Search the hub

The majority of recommendations which MBRRACE-UK assessors have identified to improve care are drawn directly from existing guidance or reports and denote areas where implementation of existing guidance needs strengthening. In a small number of instances, actions are needed for which national guidelines are not available. These are included below. To access the report and the full list of recommendations, please click on the link at the bottom of this page. New recommendations to improve care: For professional organisations 1. Develop guidance to ensure SUDEP awareness, risk assessment and risk minimisation is standard care for women with epilepsy before, during and after pregnancy and ensure this is embedded in pathways of care. [ACTION: Royal Colleges of Obstetricians and Gynaecologists, Physicians]. 2. Develop guidance to indicate the need for definitive radiological diagnosis in women who have an inconclusive VQ scan [ACTION: Royal Colleges of Physicians, Radiologists, Obstetricians and Gynaecologists]. 3. Produce guidance on which bedside tests should be used for assessment of coagulation and the required training to perform and interpret those tests [ACTION: Royal Colleges of Anaesthetists, Obstetricians and Gynaecologists, Physicians] 4. Establish a mechanism to disseminate the learning from this report, not only to maternity staff, but more widely to GPs, emergency department practitioners, physicians and surgeons [ACTION: Academy of Medical Royal Colleges]. For policy makers, service planners/commissioners and service managers 5. Develop clear standards of care for joint maternity and neurology services, which allow for: early referral in pregnancy, particularly if pregnancy is unplanned, to optimise anti-epileptic drug regimens; rapid referral for neurology review if women have worsening epilepsy symptoms; pathways for immediate advice for junior staff out of hours; postnatal review to ensure anti-epileptic drug doses are appropriately adjusted [ACTION: NHSE/I and equivalents in the devolved nations and Ireland]. 6. Ensure each regional maternal medicine network has a pathway to enable women to access their designated epilepsy care team within a maximum of two weeks. [ACTION: Maternal Medicine Networks and equivalent structures in Ireland and the devolved nations]. 7. Ensure all maternity units have access to an epilepsy team [ACTION: Service Planners/Commissioners, Hospitals/Trusts/Health Boards]. 8. Establish pathways to facilitate rapid specialist stroke care for women with stroke diagnosed in inpatient maternity settings [ACTION: Service Planners/Commissioners, Hospitals/Trusts/Health Boards]. 9. Provide specialist multidisciplinary care for pregnant women who have had bariatric surgery by a team who have expertise in bariatric disorders [ACTION: Service Planners/Commissioners, Hospitals/Trusts/Health Boards]. 10. Use the scenarios identified from review of the care of women who died for ‘skills and drills’ training [ACTION: Hospitals/Trusts/Health Boards]. 11. Ensure early senior involvement in the care of women with extremely preterm prelabour rupture of membranes and a full explanation of the risks and benefits of continuing the pregnancy. This should include discussion of termination of pregnancy [ACTION: Hospitals/Trusts/Health Boards]. For health professionals 12. Regard nocturnal seizures as a ‘red flag’ indicating women with epilepsy need urgent referral to an epilepsy service or obstetric physician [ACTION: All Health Professionals]. 13. Ensure that women on prophylactic and treatment dose anticoagulation have a structured management plan to guide practitioners during the antenatal, intrapartum and postpartum period [ACTION: All HealthProfessionals]. 14. Ensure at least one senior clinician takes a ‘helicopter view’ of the management of a woman with major obstetric haemorrhage to coordinate all aspects of care [ACTION: All Health Professionals]. iv MBRRACE-UK - Saving Lives, Improving Mothers’ Care 2020 15. Ensure that the response to obstetric haemorrhage is tailored to the proportionate blood loss as a percentage of circulating blood volume based on a woman’s body weight [ACTION: All Health Professionals]. 16. Do not perform controlled cord traction if there are no signs of placental separation (blood loss and lengthening of the cord) and take steps to manage the placenta as retained [ACTION: All Health Professionals]. 17. Be aware that signs of uterine inversion include pain when attempting to deliver the placenta, a rapid deterioration of maternal condition and a loss of fundal height without delivery of the placenta [ACTION: All Health Professionals].

In this BMJ Opinion piece, Amali Lokugamage and Alice Meredith propose that the foundation of any translation of Cultural Safety education to maternity services should consider these five key ingredients: A catalogue of patient experience videos explaining their encounters with structural inequity in healthcare from a diverse group of patients The creation of a basic module of education in decolonising the history of health, raising awareness of lingering colonial racial bias An educational tool is required to enhance healthcare professional’s reflective practice Access to continuity of care models for disadvantaged women Part of the Cultural Safety model is that when vulnerable patients feel culturally unsafe (due to racial discrimination), they can request carers from a similar ethnic background as themselves. In relation to the final point, the authors note: "There may not be enough numbers of appropriately trained personnel from the same cultural background requiring affirmative action in recruitment. An additional confounding consequence may be to cause “auto segregation” in society and could limit personal development in all healthcare personnel or systems in order to produce equitable healthcare for all. Also, the global phenomenon of disrespectful maternity care, described by the World Health Organisation in their document on the prevention and elimination of disrespect and abuse during childbirth, points to the existence of unjust interactions in countries where care is delivered by professionals from a similar background to their patients. Furthermore, by potentially allowing such requests to become day-to-day practice, there are recognised pitfalls as described recently by Roger Kline, including increased segregation towards healthcare providers, and even racism against doctors from ethnic minorities. So, this final element could be thorny when considering possible translation to a UK setting."

What will the Observatory aim to do? It will seek to achieve not only equality of access to services, but equal health outcomes irrespective of race. While discussions as to its functions and structure have only just begun, the Observatory’s aims are clear, and build on lessons of successes and failure from the past. It will provide a unified source of policy relevant evidence and information which would explain how and why racial disparities in health occur. While the evidence would be principally aimed at enhancing the knowledge and understanding of healthcare leaders, its outputs are intended to be publicly accessible. target outcomes, by translating the research into practical guidance, so that new and existing policy and programmes are renewed, designed and delivered to reduce disparities and begin with reviewing the impact of policy practice and programmes on the health and wellbeing of the ethnic minority health workforce, in collaboration with NHS England’s Workforce Race Equality Strategy. Eliminating the adverse outcomes of racism and discrimination in the NHS’s own workforce is not optional, if the Observatory is to be a credible authority in race equality into the future.