04 Mar Enhanced Maternal Care
Care of the Acutely Ill Woman
on the Maternity Unit
“Several previous reports have highlighted that critical care is a management modality not a place and should be provided wherever the woman is located and should not be delayed by bed availability on the critical care unit.”
Women accessing maternity services in the UK have more complex health needs than ever before; the majority of women who die during or soon after pregnancy have existing co-morbidities, such as cardiac disease, or other identified vulnerabilities [1,2]. The latest MBRRACE-UK confidential enquiry into maternal mortality and morbidity (2018) showed a slight increase in the rate of maternal deaths in the UK, with overall rates now at a similar level as those seen in 2010-12. Where the care of these women could be fully investigated, assessors agreed that 38% of women who died may have had a different outcome with improvements to their care .
It is clear that action must be taken if we are to achieve the National Maternity Ambition to halve the rates of maternal deaths by 2025. Most importantly, we must take action to save women’s lives, and reduce the number of women dying in preventable circumstances, of families losing a loved-one, and of children losing a mother.
To achieve this, healthcare professionals must be equipped to identify and care for the increasingly complex needs of pregnant and recently pregnant women; when these women do become acutely unwell, they should have immediate access to enhanced or critical care which is dictated by clinical need, rather than location [1,4]. In August 2018, the Royal College of Anaesthetists, together with the Royal College of Obstetricians and Gynaecologists, Royal College of Midwives, Intensive Care Society, Faculty of Intensive Care Medicine and Obstetric Anaesthetists’ Association, published new national standards: Care of the critically ill woman in childbirth; enhanced maternal care 2018.
These updated standards now set out competencies for maternity teams to provide enhanced maternal care, in order to ensure that women who become acutely unwell before, during, or after birth receive the same level of critical care expected for any other patient. These guidelines stress that training in caring for women whose condition is deteriorating or who are critically ill is necessary for “all teams involved in maternity care” .
The Need for Training
Baby Lifeline’s report: Mind the Gap, An Investigation into Maternity Training for Frontline Professionals Across the UK (2017/18) showed that improvements have been made in training provision in this area . The percentage of trusts who report that they now provide training in early recognition and management of the severely/critically ill woman and trusts reporting that they provide training in co-morbidities in pregnancy and management of high-risk pregnancies has almost doubled since a similar investigation in 2015. However, this training still varies nationally in duration, content and attendance. For example, Mind the Gap 2018 identified national variation in the content of training on co-morbidities in pregnancy and management of high-risk pregnancies. This variation may be due to identified local needs, but guidance on nationally identified priorities is needed; cardiac disease and venous thromboembolism are leading causes of death during and shortly after pregnancy [1,2] yet training on these subjects was provided to maternity staff in fewer than half of trusts. Training in Early Recognition and Management of the Severely/Critically Ill Woman more often focused on early recognition than initial management and HDU care and was mandatory for the whole maternity team in just one-fifth of trusts .
Baby Lifeline’s Response
Baby Lifeline’s newly rebranded and refreshed course Enhanced Maternal Care: Care of the Acutely Ill Woman on the Maternity Unit (previously named Developing Skills in Maternal Critical Care), aims to enhance knowledge and confidence in the physiology, early recognition and management of the acutely unwell mother on the maternity unit.
We are also delighted to welcome Dr Paarul Prinja, Consultant Acute and Obstetric Physician at Royal Wolverhampton NHS Trust, as our new course director for Enhanced Maternal Care.
This course is taught in a multi-professional, and multi-organisational environment with the aim of promoting discussion and shared learning. It is developed and delivered by frontline obstetricians, obstetric physicians, midwives, and obstetric anaesthetists. The training is continually updated in response to feedback and in line with relevant reports, recommendations, and enquiries, such as those discussed above. We will be delivering the updated course throughout 2019, it is also available to commission.
 Knight, M., Nair, M., Tuffnell, D., Shakespeare, J., Kenyon, S., and Kurinczuk, J. (Eds.) on behalf of MBRRACE-UK. (2017). Saving Lives, Improving Mothers’ Care – Lessons learned to inform maternity care from the UK and Ireland Confidential Enquiries into Maternal Deaths and Morbidity 2013–15. Oxford: National Perinatal Epidemiology Unit, University of Oxford.
 Knight, M., Bunch, K., Tuffnell, D., Jayakody, H., Shakespeare, J., Kotnis, R., Kenyon, S. and Kurinczuk, J. (Eds.) on behalf of MBRRACE-UK. (2018). Saving Lives, Improving Mothers’ Care – Lessons learned to inform maternity care from the UK and Ireland Confidential Enquiries into Maternal Deaths and Morbidity 2014-16. Oxford: National Perinatal Epidemiology Unit, University of Oxford.
 Maternity Safety Programme Team, Department of Health. (2017). Safer Maternity Care. Retrieved 4th March, 2018.
 The Royal College of Anaesthetists. (2018). Care of the critically ill woman in childbirth; enhanced maternal care. London: The Royal College of Anaesthetists.
 Ledger, S., Hindle, G. and Smith, T. (2018). Mind the Gap, An Investigation into Maternity Training for Frontline Professionals Across the UK (2017/18). Retrieved 4th March, 2018.