Story Highlight
– Maternal Care Bundle aims to standardize NHS pregnancy care.
– Maternal mortality rose 21% since 2009-2011, excluding COVID-19.
– Significant disparities exist, especially among Black and deprived women.
– Five key care areas identified to reduce mortality and morbidity.
– Full MCB implementation required by all NHS trusts by 2027.
Full Story
The Maternal Care Bundle (MCB) has been established to standardise clinical best practices across five key areas of maternity care, with the overarching goal of reducing maternal mortality and morbidity across England. This initiative has emerged in light of disturbing trends in maternal health, particularly regarding disparities in outcomes based on ethnic and socioeconomic factors.
Recent findings from the MBRRACE-UK data indicate a significant rise in maternal mortality rates, with a 21% increase recorded from the years 2009 to 2011 compared to the latest data spanning 2021 to 2023. When excluding COVID-19 related deaths, the increase stands at 7%. Demographic shifts, such as rising maternal age, increasing obesity rates, and higher incidences of pre-existing medical conditions contribute to the complexity of maternal care. Alarmingly, in the recent analysis, Black women in the UK faced a maternal mortality rate more than twice that of their white counterparts, while women from the most deprived areas had mortality rates nearly double those living in more affluent locations.
The MCB was developed through consultations involving frontline clinicians, users of maternity services, and various national stakeholders, including Royal Colleges and relevant charities. The bundle establishes a framework around five critical clinical elements that could mitigate these alarming trends in mortality and morbidity:
1. **Venous Thromboembolism (VTE)**: This component addresses the prevention of blood clots during pregnancy. Risk assessments will be mandated for all pregnant women at their first contact with NHS services, enabling appropriate thromboprophylaxis for those identified at high risk.
2. **Pre-hospital and Acute Care**: This element ensures that pregnant women experiencing acute health issues receive appropriate and timely care. Standardised protocols for monitoring maternal deterioration across all healthcare settings are to be implemented.
3. **Epilepsy in Pregnancy**: With the aim of safeguarding women with epilepsy, this element calls for improved access to multidisciplinary care to effectively manage seizures during and after pregnancy.
4. **Maternal Mental Health**: Systematic screening for perinatal mental health issues will be standardised, thereby facilitating timely and compassionate referrals to specialists as necessary based on screening outcomes.
5. **Obstetric Haemorrhage**: To enhance the management of significant bleeding during and after childbirth, this component advocates for cumulative blood loss measurements and clearly defined escalation protocols.
The collaborative approach taken in the development of the MCB has ensured that these elements are not only evidence-based but also tailored to enhance equity in maternal health services. The need for coordinated action is paramount, as the factors leading to maternal mortality extend beyond maternity care and include varying medical specialties, emergency services, mental health provisions, and primary care. Thus, a holistic approach is deemed essential for improving maternal health outcomes across the board.
The MCB establishes baseline standards reflective of best practices, allowing for iterative updates in future versions, similar to the previously instituted Saving Babies Lives Care Bundle. By the target date of March 2027, all NHS trusts providing maternity services are expected to fully implement the MCB, ensuring compliance across all regions.
The latest data underscores the pressing need for this initiative, as 611 maternal deaths were reported in the UK during 2021 to 2023, equating to a maternal mortality rate of 12.82 deaths per 100,000 births. This figure starkly contrasts against the goal of halving the maternal death rate from 2010 to 2025, thus highlighting the urgent necessity for reforms.
Further analysis reveals that a significant portion of maternal deaths could have been prevented through improved care practices. Review assessors noted that 45% of the maternal fatalities could have potentially seen different outcomes with better care, and this figure escalates to 66% for women who were recent migrants to the UK, indicating systemic inequalities in care delivery.
Among the various health conditions contributing to maternal mortality, it is striking to note that thrombosis and thromboembolism rank as the leading direct causes. This emphasizes the critical need for early risk identification and management in pregnant women. It has been identified that over half of maternal deaths (54%) stem from indirect causes such as cardiac disease and, predominantly, COVID-19. This highlights an evolving challenge in maternal healthcare for which strategies must be adaptable.
The complexities of modern maternal health signify that a burgeoning number of women enter pregnancy with existing health conditions, necessitating a robust response from NHS services. With rising rates of caesarean deliveries—associated with increased risks of complications—the MCB intends not just to address immediate risks but also to create an environment conducive to the ongoing improvement of maternity care.
In establishing effective practices that consider mental well-being, physical health, and systematic support throughout the perinatal period, the MCB aims to mitigate the severe emotional and psychological toll that maternal health challenges can impose on both women and their families.
To ensure the successful implementation of the MCB, designated organisational responsibilities will fall to NHS trusts and Integrated Care Boards (ICBs), alongside the oversight of regional NHS England teams. The inclusion of diverse voices, particularly those of service users, is critical in fostering an inclusive approach that actively considers the varied experiences and expectations of women receiving care.
Ultimately, the Maternal Care Bundle is set to operationalise a paradigm shift in how maternity care is delivered in England, promoting a consistent standard of care that places emphasis on equity and comprehensive support throughout the entirety of the maternity experience. This initiative signifies a definitive step toward addressing the distressing disparities within maternal health outcomes and enhancing the quality of care for all expectant mothers across the region.
Our Thoughts
The increase in maternal mortality rates highlighted by MBRRACE-UK underscores significant gaps in adherence to health and safety regulations within the NHS. Key lessons include the necessity for improved implementation of the Maternal Care Bundle (MCB), especially regarding urgent interventions for high-risk pregnancies such as venous thromboembolism (VTE) and timely access to multidisciplinary care.
Failures in adhering to Care Quality Commission standards and national guidelines on emergency responses may have contributed to these tragic outcomes. Compliance with the Health and Safety at Work Act 1974 requires systematic risk assessments and the implementation of protective measures—this is particularly critical in maternity care, where timely interventions can save lives.
To prevent similar incidents in the future, NHS trusts must enhance training in recognising and managing the deterioration of maternal health and ensure equitable access to care across demographics. Regular MDT case reviews should be established to identify system failures and inform ongoing training and improvements, ensuring adherence to the standards set by the MCB and the requirements placed by NHS England for maternal safety.
