Maternity services: evidence to support improvement (NIHR, 16 May 2023)

Summary

Recently, there has been a concerning increase in the number of deaths of pregnant women, especially from Black, Asian and deprived backgrounds. In addition, there have been several investigations into safety issues in maternity services, such as the Ockenden, East Kent, and Shrewsbury and Telford report. This National Institute for Health and Care Research (NIHR) Collection highlights evidence in priority areas, identified in the East Kent report, to support high-quality care and avoid safety issues in maternity services.

Content

Key messages

Maternity care aims to be safe, effective and responsive at all times. For the great majority, pregnancy and childbirth is a positive and happy experience that culminates in a healthy mother and baby. But on the rare occasions when things go wrong, the effects are life changing.

The rates of stillbirth and neonatal deaths have fallen by around 20% since 2010. However, recent years have also seen a decline in other indicators of safety and quality and notable failings in some hospitals. Outcomes for black and Asian women and those from more deprived areas in the UK were significantly worse.

As the recent NHS England Three Year Delivery plan (2023) for maternity and neonatal services points out, some families have experienced unacceptable care, trauma, and loss, and have challenged the NHS to improve.

This NIHR Collection highlights evidence from NIHR-funded studies and other important research, to support improvement in four areas that are critical to high quality maternity care. They are:

1. Kind and compassionate care
2. Teamwork with common purpose
3. Identifying poor performance
4. Organisational oversight and response to challenge.

Evidence points to the need for:

• an open, compassionate, and learning culture to be promoted by hospital boards and clinical leaders across their organisation and within clinical teams
• team development to be enabled so that team members understand the team’s objectives and each other’s roles and competencies
• women to be empowered to be involved in decisions about their care through effective communication and information sharing
• high-quality bereavement care that is compassionate and sensitive to the needs of individual families
• staff training to include cultural awareness and team-based learning
• continuity of care to be prioritised in the organisation of care so that women have a named midwife
• strong clinical and quality governance; learning from and taking action on clinical and patient experience data including severe complications of pregnancy and deaths.

The wider system needs to support these key areas, for example, by ensuring safe staffing levels and a high quality care environment.