“Te simple way to put it is it pre-programmes the baby. If the teeth are worse, there’s a link between teeth and pre-term delivery, she prob- ably has a low-level infection. If all the things you think about deprived communities and the risks, the baby isn’t born ‘new’ from scratch.” Te aim would be to get Caley into maternity
services as early as possible, says Calderwood; a midwife would advise on nutrition, cutting out alcohol and smoking cessation – something Calderwood says maternity services are “getting much better” at supporting. Physical activity, too is becoming a major rec- ommendation. “Even if you’re not used to doing any, we know it can make you feel better, it makes them fitter. And if you look at labour, it potentially is quite a stressful exercise. People being fit actually have better labour outcomes, generally.” If Caley was to become a “late booker” – someone who doesn’t engage with maternity services by week 16, it carries its own risks, warns Calderwood. Tese tend to be people who are quite young, don’t have support from their family and may be in denial about their pregnancy. “What I would say about that is we don’t make it easy for people
to access us, sometimes,” she says, remembering cases she had when she ran a clinic in West Lothian, who had to get two buses to attend appointments.
“I had a woman who couldn’t read as one of my very complicated patients, her partner was her carer and so he had to come with her.
“I’m always talking about the midwives and the obstetricians and preconception – that’s the future health of the nation”
Two buses, and because she couldn’t read, she didn’t know what bus was coming. “Tey had three other children, and that was an absolute drama for them. She often didn’t come, and it wasn’t her fault. She wasn’t being bad or uncaring or anything, it was just with three other kids and all the other stuff going on, and no money coming in apart from the carer’s allowance.” Efforts are being made to remove such barriers, Calderwood insists, pointing to the way ‘deep- end’ GP practices and community midwifery have broken down barriers with the use of extra
resource to support the time to take an asset-based approach. Calderwood’s first annual report, published in January, stimulated a national discussion on what she calls ‘realistic medicine’ – where doctors are encouraged to use fewer treatments and listen more to the wishes of patients, or as Calderwood prefers to call them, people. She says she has been satisfied by how the idea has taken off, and has spent a lot of time going round the country talking about the concept with various professionals. Social media has pushed the conversation beyond Scotland too, she says, with her report still being retweeted 50 to 60 times a week four months on.
“Te patient has this whole other life, and if you call them a patient, you narrow them down into that little box. Actually, it’s far better to
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www.holyrood.com 23 May 2016
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