Transforming maternity services
The report of a national review of maternity services in 2016 – Better Births – set out a clear vision: for maternity services across England to become safer, more personalised, kinder, professional and more family friendly. It also called for staff to be supported to deliver women-centred care.
The Five Year Forward View committed to making services develop in a safe, responsive and efficient manner that supports women’s choices and makes it easier for groups of midwives to set up their own NHS-funded midwifery services.
Next Steps on the NHS Five Year Forward View expands on the plans. These include setting up 44 local maternity systems to provide more personalised, safer care. They’d also give women unbiased evidence-based information to make choices about their care and improve continuity of care.
Through the Long Term Plan, the NHS will accelerate action to achieve a 50% reduction in stillbirth, maternal mortality, neonatal mortality and serious brain injury by 2025.
Local maternity systems should set out how they’ll make sure that babies born anywhere in England have the best possible start in life. This is consistent with the Long Term Plan and Better Births. The Maternity Transformation Programme is supporting this work.
Finding the right information
Our guidance and quality standards can help local maternity systems with their priorities to improve services for mothers and babies, as outlined in the Implementing Better Births resource pack. They can also help with making best use of resources by showing what's worth investing in and what isn't. You can find everything we’ve produced on maternity topics by browsing to the fertility, pregnancy and childbirth pages on our website.
We publish tools to help you use our guidance and quality standards on the tools and resources tabs of all our guidance and quality standards. For example, the guideline on antenatal care.
You can also browse lists of all endorsed resources and shared learning case studies.
Our into practice page will help you plan ahead, explore opportunities for saving money and make decisions on the most effective way to use your resources.
Promoting safe and effective maternity care
Guidance particularly relevant to safe and effective care includes guidelines and quality standards on:
- antenatal care
- intrapartum care for healthy women and babies
- diabetes in pregnancy
- hypertension in pregnancy
- preterm labour and birth
- developmental follow-up of children born preterm (which includes recommendations on pre-discharge support and the national neonatal audit)
- intrapartum care for women with medical conditions or obstetric complications
- donor milk banks
- twin and triplet pregnancy.
Shared learning case studies on providing safe and effective care include:
- How the JDRF (Juvenile Diabetes Research Foundation) developed an easy-to-read resource for women with type 1 diabetes planning a pregnancy.
- How Guy's and St Thomas's set up a specialist multidisciplinary antenatal clinic for hypertension in pregnancy.
- How East and North Hertfordshire NHS Trust significantly improved outcomes for multiple pregnancy by following our guideline. This was one of 30 trusts that took part in an audit by TAMBA that found following our guidance could save more than 50 babies a year.
- How Lime Square Medical Centre, through the development of templates, supported the safe prescribing (initial and repeat) of high-risk drugs.
Co-production, choice and personalisation
Co-production is a theme of the Long Term Plan. It involves engaging and communicating with people and their families to ensure that support is person-centred.
NHS England recommends that independent formal multidisciplinary committees are set up. These maternity voices partnerships (formerly maternity services liaison committees) influence and share in local decision making.
We support shared decision making through our guidance and tools. Our guideline and quality standard on patient experience in adult NHS services will help you develop women-centred services in which women actively participate in their care.
Shared learning case studies relevant to this area include:
- Gathering and using feedback from complaints, social media and other sources helped Northumbria Healthcare NHS Foundation Trust improve patients’ experience of care.
- The Birth Choice tool from Which? helps women and their partners make confident and informed decisions when planning where to give birth.
- Providing a choice of a midwifery led unit (birth centre) for women with low risk pregnancies at services runs by the South Norfolk Healthcare Community Interest Company.
Measuring, reviewing and improving service quality
NICE indicators measure outcomes that reflect the quality of care, or processes linked to better outcomes. We have a set of indicators on care for pregnancy and neonates.
The Sharing Data and Information work stream of the Maternity Transformation Programme has an agreed set of national maternity indicators and clinical quality improvement metrics. A maternity services dashboard helps organisations compare data.
Our impact report on maternity and neonatal care highlights progress made by the health and care system in implementing our guidance. The report highlights some areas for improvement to use in local discussions.
Commissioning for outcomes, and continuity of carer
We have recommendations to support commissioning maternity services. For example, in our guidelines and quality standards on:
- caesarean birth
- twin and triplet pregnancy
- inducing labour
- intrapartum care
- ectopic pregnancy and miscarriage.
Our guideline on services for women with complex social factors recommends considering setting up a specialist antenatal service for young women aged under 20, using a flexible model of care tailored to the needs of the local population. These could include a 'one stop shop', where a range of services can be accessed at the same time.
Our guideline and quality standard on antenatal care recommend that antenatal care throughout pregnancy should be provided by a small group of healthcare professionals who the woman feels comfortable with. They also recommend that women have a named midwife throughout their pregnancy.
Our impact report on maternity highlights how maternity services are being transformed in Cheshire and Merseyside. A midwife-led birthing unit in the community offers a continuity of carer approach in line with our guidance. This means that women are more likely to be looked after by a midwife who has helped them throughout their pregnancy.
A shared learning case study shows how Birmingham Women's Hospital NHS Foundation Trust developed a dedicated home birth team.
Prevention
Several of our guidelines contain recommendations on keeping mothers and babies physically healthy:
- smoking: stopping in pregnancy and after childbirth
- smoking: acute, maternity and mental health services
- maternal and child nutrition
- weight management before, during and after pregnancy.
Shared learning examples show how organisations have put our guidelines into practice:
- How University College Hospital, London, NHS Foundation Trust brought about change in current practice for smoking cessation to improve patient care and experience impact of multi-disciplinary involvement to improve smoking cessation in the acute admissions unit (AMU).
- MoreLife MUMS2B (expecting parents) and 4MUMS (new parents) launch of a weight management service for expecting and new parents.
- How Rotherham Metropolitan Borough Council improved smoking cessation in routine antenatal care.
- The Happy Mum, Healthy Bump weight management service in Aintree University Hospital NHS Foundation Trust, which helps obese women make healthy lifestyle changes during and after pregnancy.
- A community initiative for women who are overweight or obese, or not very active in Bexley.
Public Health England has produced resources that support work on prevention:
- Making the case for preconception care: planning and preparation for pregnancy to improve maternal and child health outcomes.
- Still birth and infant mortality tool helps you understand local population factors in pregnancy and early life, and exploring inequalities.
Mental health in the perinatal period
We have a guideline and quality standard on antenatal and postnatal mental health, and case studies showing how organisations have put these into practice:
Improving perinatal mental health practice across services in Bradford.
Using the NICE quality standard on antenatal and postnatal mental health to improve the quality of services for women during the perinatal period in the Thames Valley.
NHS England’s perinatal mental health care pathways support work in this area and include evidence on what works.
Neonatal and postnatal care
We’ve published guidelines on specialist neonatal respiratory care for babies born preterm and jaundice in newborn babies, and a quality standard on specialist neonatal respiratory care for babies born preterm.
The Taunton and Somerset NHS Foundation Trust used the quality standard on specialist neonatal care to promote an ethos of continuing improvement in their service.
We also have a guideline and quality standard on postnatal care.
Resources to support this work include:
- Neonatal transitional care from the British Association of Perinatal Medicine (BAPM), which emphasises the importance of keeping mothers and babies together.
- Reducing harm leading to avoidable admission of full-term babies into neonatal units. A resource pack from NHS Improvement, which includes the NICE quality standard on postnatal care.
System enablers
Workforce transformation
We can help you make sure you have the right workforce with the skills to implement the vision set out in Better Births, and adopt new ways of working, including continuity of carer.
Our resource on how we can help explains our guidance, advice and other products to help change and improve services.
Our guideline on safe midwifery staffing has recommendations on monitoring staffing levels and actions to take if there aren’y enough midwives to meet the needs of women and babies. The guideline on postnatal care lists skills that healthcare professionals need to care for women and babies up to 8 weeks after birth.
As well as guidelines and quality standards on maternity topics, we also have guidance to support employees’ health and mental wellbeing, and our guidance often includes recommendations about staff training and skills.
Digitally enabled transformation
Making use of digital technology is a big part of transforming services. We’ve worked with NHS England on an evidence standards framework for digital health technologies. The aim is to strike the right balance between supporting innovation and ensuring rigour and assurance.
Our guideline on antenatal care recommends that maternity services have a system in place for women to carry their own case notes. It also recommends that a standardised, national maternity record should be developed.
The Harnessing Digital Technology workstream of the Maternity Transformation Programme has agreed a national Maternity Record Standard which will enable seamless exchange of information between local maternity systems. Women's digital care records are being piloted across England. These give women access to their electronic maternity record and sources of comprehensive digital information.
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