Maternity

Maternity is often called the NHS’s ‘shop window’, with services used by over 700,000 families in England every year.

Having a baby is the single largest reason for admission to hospital and the experience families have during pregnancy and postnatally often colours their long-term health and wellbeing and their use of health services (1). The need to improve patient safety in this area is of paramount importance. As well as devastating emotional consequences for those who encounter adverse care, the financial implications are also profound. The NHS in England paid out £3.1 billion (49% of the value of all claims) for negligence linked to maternity care in the past decade (2).

Maternity care is unique: it cannot be demand managed and activity cannot be controlled through referrals. In the UK the service is delivered by acute trusts yet care happens mainly in the community with interdependencies with primary and community services (1). The quality of leadership and supervision in maternity care is critical to patient safety and safe maternity care depends on the work of effective, well-trained and capable multi-professional teams. Staffing is often one of the most challenging issues in maternity care, and increasing attention is being given to practical and pragmatic approaches to deploying staff flexibly, shifting tasks appropriately and creating new or extended roles within maternity services to support the safe delivery of maternity care. Confidential enquiries into poor perinatal outcomes have identified deficiencies in team working as a common factor and have recommended team training in the management of obstetric emergencies (3).

Whilst it is recognised that pregnancy and labour are normal physiological events, observation of vital signs is important and should form an integral part of care. Physiological track and trigger systems should be used to monitor all antenatal and postnatal admissions (4). Sepsis has superseded venous thromboembolism as the leading cause of maternal death in the UK and forms the maternal facing work theme of the MBBRACE collaborative, which is continuing reporting previously done by the Confidential Enquiry into Maternal Deaths (CEMD) (5).

There is a significant body of evidence that adverse maternal outcomes are linked to maternal vulnerability. Increasing social and ethnic diversity can sometimes lead to communication difficulties and other social and clinical challenges in maternity care.  Vulnerable patients also often present late to services with minimal antenatal care and fewer opportunities to promote a healthy pregnancy and outcome (6).

Sadly domestic violence (DV) in pregnancy is a very real and frequent occurrence, affecting women worldwide. As part of making maternity care safer, it is essential that we increase awareness of the prevalence of DV and help clinicians to tackle this serious public health issue (7). 

Perinatal mental health problems are very common, affecting up to 20% of women at some point during the perinatal period. They are also of major importance as a public health issue, not just because of their adverse impact on the mother but also because they have been shown to compromise the healthy emotional, cognitive and even physical development of the child, with serious long-term consequences (8).


References:

1) Commissioning Maternity Services: A Resource Pack to support Clinical Commissioning Groups. July 2012. NHS Commissioning Board. http://www.england.nhs.uk/wp-content/uploads/2012/07/comm-maternity-services.pdf Accessed on March 15, 2015

2) Intrapartum Fetal Monitoring. Patient.co.uk. http://www.patient.co.uk/doctor/intrapartum-fetal-monitoring
Accessed on March 15, 2015

3) Siassakos, D., Crofts, J., Winter, C., Weiner, C. and Draycott, T. (2009), The active components of effective training in obstetric emergencies. BJOG: An International Journal of Obstetrics & Gynaecology, 116: 1028–1032. doi: 10.1111/j.1471-0528.2009.02178.x

4) Providing equity of critical and maternity care for the critically ill pregnant or recently pregnant woman. July 2011. http://www.rcoa.ac.uk/system/files/CSQ-ProvEqMatCritCare.pdf Accessed on 2nd February, 2015

5) Transforming Maternity Services - The acutely deteriorating woman. http://www.1000livesplus.wales.nhs.uk/maternity-acutely-deteriorating-woman
Accessed on March 15, 2015

6) Understanding the patient safety issues for some vulnerable groups of women known to be at higher risk of maternal death or morbidity. NATIONAL PATIENT SAFETY AGENCY.  https://www.google.co.uk/url?sa=t&rct=j&q=&esrc=s&source=web&cd=2&cad=rja&uact=8&ved=0CC4QFjAB&url=http%3A%2F%2Fwww.npsa.nhs.uk%2FEasysiteWeb%2Fgetresource.axd%3FAssetID%3D880%26type%3DFull%26servicetype%3DAttachment&ei=cSgAVaKIKZHuaOuxgbgJ&usg=AFQjCNG1YgVGOz62e2vlfbiFcfdXazwxVg&sig2=_Dgq5Ot2H5f1BZqwv0BSng&bvm=bv.87611401,d.d2s
Accessed on March 15, 2015

7) Domestic Violence and Pregnancy. Women’s Aid. http://www.womensaid.ie/campaigns/domesticviolenc1.html
Accessed on March 15, 2015

8) The Cost of Perinatal Mental Health. LSE Centre for Mental Health. http://www.centreformentalhealth.org.uk/pdfs/costs_of_perinatal_mh_summary.pdf
Accessed on March 15, 2015

All resources on maternity