Suffolk & North East Essex Integrated Care System

Maternity and Neonatal Care

WHY this is important for people in Suffolk and North East Essex

Healthy pregnancies, health births, health parents and a health first two years of life are essential if everyone in Suffolk and North East Essex is to have a good start in life.

As an Integrated Care System we will ensure that:
  • Babies and their families receive the best quality of care throughout pregnancy and the first two years of life
  • Parents have choice and control throughout pregnancy and the first two years of life
  • Babies and their families receive safe care throughout pregnancy and the first two years of life
  • Babies and their families have better access to care and health outcomes through integrated services

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Maternity
What do we know about people’s local experiences?
  • The most important factors are patient safety, choice, support and experiences, e.g. Involvement in birth plans, and review of content of antenatal and breastfeeding classes.
  • People are worried whether there are enough midwives in mid wife-led units, particularly out of hours, and for home births.
  • People want more flexible visiting times and overnight stays for hospital births.
  • Birthing partners want more social networking opportunities.
  • People want better communication and use of appropriate language from professionals.
  • People want better awareness and recognition of perinatal mental health by professionals e.g. midwives, GPs etc.

For further information see www.healthwatchessex.org.uk and www.healthwatchsuffolk.org.uk

Two and a half years ago I had a traumatic assisted delivery at Colchester Hospital which left me witha beautiful healthy baby boy, but a grade 4 tear and significant post partum haemorrhage. It took me months to recover. We were told then that any future children would need to be delivered by caesarean section. I became pregnant again late last year. When I arrived in triage for my pre-op I was incredibly nervous to even be in the building again. I cannot convey to you enough how wonderful Denise (midwife) and the whole team were on that day, putting us at ease and explaining everything. On the day of our caesarean section Denise and the whole team were wonderful and made our section and daughters birth so special, we felt safe and cared for throughout. The continuity of having one main person care for us was the main factor in this, we completely trusted her and she was wonderful! I was home within 24hrs after the lovely Zelia and the obstetrician had checked us over. A few days later we had a follow up call from Denise to check I was fine and recovering well. Working for the NHS myself, I am fully aware of the constraints placed on services, and I would therefore like to congratulate you on achieving what felt like gold standard care within what I am sure are very limited resources. We will be forever grateful to Denise and the Venus team for giving us a wonderful birth experience.

The national plan for improving maternity and neonatal services ‘Better Births’ highlights that:
  • Healthy and supported parents, babies and children
  • Less emotional and physical stress on families due to positive pregnancies and birth outcomes
  • Improved communication between agencies about children’s development and safeguarding concerns and issues
  • Improved emotional wellbeing and support networks
  • Fewer children who require Special educational needs and disability (SEND) and continuing care input due to long term conditions/complex disabilities, as a result of birth complications
  • Improved educational attendance and attainment due to fewer children with long term conditions/complex disabilities, as a result of birth complications
    For further information on Better Births see www.england.nhs.uk/wp-content/uploads/2016/02/national-maternity-review-report-pdf
HOW we plan to make a difference 

    1.1 All babies and families will receive high quality care based on the best evidence available.

  • Our clinically led Local Maternity System will continue to shape and lead maternity transformation, reporting into the ICS Partnership Board.
  • The Saving Babies Lives Care Bundle (SBLCB) will be implemented in every maternity unit and a learning and continuous improvement cycle across the entire maternity system in place by March 2020, embedded and overseen by our clinically-led action group. Independent evaluation shows that the SBLCB supports a significant reduction in stillbirth rates.
  • Risk assessment during labour will be more holistic and consistent. Cardiotocography (CGT) monitoring will be improved by December 2020 by having standardised practice and care models; providers are already complaint with CGT training. This increased focus on pre- term births will minimise unnecessary intervention and define a more holistic approach to risk assessment during labour.
  • Extra neonatal nurses will be recruited and there will be expanded roles for some allied health professionals to support neonatal nurses by March 2024. Extending resources and expanding roles ensures the right skill mix to meet people’s care and support needs.

    1.2 Women with acute and chronic medical problems will have timely access to specialist advice and care

  • We will enable this by establishing local Maternal Medicine Network centres with clear access and treatment pathways of care for parents locally by March 2022. Timely access to specialist advice and care improves treatment outcomes. Support includes learning from research and guidance on gestational diabetes.

    1.3 Women with heightened risk of pre-term birth will receive targeted care and the health of pre-term babies will be better protected. We will enable this by:

  • Establishing specialist pre-term birth clinics for women with heightened risk of pre-term birth. These will include supporting younger parents and those from deprived backgrounds by March 2024. Specialist care addresses health inequalities for parents in high risk groups and reduces the number of babies born prematurely.
  • Increasing the use of magnesium sulphate, when clinically appropriate by December 2020. There is evidence that this measure will help reduce the number of pre-term babies born with cerebral palsy.
  • Supporting women at less than 27 weeks of gestation to give birth in a maternity service with an on-site neonatal intensive care unit (NICU) by March 2021.

    1.4 Women will be better supported to breastfeed using evidence-based best practice.

  • Maternity services will begin to deliver an accredited infant feeding programme from April 2019 e.g. UNICEF Baby Friendly Initiative. Currently only 57% of babies in England are currently born in an accredited ‘baby friendly’ environment with substantial variation between parts of England, from 84% in London to 32% in the North East.
  • A system wide feeding strategy will support women to feed their babies. In Suffolk and North East Essex the continuation rates of breastfeeding are currently significantly reduced at 6 weeks and nationally only 1% of babies are exclusively breastfed at 6 months. The health benefits of breast feeding will be shared with women to enable an informed choice.

    1.5 Families will have an enhanced experience during the worrying period of neonatal critical care.

  • Care coordinators will work with families within clinical neonatal networks and parental accommodation will be improved from April 2021. Providing support and better accommodation enables families to become more involved in the care of their baby and enhance their attachment with their child.

    1.6 Fewer babies will be born to parents who smoke during pregnancy reducing the number of babies born prematurely and/or with low birth weight and reducing the number of miscarriages and neonatal deaths. We will enable this by:

  • Educating the public about the risks of smoking and importance of healthy lifestyles during pregnancy through a public health campaign by December 2020.
  • Providing specialist midwives to coach parents to stop smoking during pregnancy by December 2020.
  • Continuing to provide nicotine replacement therapy where clinically appropriate.

    1.7 Women, partners and children will have improved access to high quality perinatal mental health care.

  • Specialist perinatal mental health services will offer a range of mental health support including parent/infant, couple, co-parenting and family intervention by March 2024. Evidence-based psychological therapies support parents’ wellbeing, and the care and wellbeing of their children.
  • Women with moderate to severe perinatal mental health difficulties will have access to specialist community care from pre-conception to 24 months after birth with increased availability of evidence based psychological therapies.
  • Bereavement counselling will be available to all families who have suffered a pregnancy loss or traumatic birth by March 2024.
  • Their partners will be able to access an assessment for their mental health and signposting to support as required. Improving access to support will contribute to helping to care for the 5-10% of partners who experience mental health difficulties during the perinatal period.
  • Specialised community-based perinatal mental health services, including Maternity outreach clinics will be expanded and offer extended periods of care and assessment to partners by March 2024. Maternity Outreach Clinics will combine maternity, reproductive health and psychological therapy for those experiencing mental health difficulties directly arising from, or related to, the maternity experience.

    1.8 Women will have improved postnatal physiotherapy to support them to recover from birth.

  • We will enable this by offering multidisciplinary pelvic health clinics and pathways. Clinics can also provide training and support for local clinicians e.g. GPs and midwives. January 2024. About 1 in 3 women will experience urinary incontinence after childbirth, 1 in 10 faecal incontinence, and 1 in 12 pelvic organ prolapse. Physiotherapy is by far the most cost-effective intervention to prevent and treat mild to moderate incontinence and prolapse.

    2.1 Families will have continuity of carer during pregnancy, birth and the postnatal period.

  • Women will be offered the opportunity to have the same midwife caring for them throughout their pregnancy, during birth and postnatally by March 2024. Women who receive continuity of carer are 16% less likely to lose their baby, 19% less likely to lose their baby before 24 weeks and 24% less likely to experience pre-term birth.

    2.2 Women will have improved access to information and their records and be able to access services and information in a more convenient and efficient way to help them make choices about their care through use of digital technologies enabling them to exercise more choice and control over their care.

  • All women will be offered a personalised care plan, including access to evidence based practice, to enable them to make the right decisions about their care by March 2021.
  • All women will be able to access their maternity notes, and information through their smart phone apps or other devices by March 2024.

    2.3 Maternity services will be rooted in, and respond to, what women and their families need and want.

  • Maternity service users will be involved at the heart of improvements through Maternity Voice Partnerships and Healthwatch by September 2019. Involving parents in design and delivery ensures services meet their needs and preferences, and are continuously improved.
  • Providers will include a focus on human factors within multidisciplinary training.

    3.1 Women and babies will receive high quality specialist neonatal care. Specialist neonatal care will be safe, effective, co-ordinated and based on best practice.

  • Neonatal critical care services will be redesigned and expanded so that the right level of care is available to babies as close to the family home as possible March 2024. Addressing the shortage of neonatal capacity and improving triage within expert maternity and neonatal centres will improve survival, safety and the quality of outcomes for babies.
  • The neonatal critical care review action plan will be implemented by March 2021. This will include reviewing capacity and staffing, and drawing up local action plans to inform future long term plan investment.
  • The recommendations of the paediatric critical care and surgery review will be implemented and a regional operational delivery network developed by March 2021.

    3.2 Unwarranted variation in quality and safety of maternity and neonatal care will be reduced.

  • Every trust with a maternity and neonatal service will be part of the National Maternal and Neonatal Health Safety Collaborative by March 2021. This will contribute to the national ambition of reducing the rates of maternal and neonatal deaths, stillbirths, and brain injuries that occur during or soon after birth.
  • Every NHS organisation involved in providing safe maternity and neonatal care has a named Maternity Safety Champion by March 2020. Multi-disciplinary working and learning is vital for safe, high-quality maternity care.

    3.3 Maternity service providers will learn from lessons when things go wrong and minimise the chances of them happening again.

  • The Perinatal Mortality Review Tool will be used by all maternity providers, in reviewing circumstances and care leading up to, and surrounding each stillbirth, and neonatal death and Learning and continuous improvement cycle implemented across the entire maternity system by March 2021.
  • We have established a process for a systematic multidisciplinary review, involving the families affected, and incorporating population health data on stillbirth and neonatal deaths, enables improvements in future care and fewer deaths in babies and young children.

    4.1 Pregnant women, babies and families will be able to access joined-up antenatal care, birth facilities, postnatal care, mental health, specialist services, health visiting and social care services.

  • Community Hubs will be established as ‘one stop shops’ for pregnant women and families, including support on growth and development of the child by March 2020. These hubs provide improved access to local-based integrated physical and mental health care and provide a fast referral service to the most appropriate care and support during pregnancy and as their baby grows in the first two years of life. Strategies include ensuring sufficient capacity and skill mix of health and care staff.
  • The most vulnerable babies and their families will have targeted integrated support by March 2024. Integrated health, social care and community-based support such as pre-birth and parent-and-baby groups for marginalised communities such as Roma, and young parents, helps ensure more effective parenting and safe care, and reduce social isolation.
  • Pregnant women, babies and families will have equality of access to services, regardless of where they live, or their circumstances by March 2024. Ensuring accessibility of services by public transport, will reaching into isolated and marginalised communities will help ensure equality of access.

We will know we are making a difference because we will see:

  • Reduction in the neonatal mortality rate, from 1.28 per 1000 live births and still births in 2016 to 0.96 in 2023/24 Increase in percentage of women with continuity of midwife care form 48.5% in 2018/19 to 100% in 2023/24
  • Reduction in the rate of infants with a brain injury occurring during or soon after birth from 5.33 per 1000 live births in 2017 to 2.50 in 2023/24
  • Increase in the proportion of women accessing specialist community perinatal mental health services from 2.3% in 2018/19 to 10% in 2023/24
  • Fewer still births and maternal mortality
  • Fewer women smoking at the time of delivery
  • Fewer premature births – less than 37 weeks gestation
  • Fewer deliveries to teenage mothers
  • An increase in breastfeeding initiation and targeted support to continue breastfeeding
  • Fewer women with chronic severe mental illness, depressive illness or postpartum psychosis
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