Accelerating delivery: Health Foundation learning to inform next generation maternity services
16 July 2015
"You need to stop the car. The baby is coming."
Those remain the ten most heart-stopping words I‘ve ever heard in my life. Fortunately for our family, with the help of a hands-free iPhone on speaker, a calm and kind London ambulance operative (thank you whoever and wherever you are), and my amazing wife, my second daughter Kitty was safely delivered in the front seat of our car; with the only damage being to our nerves and our upholstery.
As Sarah Barton, a mum who has been instrumental in the development of the myBirthplace app, reminded us at the opening of our Health Foundation Maternity Learning Event, birth is a truly life-changing event. Yet while having a baby is a normal, safe, and happy experience for the vast majority of women and families, stories of avoidable suffering, distress and harm remain too common.
Our learning event brought together 100 people from across the realms of health care delivery and policy in the UK - service users, advocates, researchers, practitioners, policymakers – all with a common commitment to improving maternity care.
We heard from Baroness Julia Cumberlege, Chair of the National Maternity Review, on the progress made in terms of improving choice, continuity and control for women over the past twenty years, and some of the challenges that her current review will seek to address.
Those challenges are significant: an increased number of births, up by nearly a quarter in the last decade; greater complexity in terms of multiple births, older mothers and expectant women with pre-existing medical conditions; persistently high still birth rates; the need to support perinatal mental health; and addressing cultural challenges in developing truly collaborative multidisciplinary team working, with services centred on women’s choices and needs.
With the array of challenges well-articulated, we heard from five teams who are already delivering approaches that are making a real difference to quality:
- Emily Gaskell and Gill Walton described the development of the myBirthplace app, a decision support tool to help women and their partners make decisions about place of birth.
- Paru King described the PROCEED model of preconception care for women with diabetes, and the sustained impact the work has had on improving access to appropriate preconception care, and reducing rates of abnormalities and still birth.
- Harriet Nicholls described the incorporation of Human Factors approaches to improve teamworking, safety climate, morale and job satisfaction in Luton and Dunstable; and Manjula Samyraju described how the same approach had been spread into Peterborough.
- Judith Hyde and Cathy Winter ran a workshop on PROMPT (Practical Obstetric Multi-Professional Training), an approach to team training which has helped Southmead hospital to reduce intrapartum preventable harm to some of the lowest reported rates in the world.
- Alison Lovatt and colleagues discussed their work on the introduction and spread of Safety Briefings in the Yorkshire and Humber Academic Health Science Network area.
We heard a powerful call from Cathy Warwick, Chief Executive of the Royal College of Midwives, to re-orientate maternity services away from the interest of institutions towards the interests of women and their families. Cathy called for common sense, can-do cultures with the flexibility to meet women’s individual needs, and described the courage, commitment and compassion that she sees in the best of midwifery practice around the country.
Our closing discussion explored the questions of how we close the gap between evidence, reports and action. Donald Peebles described the role of the Strategic Clinical Network in spreading improvement in London, and Corinne Love provided an overview of the centrally enabled, locally delivered improvement approaches to maternity care taking place in Scotland. James Titcombe eloquently reminded us of the need for openness and compassion when things do go wrong, the crucial importance of creating safe spaces to raise concerns, and the need to universalise the kind of genuine multidisciplinary team approaches to quality and safety that we had heard throughout the day.
Quoting the William Gibson aphorism that ‘the future is already here, it’s just not evenly distributed’, Health Foundation Chief Executive Jennifer Dixon urged delegates and the maternity review panel to think about what mechanisms might help accelerate the spread of the practice we had heard about throughout the day - so that pregnancy and birth will be a life-changing event for women and their families for all the best reasons.
Will Warburton is Director of Improvement at the Health Foundation, www.twitter.com/will_warburton2
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