Environmental
Posters with appropriate images for maternity
Benefits of walking in pregnancy film produced with Active Partnership
Posters to prompt and nudge
Northumbria Healthcare NHS Foundation Trust is one of the largest trusts in the country, geographically, providing services to more than half a million people.
It was one of the first Trusts to appoint a Consultant in Public Health. Embedding a strategy for population health across all aspects of work is a key strategic priority.
The approach to Active Hospitals builds upon extensive work to support physical activity for staff and patients, underpinned by the principles of Making Every Contact Count (MECC) and training to build capacity in the workforce to have MECC conversations. It incorporates the COM-B approach to behaviour change. Each pathway identified a lead and champion. It included engagement and co-design based on evidence of, not only what works, but also what mattered to pathway leads, champions, staff and patients. It included the recommendations set out within the Active Hospitals toolkit and utilised the MHPP resources (including PACC, and elearning), Moving Medicine resources and Active Conversations training. Maternity included Active Pregnancy Foundation “This Mum Moves” training.
The maternity pathway is a key workstream in public health Northumbria, North East and North Cumbria ICS: Public health prevention in maternity and with local authority partners as part of joint NHS and LA Healthy Weight Declaration.
Pathway
Consultant clinic / high risk obstetric pathway – Health coach appointment for all with BMI >30
Three health coach conversation appointments – at 12-16, 20 and 28 weeks to support what matters most to mum
PA option: Midwife led aqua natal exercise class option
PA option: Midwife led bump and buggy walk supported by local authority health trainers
Direct
Support for goal setting and action planning
Signposting or support to access on demand and community PA options
Gestational Diabetes and Physical Activity leaflet if appropriate
Aqua exercise
Social connections
PA conversation
Signposting and recommendations
Midwife conversation and support
Health
Social connections
PA conversation
Signposting and recommendations
Midwife and health trainer conversation and support
Indirect
Training
Governance Framework
Environmental Changes
Communications/Promotion
Click on the boxes below to find out more information about the interventions used in this pathway.
Communications /Promotion
– Internal – AH trust website page and staff bulletins, Trust Maternity Voices website
– External – maternal obesity steering group attended by local authority leads, maternity MDT and maternity voices service user representative, press releases, social media, NENC ICS public health prevention in maternity
Training
PA training agreed as part of mandatory provision for all maternity staff
Year 1: e-LfH module ‘Physical activity in pregnancy and postnatal’
Year 2: Face to face 1 hour session from This Mum Moves Ambassador
Additional training: Moving Medicine Active Conversations and PACC offered to all staff in healthy weight pathway
This Mum Moves Ambassador train the trainer – PH midwife
Delivered to obstetric staff and MDT and to medical students
Health walk leader and Aqua natal exercise instructor training for midwives
PA messaging framework – unique to Northumbria as an extension to PhD research. Commissioned by Northumbria as a resource with workshop to train Trust, local authority public health and sport and leisure, Active Partnership and comms and marketing colleagues in the use of the framework and checklist. Resource is then used in comms and marketing relating to PA.
Williamson, C., Baker, G., Tomasone, J.R. et al. The Physical Activity Messaging Framework (PAMF) and Checklist (PAMC): International consensus statement and user guide. Int J Behav Nutr Phys Act 18, 164 (2021). https://doi.org/10.1186/s12966-021-01230-8
Williamson, C., Kelly, P., Tomasone, J.R. et al. A modified Delphi study to enhance and gain international consensus on the Physical Activity Messaging Framework (PAMF) and Checklist (PAMC). Int J Behav Nutr Phys Act 18, 108 (2021). https://doi.org/10.1186/s12966-021-01182-z
NMAHP preceptorship includes Active Hospitals and MECC
5 maternity staff and 3 health coaches attended the Ambassador training, which has led to a cascade using the Train the Trainer model to 250 maternity staff in 2022/23, 12 midwives completed aquanatal (a further 10 will complete in March 2023), Walk Leader – 8 maternity staff are trained
Physical Activity Conversations
Gestational Diabetes and PA patient information leaflet developed
Part of maternity booking process and follow up appointments
Health coach and Best Start in Life advisors – support and MECC conversations includes PA calculator
Health coach support in high BMI pathway (BMI 35 and over)
Targeted PA support
Weekly community activities led by midwives such as bump and buggy walks and aqua natal classes with local authority support. The walks were initially started as a result of a survey of women asking what activities they would like postnatally in their area – they were started during covid restrictions so an outdoor activity was essential. The Trust Health Trainer service collaborated with us to start the walks alongside our midwifery team. Once the maternity team completed their ‘walk leader’ training, the Health Trainer team stepped back and they are now maternity ran only – which has been positively received by the women who attend. They were also expanded to offer a ‘Bump and Buggy’ walk as pregnant women heard about the group through the maternity team and wanted to take part. 8-10 women per week attend the walk.
Signpost and refer to local authority programmes of pre and postnatal PA and Active Pregnancy Foundation on demand options
Physiotherapy led classes and Trust filmed YouTube exercise options
Governance
AH steering group attended by head of maternity service
PH midwife as clinical lead and champion, supported by AH delivery lead. Trust leadership from consultant in public health who reported to exec board level . 
Outcomes
Data Gathering
Training record includes maternity staff trained, the training completed, and qualitative feedback
Record of referrals to health coach support, conversation themes and qualitative feedback from mums
PHD PA messaging research qualitative interviews with new mums
Staff health and well-being case study
Patient feedback in the development of the GD and PA leaflet as part of the patient information leaflet process
Evaluation up to July 2022
- PH midwife trained as This Mum Moves Ambassador trainer and cascading training in mandatory training programme 2022/23
-8 staff supporting maternity pathway trained as This Mum Moves Ambassadors
-15 midwives trained to deliver Aquanatal sessions
-8 midwives trained as walk leaders
-98 service users referred to the health coach for additional support - Feedback from mothers attending health coach appointments has been excellent. Really appreciated the focus on PA
- Maternity staff reporting increased confidence to discuss physical activity
Qualitative feedback from mothers who have attended all three health coach appointments has been excellent. Mothers have appreciated the one-on-one time, and the holistic nature of the appointment which enables them to speak about a range of issues. Specifically, mothers have appreciated the focus on physical activity.
It’s very holistic and they appreciated that approach of physical activity rather than a lecture about risks when you have a high BMI in pregnancy, which is the historic way that we’ve dealt with these women.
Maternity pathway representative
The staff delivering the community-based interventions also reported anecdotal evidence of positive impacts on the mothers who had participated in activities. In particular, they had witnessed mothers increase in confidence relating to physical activity, develop support networks which opens possibilities for them to meet to walk/swim independently of the formal trust-run sessions.
I can actually see a difference from the ladies from when they first attended the sessions. Some of them were just so quiet now and to see the difference in them, their confidence, it’s just lovely to see, it really is. And I think friendship groups as well. The ladies decided to make a WhatsApp group so they were exchanging numbers. And hopefully this will then lead onto the buggy walk and other things and at that moment I thought, yes, this is what we’re trying to achieve
Maternity pathway representative
Furthermore, feedback the trust has received from mothers via social media demonstrates the importance mothers place on the sessions being run by midwives or nursing assistants, as it provides mothers with regular opportunities to discuss any questions or concerns. Staff reported that this had a positive impact on mothers’ confidence that positively impacted the whole of their maternity journeys, not just as it related to physical activity.
But even wider than that, women who are confident, empowered in pregnancy will make their own choices and we’re very much about decision making and shared decision making and choice in maternity. And I think that’s really important that women are confident and they know that they can speak up now they’ve got support networks.
Maternity pathway representative
Tips
Click on the numbers below for some tips from our Active Hospital team
1
Communication
Communication – engagement at every stage, exec board and senior clinical leadership buy in. Identify a clinical lead and champion.
2
Embed in existing pathways and systems
3
Education
Education, removing barriers, addressing concerns with PA and pregnancy, include in pre-reg education
4
Create and Maintain links
Funding/ongoing sustainability – create and maintain links, explore partnership working opportunities, lead and champion to keep momentum and drive
5
Develop a Process to address DNA and engagement
6
Develop a sustainability next steps plan
Build in PA calculator to newly introduced Badger net electronic patient record
Leadership from PH midwife, built in to role
Continued PA training for maternity workforce and health coaches with HEE CPD funding
PA messaging framework and training shared with local authority leads for comms and marketing, Place based campaigns to implement framework.
AH steering group maintained, leadership from consultant in PH. Partnership working on AH led by Northumbria with local authority and active partnership. Maternity pathway delivery plans updated and included in maternal obesity action plans.
Sharing AH report in NENC ICS pathways, LMC, and with Maternity Voices
Clinical educator role to support translating PA training into clinical practice