The Maternity Care strand aims to support clinical teams in Scotland to improve the quality and safety of maternity healthcare. The overall aim is to reduce the incidence of avoidable harm and acute maternal morbidity in women and babies by 30% by March 2019.
Avoidable harm is defined by the further sub aims to:
- reduce stillbirths by 35%
- reduce neonatal mortality by 15% (shared aim with the neonatal care programme)
- reduce severe postpartum haemorrhage (PPH) by 30%
Core measures for maternity care
The core measures, for which MCQIC will support improvement activity across all boards, for maternity care are detailed below. All remaining measures will be supplementary.
Fetal monitoring (CTG)
Fetal growth – fundal height measurement
MEWS (prototyping activity)
Collaborative working for maternity and neonatal care
Neonatal mortality rate (to focus on reduction in preterm death rate which contributes to a large proportion of overall mortality rate)
Preterm perinatal wellbeing package to include:
- Delivery in appropriate centre
- Early breast milk administration
- Administration steroids
- Administration magnesium sulphate
- Delayed cord clamping
To achieve this, MCQIC uses the Breakthrough Series Collaborative Model. Networking events are held every six months to encourage sharing and learning. These are interspersed with action periods, when local teams undertake small tests of change to improve care.
The Model for Improvement is used to support testing and implementing changes. Frontline staff are also supported through monthly WebEx sessions.
A key element of monitoring and guiding improvements is the use of data. All units are collecting and using local data to drive improvements.
A range of tools and resources for frontline staff, including the measurement plan, can be found in the SPSP Members’ Area and Tools and Resources below.
A mum’s personal story that demonstrates how MCQIC is improving outcomes for mothers and babies.
The following are recordings and PDFs of the PowerPoint presentations from the MCQIC Maternity Care WebEx series.
27 June 2017 - Postpartum Haemorrhage (PPH) risk assessment tool – reducing harm by reducing PPH (PDF) by Dr Jenny Boyd, Consultant Obstetrician at NHS Fife. You can contact Dr Boyd by email on email@example.com
6 September 2017 - Normal Physiological Birth and Positive Childbirth Experience by Sheena Byrom, OBE and Karen King (PDF), Head of Midwifery at NHS Dumfries & Galloway.
2 October 2017 - Management of Second Stage of Labour and Trail of Instrumental Delivery by Dr Clare Willocks (PDF), Obstetric Clinical Lead at Healthcare Improvement Scotland and Dr Philip Dutton (PDF), Consultant Obstetrician and Gynaecologist at NHS Dumfries & Galloway.
7 November 2017 - Seasonal Flu and Progress with National MEWS (PDF) by Cheryl Clark, Associate Improvement Advisor at Healthcare Improvement Scotland.
6 December 2017 - CTG - NHS Forth Valley's progress with the package (PDF) by Debbie Forbes, Quality Improvement/Practice Development Midwife at NHS Forth Valley.
Why is there a need for improvement in maternity care?
Getting maternity care right for every woman and baby is the cornerstone of family health and an essential element of giving all Scotland’s children the best possible start in life. Although maternity care in Scotland is among the safest and of the highest quality in the world, inequalities remain in maternal and infant health outcomes.
A quality improvement programme designed specifically for maternity care is a key step towards reducing inequalities in outcomes. Helping to deliver the content of current policy recommendations and evidence-based care will ensure safe, high-quality maternity care is delivered with a more positive experience for women, babies and families.
How does this align to other national initiatives?
All activities take cognisance of existing national policies and approaches, including the Healthcare Quality Strategy for NHSScotland (2010), Refreshed Framework for Maternity Care in Scotland (2011), Keeping Childbirth Natural and Dynamic (KCND) and Getting it Right for Every Child (GIRFEC). In 2017, the Scottish Government launched The Best Start: A five year forward plan for maternity and neonatal care in Scotland. Key recommendations from this are central to the maternity care programme.
Other national initiatives are in progress to improve outcomes for women, babies and children. We work closely with the Children and Young People Improvement Collaborative (CYPIC) and leads of other national programmes such as Mothers and babies: reducing risk through confidential enquiries in the UK (MBRRACE-UK), the AFFIRM study, Growth Assessment Protocol and Each Baby Counts to ensure consistency across Scottish maternity units.
Who is involved?
Key partners involved in the maternity care programme include:
- NHS territorial boards, including front-line staff in all maternity units across Scotland
- Service user representatives
- Healthcare Improvement Scotland
- NHS Education for Scotland (NES)
- Health Protection Scotland
- NHS Health Scotland
- NHS National Services Scotland, Information Services Division
- Professional organisations and colleges
- Scottish Government
What resources are available?
The emphasis is not on putting extra staff in place to deliver improvements but on existing staff ensuring reliability of care processes, so that every person every time receives the care they need and want. Consequently, there is an emphasis on boards building capacity and capability in quality improvement science.
NHS board staff are supported to undertake further development through the Scottish Quality and Safety Fellowship Programme, Improvement Science In Action and Scottish Improvement Leader (ScIL) courses, as well as providing links to online modules via NES and Institute for Healthcare Improvement (IHI).
Postpartum Haemorrhage (PPH) 4-Stage Approach
PPH 4-Stage Approach tool facilitates a multidisciplinary team approach to recognising, responding to and managing postpartum haemorrhage.
The tool can be downloaded here.
View the Postpartum Haemorrhage 4-Stage Approach: Practical Guide (PDF)
View the Postpartum Haemorrhage 4-Stage Approach Handy Guide (PDF)
Reducing admissions due to hypothermia
Karen Creer at NHSLanarkshire worked in collaboration with maternity and neonatal colleagues to reduce term admissions to the neonatal unit from hypothermia. Here is one of the resources Karen and her team implemented using QI methodology.
The maternity care driver diagram (PDF) maps out the aims, outcomes and change packages for the programme.
More than Minutes
More Than Minutes documented our Maternity Networking event on 14th March 2017. Below are the images they captured on the day.
Further tools and resources related to the maternity care programme, including the measurement plan, can be found in the Member's Area.
The Safety Culture Handbook for Maternity Services (PDF) was designed to support NHS boards in improving and maintaining patient safety.
SPSP Maternity Networking Event, 10 October 2017
SPSP Maternity Care held a Maternity Networking Event on Tuesday 10 October 2017 in Dundee. The event focused on stillbirth, and gave delegates an opportunity to come together as a group to network, learn from each other and plan future improvements.
To view the presentations from the event please access the links below: