Why is Multi-Professional Training Essential to Save Mothers’ Lives?

As part of our on-going work to improve maternity training levels in the UK, we are always looking at and responding to research. Research conducted by leading professional bodies and the NHS are used to develop Baby Lifeline Training courses. Our aim is to reduce the number of avoidable deaths and injuries through childbirth across the UK through the provision of high quality training developed by leading healthcare professionals from across the full spectrum of maternity related disciplines.

If you would like to speak to a member of our team about your training needs or to commission a course you can email us or call us on 01676 534671.

Avoidable Maternal Mortality

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 (MBRRACE 2018). This represents 225 women who died and 368 motherless children left behind in the UK during the three years covered by the report (2014-2016), 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 more needs to be done in order to achieve the National Maternity Safety Ambition to halve the 2010 rates of maternal death by 2025 (announced in 2015 – NHS England).

Most mothers who die during pregnancy or the postpartum period have identified co-morbidities or vulnerabilities, meaning that they will be cared for in many different settings, by many different professionals who are not necessarily specialists in caring for pregnant/recently pregnant women. (MBRRACE 2017 & 2018). Many professionals come into contact with seriously unwell women, meaning there are multiple opportunities to improve care, communication between teams, rapid recognition and referral of women who are unwell. For example – in the latest MBRRACE (2018) confidential enquiry into women who died – of those who gave birth, 16% did so in an emergency department or an ambulance.

Recommendations for Improvements

From the extensive research there have now been multiple reports which recommended training in caring for women, during pregnancy or postpartum, for non-specialists. Most recently, the Enhanced Maternal Care guidelines (RCoA, 2018) stated that education and training in the care of women who are acutely deteriorating/critically ill, is essential for all teams involved in maternity care. In this report (and others), there is also an emphasis on care at the ‘right place at the right time’ and equal access to care for maternity patients (RcoA, 2018; MBRRACE 2017; Better Births 2016).

“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.” – MBRRACE 2017

Despite this, there is still a lack of standardisation in how enhanced or critical care is delivered for women across the country. NHS organisations use different criteria for admission to intensive care, and (in England and Wales) there is no standardised recording of the number of women receiving HDU care in maternity settings. There is an incomplete picture of how often and by what means critical care is provided to unwell women, and the number of women becoming critically unwell in pregnancy is unclear (NMPA 2019).

Baby Lifeline’s reportMind the Gap, An Investigation into Maternity Training for Frontline Professionals Across the UK (2017/18) – reiterated and confirmed this lack of standardisation in implementation of best practice. One example showed that despite recommendations for whole team training, just one-fifth of trusts required that training on early recognition and management of the severely/critically ill woman be attended by the whole maternity team. This data does not include training requirements for acute care teams, which could mean that an even smaller number of trusts train entire multi-disciplinary teams involved in care.

Baby Lifeline’s Response

Feedback from Baby Lifeline’s Enhanced Maternal Care courses shows that delegates evaluate the courses more highly and find it more effective when the delegate audience is more multi-professional. Our unique, flexible structure enables us to be reactive to the feedback we receive from our training courses. We aim for our training to be as responsive as possible, to both delegate feedback and the evolving evidence base. If we receive suggestions for the course to be more ‘hands-on’ we can adapt it to make it more practical.

Shared Learning Across Professions

We have recently appointed our new Course Director, Dr Paarul Prinja. Paarul currently works at Royal Wolverhampton NHS Trust as both an Acute and Obstetric Physician. She is perfectly placed to facilitate learning that is relevant to the needs of both the maternity and the acute care teams.

Paarul is working with Baby Lifeline to upgrade and update our Enhanced Maternal Care course. So far we have been developing new practical sessions including neurological assessment and simple airway management in the maternity patient. We are also adding ‘Learning from Incidents and Implementing Change’ which will include group discussions based on real-life vignettes from confidential enquiries.

We are also expanding the audience for whom this course is relevant to include all members of the maternity and acute care teams who may be involved in the recognition and management of acutely unwell maternity patients, including: Midwives, Obstetricians, Nurses and Trainees in Intensive Care Medicine, Emergency Medicine, Acute Medicine and Anaesthesia.

This is in direct response to the Better Births (2016) report which recommended that ‘those who work together should train together’. We want to ensure multi-professional representation on this vital study day, to enhance the learning of all delegates, improve communication between teams, and share learning to standardise how care is delivered to women who become critically unwell.

Book your place now

If you are interested in attending or finding more about this course you can visit the Enhanced Maternal Care course page on our website. If you have any questions about maternity training or anything in this article make sure you get in touch with us. You can email or call us on 01676 534671 or you can follow us on Facebook, Twitter, LinkedIn and Instagram.

 

 

References

MBRRACE 2018: 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.

MBRRACE 2017: 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.

MTG 2018: Ledger, S., Hindle, G. and Smith, T. on behalf of Baby Lifeline (2018). Mind the Gap, An Investigation into Maternity Training for Frontline Professionals Across the UK (2017/18)Retrieved 4th March, 2018.

RCoA 2018: The Royal College of Anaesthetists. (2018). Care of the critically ill woman in childbirth; enhanced maternal care. London: The Royal College of Anaesthetists.

Better Births (2016): National Maternity Review. (2016). Better Births: Improving outcomes of maternity services in England – A Five Year Forward View for maternity care. London: NHS England.

NMPA 2019: Jardine J, NMPA Project Team. Maternity Admissions to Intensive Care in England, Wales and Scotland in 2015/16: A Report from the National Maternity and Perinatal Audit. London: RCOG; 2019.

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