UK Maternity Services Research Articles

Optimising digital clinical consultations in maternity care: a realist review and implementation principles.

The COVID-19 pandemic has led to increased use of digital clinical consultations (phone or video calls) within UK maternity services. This project aimed to review the evidence on digital clinical consultations in maternity systems to illuminate how, for whom and in what contexts, they can be used to support safe, personalised and equitable care. A realist synthesis, drawing on diverse sources of evidence (2010-present) from OECD countries, alongside insights from knowledge user groups (representing healthcare providers and service users). The review used three analytical processes (induction, abduction and retroduction) within three iterative stages (development of initial programme theories; evidence retrieval and synthesis; validation and refinement of the programme theories). Ninety-three evidence sources were included in the final synthesis. Fifteen programme theories were developed showing that digital clinical consultations involve different mechanisms operating across five key contexts: the organisation, healthcare providers, the clinical relationship, the reason for consultation and women. The review suggests that digital clinical consultations can be effective and acceptable to stakeholders if there is access to appropriate infrastructure/digital resources and if implementation is able to ensure personalisation, informed choice, professional autonomy and relationship-focused connections. The review found relatively less evidence in relation to safety and equity. Due to the complexity of maternity systems, there can be 'no one-size fits all' approach to digital clinical consultations. Nonetheless, the review distills four 'CORE' implementation principles: C-creating the right environment, infrastructure and support for staff; O-optimising consultations to be responsive, flexible and personalised to different needs and preferences; R-recognising the importance of access and inclusion; and E-enabling quality and safety through relationship-focused connections. Service innovation and research are needed to operationalise, explore and evaluate these principles, particularly in relation to safety and equity. CRD42021288702.

Induction of labour care in the UK: A cross-sectional survey of maternity units.

To explore local induction of labour pathways in the UK National Health Service to provide insight into current practice. National survey. Hospital maternity services in all four nations of the UK. Convenience sample of 71 UK maternity units. An online cross-sectional survey was disseminated and completed via a national network of obstetrics and gynaecology specialist trainees (October 2021-March 2022). Results were analysed descriptively, with associations explored using Fisher's Exact and ANOVA. Induction rates, criteria, processes, delays, incidents, safety concerns. 54/71 units responded (76%, 35% of UK units). Induction rate range 19.2%-53.4%, median 36.3%. 72% (39/54) had agreed induction criteria: these varied widely and were not all in national guidance. Multidisciplinary booking decision-making was not reported by 38/54 (70%). Delays reported 'often/always' in hospital admission for induction (19%, 10/54) and Delivery Suite transfer once induction in progress (63%, 34/54). Staffing was frequently reported cause of delay (76%, 41/54 'often/always'). Delays triggered incident reports in 36/54 (67%) and resulted in harm in 3/54 (6%). Induction was an area of concern (44%, 24/54); 61% (33/54) reported induction-focused quality improvement work. There is substantial variation in induction rates, processes and policies across UK maternity services. Delays appear to be common and are a cause of safety concerns. With induction rates likely to increase, improved guidance and pathways are critically needed to improve safety and experience of care.

‘My doctor just called me a good girl and I died a bit inside’: From everyday misogyny to obstetric violence in UK fertility and maternity services

This paper begins with the common phrase ‘good girl’ as a lens through which to explore the insidious nature of patronising and paternalistic language on women's agency in obstetric care. Here we see how misogynistic language is both violence against women in its own right, and serves to create a context in which more extreme obstetric violence can be precipitated. Based on thematic analysis of discussion on Mumsnet, and on contributions to a research-focused Facebook group, this paper illustrates the complexity of recognising and refuting misogyny as a female patient as well as the damage that can occur from a cultural context in which this language is normalised. Here, words both boast a materiality through the environments they reify, and become transient and slippery, with semiotic uncertainty.

Provision of interpreting support for cross-cultural communication in UK maternity services: A Freedom of Information request

BackgroundLanguage, communication and understanding of information are central to safe, ethical and efficient maternity care. The National Health Service (NHS) commissioning board, NHS England, describes how healthcare providers should obtain language support through professionally trained interpreters. Providers of interpreters are commissioned to deliver remote/face to face interpretation across the NHS. Services can be booked in advance or calls can be made in real time. However, women report infrequent use of professionally trained interpreters during their maternity care, often relying on friends and family as interpreters which can compromise confidentiality, disclosure and accuracy. MethodsTo determine the demand for, and provision of, professionally trained interpreters in practice, we sent a Freedom of Information (FOI) request to 119 NHS Trusts delivering maternity services in England in November 2022. For the financial years 2020/2021 and 2021/2022, we asked how many women in the maternity service were identified as needing an interpreter, the number and mode of interpreter sessions, and the annual spend on interpreting services. Data were analysed using descriptive statistics. ResultsOne hundred maternity Trusts responded by 21st April 2023 (response rate 100/119–84 %). Of these, 56 (56 %) recorded a woman's need for an interpreter. Nineteen Trusts relied on documentation in paper notes and 37 Trusts recorded the information on a digital system. From the 37 Trusts where this information could be digitally retrieved, women requiring interpreter support reflected between 1 and 25 % of the annual birth rate of the Trust (average 9 %) and received an average of three interpreter sessions across their pregnancy, birth and postnatal journey. Telephone was the dominant mode used for interpreting sessions, though 11 Trusts favoured face to face interpreting. Financial spend on interpreting services varied across Trusts; some funded their own in-house interpreting services, or worked with local community groups in addition to their contracted interpreting provider. ConclusionInformation obtained from this FOI request suggests that documentation of a woman's interpreting need is not complete or consistent across NHS maternity services. As a result, it is not clear how many women require an interpreter, the mode of provision or how frequently it is provided, and the cost involved. However, the limited information available suggests a failure to provide interpreter support to women at each scheduled care encounter. This raises questions about, the risk of women not understanding the care being offered, and the increased risk of uninformed, unconsented care as women traverse pregnancy and birth. TweetableThere appears to be failure to provide interpreter support to women at each scheduled maternity care encounter increasing the risk of uninformed, unconsented care.

Donna Ockenden: dedicated to improving UK maternity services

Donna Ockenden is a respected UK health-services leader. A Welsh native and nurse and midwife by training, she is Chair of the Independent Review of Maternity Services at the Nottingham University Hospitals NHS Trust, UK. Speaking about her priorities in the role, the straight-talking Ockenden says: “I’m absolutely clear that all voices that want to be heard, will be heard, and will be amplified. And what they tell us absolutely will be acted upon. We know that Nottingham has a diverse population and a community and from day one we are ensuring that we listen to and act upon the voices of all those women and families.” Noting that families campaigned for the review after the deaths of babies, she adds that “we need to make sure that families get the answers that they deserve, but also that they can see meaningful and sustainable change in the safety and quality of maternity services for their local communities…We will work with the trust to ensure that change happens in a timely way.”

The Tommy’s Clinical Decision Tool, a device for reducing the clinical impact of placental dysfunction and preterm birth: protocol for a mixed-methods early implementation evaluation study

BackgroundDisparities in stillbirth and preterm birth persist even after correction for ethnicity and social deprivation, demonstrating that there is wide geographical variation in the quality of care. To address this inequity, Tommy’s National Centre for Maternity Improvement developed the Tommy’s Clinical Decision Tool, which aims to support the provision of “the right care at the right time”, personalising risk assessment and care according to best evidence. This web-based clinical decision tool assesses the risk of preterm birth and placental dysfunction more accurately than current methods, and recommends best evidenced-based care pathways in a format accessible to both women and healthcare professionals. It also provides links to reliable sources of pregnancy information for women. The aim of this study is to evaluate implementation of Tommy’s Clinical Decision Tool in four early-adopter UK maternity services, to inform wider scale-up.MethodsThe Tommy’s Clinical Decision Tool has been developed involving maternity service users and healthcare professionals in partnership. This mixed-methods study will evaluate: maternity service user and provider acceptability and experience; barriers and facilitators to implementation; reach (whether particular groups are excluded and why), fidelity (degree to which the intervention is delivered as intended), and unintended consequences. Data will be gathered over 25 months through interviews, focus groups, questionnaires and through the Tommy’s Clinical Decision Tool itself. The NASSS framework (Non-adoption or Abandonment of technology by individuals and difficulties achieving Scale-up, Spread and Sustainability) will inform data analysis.DiscussionThis paper describes the intervention, Tommy’s Clinical Decision Tool, according to TiDIER guidelines, and the protocol for the early adopter implementation evaluation study. Findings will inform future scale up.Trial registrationThis study was prospectively registered on the ISRCTN registry no. 13498237, on 31st January 2022.

Removal at birth and its challenges for midwifery care

In England, care proceedings refer to the process whereby the family court decides to remove a child from its parents against their wish, due to a heightened risk of significant harm. There has been a worrying increase of the number of babies that are removed shortly after birth due to care proceedings in England. The removal of a newborn baby from its parents often occurs while the mother is still recovering in hospital and is a deeply distressing, intrusive and emotionally impactful event, both for parents as well as for midwives involved in their care.Although the number of removals of newborn has risen, increasing support for those involved has not followed the same pace. These women are particularly vulnerable after the removal of a child but there is a lack of evidence and guidance to improve the experiences and the perinatal outcomes of these mothers and their infants. At a healthcare professional level, the impact of care proceedings and removals at birth on the midwifery workforce cannot be underestimated and has been described as one of the most challenging aspects of contemporary midwifery practice. In order to improve the care and outcomes of this under-researched and often stigmatized group of mothers, midwives need to have access to adequate training and supervision. Against the current challenges within UK maternity services, this is of the utmost importance to prevent further burnout among midwives.

Preparedness for maternal and neonatal emergencies in UK midwifery units: A national survey using the UK Midwifery Study System (UKMidSS)

ObjectiveWe aimed to document and describe variation in a range of factors impacting on preparedness for and the management of emergencies in midwifery units in the UK. Design, setting and participantsNational cross-sectional survey administered online through the UK Midwifery Study System (UKMidSS) to midwife ‘reporters’ in all 206 alongside and freestanding midwifery units in the UK, January-April 2020. Topics investigated included communication with the ambulance service in freestanding units, staff support for emergencies, training and equipment held. FindingsIn total, 137 (67%) midwifery units responded, representing 75% of eligible UK maternity services. There was no evidence of differences between responding and non-responding units in terms of type of unit, annual number of births, or country/region of the UK. Overall, 10 freestanding units (20%) reported using an ordered categorical system (e.g. ‘category 1’ or ‘code red’) to communicate an emergency to the ambulance service, 17 (35%) reported using other words describing urgency (e.g. ‘obstetric emergency’), and 15 (31%) reported having no agreed word or phrase. Almost all alongside units reported that a senior midwife, paediatrician/neonatologist and obstetrician might attend in an emergency, whereas most freestanding units reported the attendance of paramedics and/or a senior midwife. The type and frequency of staff training varied, with 77% of units reporting annual skills and drills training, and lower proportions reporting annual multi-disciplinary simulation (55%), in-situ simulation (50%) and neonatal life support training (59%). The equipment kept in midwifery units varied between different types of unit. For example, 28 alongside units (32%) reported keeping ventouse in the unit and 21 (24%) kept forceps, compared with 4 (8%) and 2 (4%) freestanding units respectively. Almost half of freestanding units (47%) and around a quarter of alongside units (24%) reported having a cardiotocograph (CTG) in the unit. ConclusionsThe study found wide variation in factors that impact on preparedness for and management of emergencies in UK midwifery units. Although some variation is inevitable given the varying size and location of units, this study has identified some areas where greater consistency might improve outcomes.

Black, Asian and minority ethnic women's experiences of maternity services in the UK: A qualitative evidence synthesis.

AimsBlack, Asian and minority ethnic women are at higher risk of dying during pregnancy, childbirth and postnatally and of experiencing premature birth, stillbirth or neonatal death compared with their White counterparts. Discrimination against women from ethnic minorities is known to negatively impact women's ability to speak up, be heard and their experiences of care. This evidence synthesis analysed Black, Asian and minority ethnic women's experiences of UK maternity services in light of these outcomes.DesignWe conducted a systematic review and qualitative evidence synthesis using the method of Thomas and Harden.Data SourcesA comprehensive search in AMED, Cinahl, Embase, Medline, PubMed and PsycINFO, alongside research reports from UK maternity charities, was undertaken from 2000 until May 2021. Eligible studies included qualitative research about antenatal, intrapartum and postnatal care, with ethnic minority women in maternity settings of the UK NHS.Review MethodsStudy quality was graded using the Critical Appraisal Skills Programme tool.ResultsTwenty‐four studies met the inclusion criteria. Our synthesis highlights how discriminatory practices and communication failures in UK NHS maternity services are failing ethnic minority women.ConclusionThis synthesis finds evidence of mistreatment and poor care for ethnic minority women in the UK maternity system that may contribute to the poor outcomes reported by MBRRACE. Woman‐centred midwifery care is reported as positive for all women but is often experienced as an exception by ethnic minority women in the technocratic birthing system.ImpactEthnic minority women report positive experiences when in receipt of woman‐centred midwifery care. Woman‐centred midwifery care is often the exception in the overstretched technocratic UK birthing system. Mistreatment and poor care reported by many ethnic minority women in the UK could inform the inequalities of outcomes identified in the MBRRACE report.

Factors contributing to maternal health inequalities for women who are not white British in the UK

Background Women of non-white British ethnicity have a higher maternal mortality risk for reasons not yet fully understood, and report significant concerns about stereotypes, racism and overall dissatisfaction in care. This study aimed to examine what midwives perceive to be contributing factors to ethnic disparity in maternity care. Methods A systematic search of the literature was conducted to find contemporaneous, relevant studies which were appraised for inclusion and quality. Four qualitative studies were included. Results Midwives spoke about practical, cultural and logistical concerns that contribute to health inequalities; none mentioned racism. Three themes emerged: relationship barriers, logistical barriers and a sense of us vs them. Three areas of us vs them were explored: ‘incongruent expectations’, ‘structural racism, stereotypes and implicit bias’ and ‘culture vs professional accountability’. Conclusions Further research into the impact of implicit bias is needed to adequately address health inequalities for non-white British women. A national strategy could be used to set expectations for women accessing UK maternity services early in pregnancy. Midwives need to be empowered and supported to thoroughly document women's choices so that their professional responsibilities are met.

Project20: interpreter services for pregnant women with social risk factors in England: what works, for whom, in what circumstances, and how?

BackgroundBlack and minority ethnic women and those with social risk factors such as deprivation, refugee and asylum seeker status, homelessness, mental health issues and domestic violence are at a disproportionate risk of poor birth outcomes. Language barriers further exacerbate this risk, with women struggling to access, engage with maternity services and communicate concerns to healthcare professionals. To address the language barrier, many UK maternity services offer telephone interpreter services. This study explores whether or not women with social risk factors find these interpreter services acceptable, accessible and safe, and to suggest solutions to address challenges.MethodsRealist methodology was used to refine previously constructed programme theories about how women with language barriers access and experience interpreter services during their maternity care. Twenty-one longitudinal interviews were undertaken during pregnancy and the postnatal period with eight non-English speaking women and their family members. Interviews were analysed using thematic framework analysis to confirm, refute or refine the programme theories and identify specific contexts, mechanisms and outcomes relating to interpreter services.ResultsWomen with language barriers described difficulties accessing maternity services, a lack of choice of interpreter, suspicion around the level of confidentiality interpreter services provide, and questioned how well professional interpreters were able to interpret what they were trying to relay to the healthcare professional during appointments. This resulted in many women preferring to use a known and trusted family member or friend to interpret for them where possible. Their insights provide detailed insight into how poor-quality interpreter services impact on their ability to disclose risk factors and communicate concerns effectively with their healthcare providers. A refined programme theory puts forward mechanisms to improve their experiences and safety such as regulated, high-quality interpreter services throughout their maternity care, in which women have choice, trust and confidence.ConclusionsThe findings of this study contribute to concerns highlighted in previous literature around interpreter services in the wider healthcare arena, particularly around the lack of regulation and access to high-quality interpretation. This is thought to have a significant effect on pregnant women who are living socially complex lives as they are not able to communicate their concerns and access support. This not only impacts on their safety and pregnancy outcomes, but also their wider holistic needs. The refined program theory developed in this study offers insights into the mechanisms of equitable access to appropriate interpreter services for pregnant women with language barriers.

Experiences of maternity care during the COVID-19 pandemic in the North of England

Background During 2020, UK maternity services made changes to service delivery in response to the COVID-19 pandemic. Aims To explore service users' and their partners' experiences of maternity services in the North of England during the COVID-19 pandemic. Methods Respondents (n=606) completed a co-produced survey during August 2020. Data were analysed using descriptive statistics and content analysis. Findings Five major categories were identified: valuing support from health professionals, feeling lost in and let down by the system, the impact of restrictions to partners and others, virtual contact is not the same as in-person contact, and the need for emotional and psychological wellbeing support. Conclusion The changes implemented may have compromised mental health and wellbeing in a critical period of vulnerability. Bringing stakeholders together can maximise learning from the emergency measures, to better inform future service provision. Work is needed to better hear from minoritised groups and ensure they are not further marginalised by changes.

2. Labour and birth.

This chapter describes the national guidance for care during labour and childbirth in the United Kingdom during the COVID-19 pandemic. The content largely draws attention on the guidance developed by the Royal College of Obstetricians (RCOG) and the Royal College of Midwives (RCM), and specific guidance on infection prevention and control measures from Public Health England.The key areas addressed are as follows:•Testing of pregnant women before and on admission for labour and birth•Overall approach to intrapartum care for women with and without symptoms of COVID-19•Timing, place, and type of birth considerations•Personal Protective Equipment (PPE) during labour and birth – for staff, women, and birth supporters•Use of birthing pools and waterbirth•Foetal monitoring•Immediate care of the newborn and support for breastfeeding.The chapter refers to some of the ways in which the guidance was translated in practice.The guidance was developed using a rapid analysis approach to emerging research and evidence, along with evidence from previous experiences of coronavirus combined with consensus expert opinion from all key professionals providing maternity care in the UK.What is knownThe UK RCOG/RCM COVID-19 guidance was widely accepted across the UK maternity services and also worldwide as a reliable and credible source of information to shape care during the pandemic.What is not knownThe full impact of the pandemic on the experiences and outcomes for babies and women of pregnancy, childbirth, and early parenting in the UK.The impact of the new approaches to intrapartum care on experiences and outcomes for women, babies, and families.The impact of the changes required to intrapartum care as a result of the pandemic on the professional care provided; in terms of pressure created by rapidly changing approaches to care and restrictions on the ability to provide normal levels of care.

Ethnic health inequalities in the UK's maternity services: a systematic literature review

BackgroundBlack, Asian, and minority ethnic (BAME) women have significantly higher morbidity and mortality rates in the UK as well as poorer experiences of care. To date, a systematic literature review has not been undertaken in the UK to explore ethnicity based health inequalities.AimTo explore the maternal health inequalities encountered by BAME women in the UK in relation to their experiences and use of services.MethodA systematic literature search was conducted via five databases (PubMed, MEDLINE, CINAHL, MIDIRS and BNI). Inclusion-exclusion criterion and a keyword strategy were implemented to screen for literature published between 2013–2018.FindingsA total of eight studies with various ethnicities and geographical locations were included. Five themes emerged following thematic analysis: communication, midwife-woman relationship, healthcare services and systems, culture and social needs.ConclusionThe review identified consistency within and across the five themes. Maternity services and systems is a predominant theme that has a residual effect on the remaining four themes.

Maternity services in the UK during the coronavirus disease 2019 pandemic: a national survey of modifications to standard care.

To explore the modifications to maternity services across the UK, in response to the coronavirus disease 2019 (COVID-19) pandemic, in the context of the pandemic guidance issued by the Royal College of Obstetricians and Gynaecologists (RCOG), Royal College of Midwives (RCM) and NHS England. National survey. UK maternity services during the COVID-19 pandemic. Healthcare professionals working within maternity services. A national electronic survey was developed to investigate local modifications to general and specialist maternity care during the COVID-19 pandemic, in the context of the contemporaneous national pandemic guidance. After a pilot phase, the survey was distributed through professional networks by the RCOG and co-authors. The survey results were presented descriptively in tabular and graphic formats, with proportions compared using chi-square tests. Service modifications made during the pandemic. A total of 81 respondent sites, 42% of the 194 obstetric units in the UK, were included. They reported substantial and heterogeneous maternity service modifications. Seventy percent of units reported a reduction in antenatal appointments and 56% reported a reduction in postnatal appointments; 89% reported using remote consultation methods. A change to screening pathways for gestational diabetes mellitus was reported by 70%, and 59% had temporarily removed the offer of births at home or in a midwife-led unit. A reduction in emergency antenatal presentations was experienced by 86% of units. This national survey documents the extensive impact of the COVID-19 pandemic on maternity services in the UK. More research is needed to understand the impact on maternity outcomes and experience. A national survey showed that UK maternity services were modified extensively and heterogeneously in response to COVID-19.

Local guidelines for admission to UK midwifery units compared with national guidance: A national survey using the UK Midwifery Study System (UKMidSS).

To describe the extent to which local guidelines for admission to UK midwifery units align with national guidance; to describe variation in individual admission criteria; and to describe the extent to which alongside midwifery units (AMUs) are the default option for eligible women. National cross-sectional survey. All 122 UK maternity services with midwifery units, between October 2018 and February 2019. Alignment of local admission guidelines with national guidance (NICE CG190); frequency and nature of variation in individual admission criteria; percentage of services with AMU as default birth setting for eligible women. Admission guidelines were received from 87 maternity services (71%), representing 153 units, and we analysed 85 individual guideline documents. Overall, 92% of local admission guidelines varied from national guidance; 76% contained both some admission criteria that were 'more inclusive' and some that were 'more restrictive' than national guidance. The most common 'more inclusive' admission criteria, occurring in 40-80% of guidelines, were: explicit admission of women with parity ≥4; aged 35-40yrs; with a BMI 30-35kg/m2; selective admission of women with a BMI 35-40kg/m2; Group B Streptococcus carriers; and those undergoing induction of labour. The most common 'more restrictive' admission criteria, occurring in around 30% of guidelines, excluded women who: declined blood products; had experienced female genital cutting; were aged <16yrs; or had not attended for regular antenatal care. Over half of services (59%) reported the AMU as the default option for healthy women with straightforward pregnancies. The variation in local midwifery unit admission criteria found in this study represents a potentially confusing and inequitable basis for women making choices about planned place of birth. A review of national guidance may be indicated and where a lack of relevant evidence underlies variation in admission criteria, further research by planned place of birth is required.

Planning, implementation and evaluation of antenatal weight management programmes: What are the key components? A mixed methods study

ObjectiveTo provide an understanding of the influential components required for the planning, delivery and evaluation of antenatal weight management programmes for women who are overweight or obese. DesignTwo phase sequential explanatory mixed methods design comprising of an online survey and one-to-one telephone interviews. Setting and participantsAll UK maternity services (n = 168) and local government councils (n = 417). FindingsFrom the 378 responses, 49 maternity services and 28 local government councils reported having an antenatal weight management programme. Of the 62 responses that specified BMI as an inclusion criterion only two-fifths (40.3% n = 25) adhered to the recommended threshold to include women with a BMI ≥30 kg/m2. Although having a multi-disciplinary team was identified as fundamental when planning a programme, only 20.6% (n = 14/68) of the programmes involved service users during the planning phase. How the programme was communicated to a woman was a key factor which determined whether she partook in the programme or not. Having administrative support and staff with expertise in data collection were essential when evaluating a programme. Staff having protected time was identified as important when planning, delivering and evaluating a programme. Three overarching themes were identified from the individual interviews (n = 14) ‘choices and decisions’, ‘demands and resources’ and ‘engagement and disengagement’. Key conclusionsNational guidelines recommendations regarding service user involvement when planning programmes and the BMI threshold used for inclusion are not being met. In addition to having adequate time, personnel and finances, successful programmes are dependent on the confidence and communication skills of midwives to raise the issue of obesity with these women at the booking appointment. Without staff having the time and necessary knowledge and skills, evaluation, and hence demonstrating programme impact, will likely remain difficult. Organisational support is needed to release resources to plan, deliver and evaluate these programmes. Strategic communication strategies are needed to promote the programme to both women and staff within organisations. Future programmes need to ensure there is engagement with service users from the planning of the programme through to evaluation.

Pregnancy related risk perception in pregnant women, midwives & doctors: a cross-sectional survey

BackgroundRisk perception in relation to pregnancy and birth is a complex process influenced by multiple personal, psychological and societal factors. Traditionally, the risk perception of healthcare professionals has been presented as more objective and authoritative than that of pregnant women. Doctors have been presented as more concerned with biomedical risk than midwives. Such dichotomies oversimplify and obscure the complexity of the process. This study examines pregnancy-related risk perception in women and healthcare professionals, and what women and professionals believe about each other’s risk perception.MethodsA cross sectional survey of set in UK maternity services. Participants were doctors working in obstetrics (N = 53), midwives (N = 59), pregnant women (N = 68). Participants were recruited in person from two hospitals. Doctors were also recruited online. Participants completed a questionnaire measuring the degree of perceived risk in various childbirth-related scenarios; and the extent to which they believed others agreed with them about the degree of risk generally involved in childbirth. Main outcome measures were the degree of risk perceived to the mother in baby in pregnancy scenarios, and beliefs about own perception of risk in comparison to their own group and other groups.ResultsThere were significant differences in total risk scores between pregnant women, doctors and midwives in perception of risk to the mother in 68/80 scenarios. Doctors most frequently rated risks lowest. Total scores for perceived risk to the baby were not significantly different. There was substantial variation within each group. There was more agreement on the ranking of scenarios according to risk. Each group believed doctors perceived most risk whereas actually doctors most frequently rated risks lowest. Each group incorrectly believed their peers rated risk similarly to themselves.ConclusionsIndividuals cannot assume others share their perception of risk or that they make correct assessments regarding others’ risk perception. Further research should consider what factors are taken into account when making risk assessments,

Sign in, time out, sign out checklist-changing practice through interdepartmental teamwork to improve safety at caesarean section.

Three similar clinical incidences over a three-month period highlighted an issue with the readiness and availability of neonatal resuscitation personnel and equipment at the time of caesarean section (CS). This identified a potential risk to the wellbeing of the mother and baby that had to be addressed. A joint venture was undertaken with the maternity and theatre directorates. A maternity-specific checklist in use in the UK maternity services was sourced, adapted and implemented. No further incidents have been reported since with resulting overall enhanced safety of pregnant women and newborn babies in the unit.

Saving babies\u2019 lives project impact and results evaluation (SPiRE): a mixed methodology study

BackgroundReducing stillbirth and early neonatal death is a national priority in the UK. Current evidence indicates this is potentially achievable through application of four key interventions within routine maternity care delivered as the National Health Service (NHS) England’s Saving Babies’ Lives care bundle. However, there is significant variation in the degree of implementation of the care bundle between and within maternity units and the effectiveness in reducing stillbirth and improving service delivery has not yet been evaluated. This study aims to evaluate the impact of implementing the care bundle on UK maternity services and perinatal outcomes.MethodsThe Saving Babies’ Lives Project Impact and Results Evaluation (SPiRE) study is a multicentre evaluation of maternity care delivered through the Saving Babies’ Lives care bundle using both quantitative and qualitative methodologies. The study will be conducted in twenty NHS Hospital Trusts and will include approximately 100,000 births. It involves participation by both service users and care providers. To determine the impact of the care bundle on pregnancy outcomes, birth data and other clinical measures will be extracted from maternity databases and case-note audit from before and after implementation. Additionally, this study will employ questionnaires with organisational leads and review clinical guidelines to assess how resources, leadership and governance may affect implementation in diverse hospital settings. The cost of implementing the care bundle, and the cost per stillbirth avoided, will also be estimated as part of a health economic analysis. The views and experiences of service users and service providers towards maternity care in relation to the care bundle will be also be sought using questionnaires.DiscussionThis protocol describes a pragmatic study design which is necessarily limited by the availability of data and limitations of timescales and funding. In particular there was no opportunity to prospectively gather pre-intervention data or design a phased implementation such as a stepped-wedge study. Nevertheless this study will provide useful practice-based evidence which will advance knowledge about the processes that underpin successful implementation of the care bundle so that it can be further developed and refined.Trial registrationwww.clinicaltrials.gov NCT03231007 (26th July 2017)