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Prepared for Pregnancy? Preconception health, education and care in Scotland

An overview of Missed Periods: Scotland’s Opportunities for Better Pregnancies, Healthier Parents and Thriving Babies the First Time ... and Every Time

In Scotland today, far too many pregnancies do not achieve positive outcomes. Of the 70,000 known conceptions last year, there were fewer than 54,000 live births – which means that 16,000 (more than 1 in 5) pregnancies ended in a termination, miscarriage or stillbirth. Of the live births, more than 1 in 10 required ‘extra care’ immediately after delivery and around 1 out of every 5 resulted in longer-term additional support needs.

The human, societal and !nancial costs of Scotland’s ‘blind spot’ about preconception health, education and care are unacceptably high.iii Therefore, it is time to stop accepting these costs and start treating them as largely preventable, not inevitable.

Even the majority of positive outcomes were not the result of careful planning and active preparation before pregnancy. Unnecessarily risky pregnancies are common across Scotland. Unwanted, mistimed, and ill-prepared-for pregnancies jeopardise the lives of mothers and babies each year, as well as the wellbeing of families, including fathers. Pre-existing good health, good luck and good antenatal care have long been the foundation of most successful pregnancies in Scotland.

This situation is not Scotland’s destiny. Healthier pregnancies, healthier parents and healthier babies are goals Scotland can achieve right now. Seizing these opportunities begins with seeing the preconception period as the earliest and best time to prevent harm, promote health and reduce inequalities. Closing gaps in pregnancy and birth at any time is good, but preventing inequalities from opening in the !rst place is far better. But, positive outcomes will not happen by accident or by squandering the numerous chances to improve preconception health, education and care.

Traditionally, it has been assumed there are only two stages that matter, i.e. either avoiding pregnancy or being pregnant. The middle stage of preparing for the best possible pregnancy continues to be overlooked in policy, professional practice and individual thinking in Scotland.

Personal and professional experience, as well as a mountain of international research, make it plain that women who are in good shape (physically, mentally, socioeconomically and in terms of their personal relationships) before conception are most likely to come through their pregnancy successfully. They are also most likely to give birth to a thriving baby.

Most of the risks prospective parents face – chronic medical conditions, stress, obesity, depression, exposure to toxic/teratogenic substances, serious illnesses, smoking, domestic abuse, alcohol and drug use – would have been far better dealt with during the preconception period than when already pregnant. ‘Naming, shaming and blaming’ prospective mothers and fathers is both unkind and ine"ective. The key is to understand the reasons why these risks have developed; how best they can be prevented, reduced or eliminated; and then, to take the compassionate, supportive actions necessary.

Delaying pregnancy is already the norm in Scotland. The average age of giving birth in Scotland today is 29.5 years – and 28 years old for !rst time mothers. In fact, less than 1 out of every 23 births in Scotland last year was to a mother under the age of 20.

Nevertheless, steering clear of childbearing is not the same as preparing well for pregnancy.