National Maternity Review Research Articles

Identifying Complex Social Needs in Pregnancy

The national maternity review: Better births (NHS England 2016) identified that every woman, pregnancy, baby and family is different. It is therefore vital that quality services are personalised and meet the needs of the baby as well as the wider family. The learning and research around early identification of social factors and intervention in pregnancy remains fairly new. However, there is a plethora of documents and research that focus on identification and intervention in the early years of a child’s life, to ensure that children are able to thrive and have good long-term social, emotional and physical outcomes. As an occasional part of the Evidence series, we explore different aspects of research to make this knowledge accessible and relevant. It aims to help midwives understand, use and engage with research, and consider how research matters to their practice.

An evaluation of mindfulness-based childbirth and parenting courses for pregnant women and prospective fathers/partners within the UK NHS (MBCP-4-NHS)

An evaluation of mindfulness-based childbirth and parenting courses for pregnant women and prospective fathers/partners within the UK NHS (MBCP-4-NHS).Objective: To explore the usefulness within the National Health Service (NHS) of a brief (four week, ten hour) course based upon the Mindfulness Based Childbirth and Parenting (MBCP) programme (Duncan and Bardacke, 2010) described here as MBCP-4-NHS.Background: The National Maternity Review (2016) and report of The Independent Mental Health Taskforce to the NHS (2016a, 2016b) in England highlight the need for significant investment into perinatal mental health services, with the Government pledging funding to improve such services through a range of measures. Whilst the field of mindfulness during the perinatal period is in need of well controlled trials and studies exploring the mechanisms of action (Hall et al., 2016) the limited research to date supports the potential for mindfulness based interventions in pregnancy and the need for further scientific study in this area (Dhillon et al., 2017; Shi and Macbeth, 2017). Particularly because it may broaden women's repertoire of coping strategies with the potential to improve the developmental trajectory of both parents and infants (Dunn et al., 2012; Duncan and Bardacke, 2010; Vieten and Astin, 2008). However, most of the studies to date have involved lengthy courses of around 8–9 weeks (24 h) duration, which may not be feasible or economical within a UK NHS setting and therefore, would be unlikely to be adopted as routine practice.Design: An initial pilot study to discover if MBCP-4-NHS is acceptable and feasible within NHS maternity services, comparing maternal and paternal pre and post intervention self-report measures of mental health to begin to explore the effectiveness of this intervention.Setting: NHS antenatal education classes held in children's centres for expectant parents across Oxfordshire.Participants: All expectant parents receiving Oxfordshire maternity services between October 2014 and January 2015 were invited to self-refer into the intervention, of which 155 individuals (86 women and 69 men) took part.Intervention: ‘MBCP-4-NHS’ – A brief (four week, ten hour) course developed from the nine week Mindfulness Based Childbirth and Parenting (MBCP) intervention.Measures: Self-report measures of mental health including low mood/depression, mindfulness, stress, anxiety, pregnancy related distress and experiences.Findings: The results showed a significant increase in both maternal and paternal mental health with women demonstrating a significant improvement in symptoms of stress, anxiety, depression, pregnancy-related distress, labour worry and positive and negative pregnancy experiences; and men improving significantly in symptoms of anxiety, depression and showing a trend for improvement in self-reported symptoms of perceived stress.Conclusions: This is a promising antenatal intervention that can be feasibly implemented within NHS which might have the potential to impact upon parental mental health and, therefore, possibly also the health of next generation. However, caution is needed interpreting these findings given that this study did not include an active control group.Implications for practice: This research provides a clear rationale and justification for a large randomised control trial of this intervention within the NHS, which should include a more diverse population, across multiple centres and should explore both the potential health benefits for parents and infants/children as well as potential economic costs/benefits.

A woman's cry for her midwife

Two years on from the launch of the National Maternity Review's Better Births document, Jacqueline Dunkley-Bent OBE provides a unique reflection of her 30-year midwifery career

Reflections on the National Maternity Review

There are just over 660 000 live births in England each year,1 the majority of which are of healthy, term babies. However, one in nine babies born—more than 77 000...

UK Secretary of State for Health proposes new model for compensating the victims of adverse outcomes resulting from medical/midwifery errors during childbirth.

On Monday 17 October 2016, Jeremy Hunt, the UK Secretary of State for Health, acknowledged in a press release the medico-legal crisis in maternity care. In August 2016 the National Health Service (NHS) Litigation Authority (www.nhsla.com) reported that the annual cost of settling legal claims had reached £1488.5 million pounds ($1816 million; lawyers take 36% of the total). Of the £2896 million claims received in the financial year 2015/16, 42% were for negligence in maternity care: £1216.5 million (with £989.7 million for cerebral palsy cases alone). Compensating claimants now costs about 20% of the maternity budget (about £800 for each birth); however, Hunt allocated just £8 million for multidisciplinary training, which is 20% less than the current maximum award for a single cerebral palsy case (£10 135 511; T versus Kings College Hospital NHS FT High Court 22 January 2015). The Health Secretary ‘will also consult on a new Rapid Resolution and Redress (RRR) scheme to give eligible families a thorough and independent investigation, and the option to join an alternative system of compensation that offers support and regular payments without the need to bring a claim through the courts’. His proposal was foreshadowed by the National Maternity Review, published in February 2016 (www.england.nhs.uk/2016/02/maternity-review-2/). This suggests that ‘Where the harm was caused by acts or omissions related to care during term labour, a financial settlement should be provided to support the baby's care… Such a scheme would pay out for birth injuries without families needing to go to court and prove negligence in a lengthy and difficult process. Removing the threat of individual clinicians being branded negligent would improve the effectiveness of serious incident investigations, and help ensure that similar mistakes were avoided’. However, it is difficult to envisage a system where an individual who makes a serious error of judgment is not in some way held to account or subjected to a practice review. Local investigation of those involved can be hampered by a reluctance to criticise colleagues. Moreover, the problems with this approach were recognised in the second report of the Parliamentary Health Committee almost 25 years ago (Winterton Report, 1992), to which I was an advisor. They opined that ‘no-fault compensation might reduce the number of awards, but would still leave the problem of accountability for mistakes… it would also fail to address the problem of equity, for only a small proportion of longterm handicap can be attributed to medical or midwifery error. Thus even a no-fault system of compensation would only ameliorate the lot of a small fraction of children needing special provision’. They recommended ‘improving education of maternity care givers’ and ‘improving care for disabled children and adults so that multi-million pound settlements are not seen as the only way to ensure their longterm protection’. At present, costs of care are based entirely on care in the private sector. Allowing judges to take into account the available NHS provision would allow considerable reductions in compensation; however, lawyers are probably still a long way from losing their income from mistakes in maternity care. None declared. Completed disclosure of interests form available to view online as supporting information. Linked article This article is comment on by SL Clark, p. 1334 in this issue. To view this mini commentary visit https://doi.org/10.1111/1471-0528.14621. Please note: The publisher is not responsible for the content or functionality of any supporting information supplied by the authors. Any queries (other than missing content) should be directed to the corresponding author for the article.

Clinical practice: Perineal suturing

This article highlights the important midwifery skill of perineal assessment and suturing. Perineal trauma resulting from vaginal birth is the most common form of obstetric injury experienced by women, and can be associated with considerable maternal morbidity ( RCOG, 2015 ). Midwives, being the lead practitioner for normal birth, should therefore be competent and skilled in the assessment and repair of perineal trauma. Providing a service which is evidence based and personalised as recommended within Better births ( National Maternity Review, 2016 ) has a massive potential for positive impact upon a women's quality of life as she enters motherhood after vaginal birth.

A better start for Bradford?

Bradford was one of five areas across the UK successful in a bid for funding from the Big Lottery Fund's A Better Start initiative. The £49 million funding that Bradford won is being used to further develop 22 projects to improve the social and emotional development, communication and language development, and health and nutrition of children aged 0–3 years. One of these projects is a 3-year pilot of a personalised midwifery care team. Using a ‘buddy’ system, the midwifery team aims for the named midwife or buddy to provide 90% of all antenatal and postnatal midwifery care. Each midwife has a maximum caseload of 60 women and is, therefore, able to offer an enhanced care package, individualised to each woman's needs. The pilot began in October 2015 and the learning from this model of care is being fed into the local discussions about the National Maternity Review.

Ensuring better births for women in England

In July I was delighted to take part in an event highlighting the exciting developments in maternity care following the publication of the report of the National Maternity Review: Better Births.

The National Maternity Review’s Rapid Resolution and Redress scheme model: A comparison with other worldwide compensation schemes

The National Maternity Review has proposed an insurance-based Rapid Resolution and Redress scheme be considered by the Department of Health. This article will outline and examine the Maternity Review’s proposals; drawing parallels and highlighting contrasts between the proposals and other schemes.

A legacy from Sheila Kitzinger: Continuity of care is crucial

British Journal of MidwiferyVol. 24, No. 4 BirthwriteA legacy from Sheila Kitzinger: Continuity of care is crucialLesley PageLesley PageSearch for more papers by this authorLesley PagePublished Online:7 Apr 2016https://doi.org/10.12968/bjom.2016.24.4.234AboutSectionsView articleView Full TextPDF/EPUB ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareShare onFacebookTwitterLinked InEmail View article References National Maternity Review (2016) Better Births: Improving outcomes of maternity services in England. A Five Year Forward View for maternity care. http://tinyurl.com/NMR2016 (accessed 22 March 2016) Google Scholar FiguresReferencesRelatedDetails 2 April 2016Volume 24Issue 4ISSN (print): 0969-4900ISSN (online): 2052-4307 Metrics History Published online 7 April 2016 Published in print 2 April 2016 Information© MA Healthcare LimitedPDF download

Operationalising the Lean principles in maternity service design using 3P methodology

The last half century has seen significant changes to Maternity services in England. Though rates of maternal and infant mortality have fallen to very low levels, this has been achieved...