in a increase in attendance at antenatal appointments in the Wishaw locality by March 2015. Goals of initiative

5. Decrease in Do Not Attend rates at antenatal appointments in the Wishaw locality by March 2015. Primary drivers Secondary drivers Awareness of impact of lifestyle on unborn baby resulting in positive choices/changes Willingness to attend Engagement with Maternity Services Understanding value of services provided Available information Cultural Norms Ability to attend (organisationa l skills) Specific Change Ideas Focused Improvement Concepts Ideas: 1)Ante natal text prompt reminder with date and time. 2)Provide information on what to expect at appointment. 3)Promoting positive messages during pregnancy. Increase Uptake with texting service Guidance Engagement Relationship with staff and service Promote enhanced interactions between parents and their unborn baby, resulting in improved attachment as well as strengthening engagement with maternity services. Aim

6. Changes/Improvements  There have been lot’s of challenges with this project, the main challenge being IT. However we are working towards a resolution and in the meantime the texts are being sent manually.  Recruitment has also been a challenge, no woman has ever declined and feedback has been positive numbers remain low.  Our focus has changed from appointment reminders to positive messages to promote attachment.

7. Who is involved?  Anna McGinlay, parent education secondment midwife.  AnneMarie Bruce Infant Feeding Midwife.  Carol Burton- clerical support  Wishaw community midwives covering 2 GP clinics in Wishaw Health centre.  Pregnant women in the Wishaw area  eHealth

8. Data! Data! Data!  Due to maternity leave it was necessary to completely change the clinic implementing the test of change. We have data for the 3 months the test has been running for. MonthNumber of DNA’s Numbers recruited November829 December433 January434

9. Impact of the intervention I have developed my sense of smell; can hear more and I am also beginning to remember things. I am getting to know and I am soothed by my family’s voices. I like when you talk, sing and play music and respond to my movements. 01698354966 29 weeks  Examples of Texts sent Keep us both healthy – you should have an appointment with your midwife around now. I have now grown to around 42cm long and can react to light. Why not try shining a torch over your tummy, play music or read me stories and see how I respond? 01698354966 Between 31-32 Weeks Appointment (Prim)

10. The Human Factor  Feedback from mothers Like the baby development messages. The text messages would encourage me to talk to my baby. Liked all the messages I have received, I would recommend the service. I especially liked the baby development messages. I would recommend the texting service. I really like receiving the messages as I have a 1 year child, so don't always have time to read or refer to my book

11. Next Steps  Implement automated service, liaising with eHealth to do this.  Roll out text message service throughout Wishaw community area.  As the it support has taken so long we may need to apply for additional funding into next year to roll out on a bigger scale.

12. “So What?”  Initial feedback has been positive, with women enjoying receiving the messages and trying the activities suggested. There is strong evidence that effective attachment begins in the antenatal period and if these messages facilitate this the benefits are immeasurable.  Women attend clinics because of better engagement and a desire to ensure wellbeing rather than a task.

13. Investment of Resources  What have you invested into this improvement work?  We obtained funding of £2,354 to implement service by paying for clerical support and purchase software required, due to delay in software development we have a slight under spend. The project has been very demanding of time.  What resources would you hope to reduce/stop in the future by implementing this change?  Increased attendance at antenatal clinic appointments and parent education sessions results in better use of midwives time. The positive health and wellbeing messages if they result in improved attachment would have immeasurable benefits on all aspects of health and wellbeing.

14. For More Information  AnneMarie Bruce or Anna McGinlay  Women's Services  Wishaw General Hospital  01698 366290