I only commenced this role as SRO for the Local Maternity System in Humber, Coast and Vale in January – and it’s not been quite as I expected!
To begin with I spent time with the LMS core team which has been working to address the requirements of both the national maternity review ‘Better Births’ released in 2016, and the NHS Long Term Plan, released at the start of 2019.
Both documents make it clear that the benefits of having a good quality and safe pregnancy and birth experience are vital in setting up that family for better health throughout their lives.
The team had pulled together a plan for the remainder of the 19/20 financial year, and one for 20/21 – the latter with a strong focus on the different ‘prevention’ workstreams they wanted to tackle.
This included taking a fresh look at how we could reduce smoking in pregnancy across the area, how we could encourage more women to breastfeed for longer; whilst also giving support to those with other types of feeding regimen, and a new look at how the LMS could work with colleagues to support those with diabetes in pregnancy.
There was also a lot of actions to progress the rollout of ‘Continuity of Carer’ in all our maternity services – the process of ensuring that a woman is allocated to a midwife, who will provide advice and clinical support throughout pregnancy, labour and beyond.
The benefits are well documented, for example we know that this can help prevent problems with pregnancy, including reducing the numbers of pre-term deliveries and stillbirths, and it can also help prevent perinatal mental health issues.
Locally we have had Continuity teams in some areas of the LMS for over a year now and the feedback we get from the women who are supported by these teams is excellent. Our ambition is to reach 51% of women across the area by the end of March 2021, and we are already on track to do this, having reached 43.4% in March 2020.
However, the escalation of the Covid-19 pandemic in March brought a new focus for myself, the team and our colleagues in the different maternity providers. Suddenly it was clear that we needed to be even more careful in prioritising the safety of the women, families and staff and that meant a number of the pathways that supported women through pregnancy, birth and beyond would need to significantly change.
My LMS core team consulted with the heads of midwifery at each acute site and all agreed that they would maintain their previous team formation and switch to support the redesign of pathways across the whole area.
This meant that work could be done efficiently in one place, tested and rolled out, rather than being designed in three areas separately. The consistency of message and offer to women and families meant there was clarity as to what had changed and why – with the aim of providing certainty in an uncertain time.
Whilst many services were stepped down to deal with Covid-19; in maternity services we did not have this choice as babies were going to keep coming despite being in the midst of a global pandemic.
The amount of work that took place to ensure ‘business as (near) usual’ carried on was simply enormous. Weekly meetings commenced and staff who needed to be working at home for shielding purposes were drafted in to support ongoing work. We also had significant support from networks of colleagues across the Yorkshire and Humber area.
One of the first changes introduced was based on the fact that it was really important that we found a way of communicating with women and families, to keep up them up to date with the rapidly changing situation, to reassure them about concerns and to highlight any messages we thought they might need to know as their pregnancy or labour progressed.
We worked with the individual maternity provider organisations to set up an ‘Ask a Midwife’ service linked to existing Facebook pages for each area. This had consistent hours across the LMS; and women could leave messages or queries during this time and receive a rapid reply from local midwives.
A list of frequently asked questions was compiled from the outset, and as these grew it enabled us to identify trends in the types of query – so we could proactively put together information that could be posted on the Facebook pages.
This again was consistent across the LMS; so women got the same messages at the same time, whilst also being able to ask specific questions about the unit they had chosen for their birth. The LMS core team coordinated weekly conversations to ensure that, where possible, the units were working to the same standards and processes, and where there were differences due to the geography, layout of departments or availability of staff everyone understood why that was.
The service has been really well received; with women commenting on the timeliness of the advice, the clear answers to questions, and the relief they felt knowing there was a midwife available to them. The staff involved were able to use their skills effectively at this time, and to know they were supporting their colleagues by taking some of the burden that would otherwise be blocking phone lines across our hospitals.
I know we also saw a lot of queries that weren’t related to Covid-19, particularly those around early pregnancy and had a lot of understandable concern where some sonography teams felt they didn’t have space to safely have a partner attending scans.
Teams have worked with families to explain the rationale, and with the sonographers to test other options. Whilst these conversations have sometimes been difficult, the ability to identify concerns and discuss them directly has been invaluable.
Other areas where women will have seen change include some of the previous face-to-face interactions now being done virtually; this includes birth education in the form of ante-natal classes. I’ve been really impressed about how all our staff have adapted to working differently, and it’s been interesting to read the feedback from women where they feel that there are benefits to not having to travel or find childcare for existing children.
I have also been delighted that our Maternity Voices Partnership (MVP) Chairs across the LMS area have been hugely involved in this transformation and sharing of messages to their members.
A new survey has recently launched to get more information about how women feel about their pregnancies and births at this time and our MVP will be helping to assess the outcomes and choose next steps for the LMS strategy; what changes should be embedded and what needs to continue to change.
I strongly believe that our maternity services will be better for the work that the LMS, partners and all the staff have put in during Covid-19; and it will continue to support the work the teams are doing. I am so pleased to be part of this programme.