Tommy’s opens the National Centre for Maternity Improvement
On 1st September, the Tommy’s National Centre for Maternity Improvement was launched. Tommy’s, The Royal College of Midwives (RCM) and the Royal College of Obstetricians and Gynaecologists (RCOG) have formed an alliance to launch the centre.
The three-year programme of work will drive improvement with the aim of preventing 600 stillbirths and 12,000 preterm births nationally. These reductions will support government targets to make the UK the safest place in the world to give birth by halving stillbirth rates and reducing preterm birth from 8% to 6% by 2025.
In the UK, nearly 60,000 babies are born prematurely every year (before 37 weeks). Some do not survive, and those that do can face a lifetime of health issues. Tragically, 2,700 babies per year in the UK are stillborn. In terms of stillbirth, the UK is outside of the top 20 safest high-income countries in which to give birth.
The Tommy’s National Centre for Maternity Improvement will build on existing research and initiatives, and focus on personalised, patient-centred care, to create a model of care that can be scaled up nationally. This will help reduce current geographical and socio-demographic inequalities in the quality of care experienced between providers, with a focus on improving outcomes in the poorest performing 80% of UK regions to reach the level of the top 20%.
The Centre will also develop a digital tool, that will be freely available to every woman and their healthcare providers, in the UK. Women will input their own data and be signposted to advice related to their care or lifestyle choices that can improve their chance of a healthy baby. Medical professionals will also contribute clinical data to a woman’s record, and these combined data will be used to personalise risk and choices with signposting to advice and more options. This will be achieved through five workstreams:
1. Identification and implementation of interventions to mitigate and manage preterm birth
2. Identification and implementation of interventions to mitigate and manage stillbirth
3. Implementation and improvement science to inform development, implementation and evaluation of interventions to support practice change
4. Practical implementation of interventions identified
5. Data analysis for improvement
Professor Tim Draycott is the Clinical Director for The Tommy’s National Centre for Maternity Improvement and the team of midwives, clinicians, obstetricians, academics and experts. Tim is a senior practising clinician (North Bristol NHS Trust) and Improvement Scientist with world-leading experience of delivering improvements in maternity care. Tim will be supported by two Deputy Directors: Professor Jane Sandall, a midwife who will bring implementation science and collaborative cross-boundary leadership experience; and Professor Andrew Judge, a professor of translational statistics with expertise in medical statistics and in conducting epidemiological research using ‘big’ health registry data across multiple health conditions.
Multi-professional clinical leadership will be provided by consultant obstetricians Professor Basky Thilaganathan and Professor Dilly Anumba, midwife Cathy Winter, with support from clinicians and data scientists across the UK. Maria Viner, CEO of charity Mothers for Mothers and a member of the RCOG’s Women’s Network, will provide leadership and representation for the parents who will contribute to the centre’s work.
The article regarding the centre can be found here.
A new wellbeing resource for pregnancy and post-birth
1 in 5 women experience mental health issues during and after pregnancy. The Wellbeing Plan is like a birth plan for mental wellbeing.
On 29th July 2019, Tommy's launched a digital version of the NICE-approved Pregnancy and Post-birth Wellbeing Plan. The new digital tool, created in partnership with the Institute of Health Visitors (IHV), the National Childbirth Trust (NCT), Netmums, Public Health England (PHE) and the Royal College of Midwives (RCM) is called: Your Baby’s Mum: A wellbeing plan for pregnancy and post-birth.
The resource, and accompanying Your Baby’s Mum campaign, is designed to help all pregnant women to think and talk about their mental wellbeing in the pregnancy and post-birth period, and to plan early for support and self-care after the birth. The tool is suitable and available for all pregnant women and can be completed at any point in pregnancy.
The tool will help pregnant women make a plan for their mental wellbeing and it will offer extra support to those who need it during pregnancy. It has a tailored route for women who have suffered a previous pregnancy loss or premature birth, which acknowledges the extra anxiety this can cause.
The Wellbeing Plan aims to: encourage self-care for emotional wellbeing, help women identify symptoms of mental health problems, help women prepare mentally for the post-birth period, help women identify sources of support after the birth that can improve wellbeing.
The tool will also identify women who are at higher risk of poor mental health, offering a Tommy’s midwife call-back to women who may need extra support.
Jane Brewin, CEO of Tommy’s, said of the tool: "The importance of maternal mental health cannot be stressed enough. Suicide is the leading cause of death during the first year after pregnancy. Despite this, there is far more information provided to pregnant women on physical wellbeing than on mental wellbeing. The majority of resources and services that do exist tend to focus on women with an existing mental illness diagnosis, rather than helping those who develop problems during their pregnancy. The Tommy’s digital mental health tool will help women think about and plan for their mental wellbeing and get support if they need it - because the mother’s wellbeing affects the whole family."
With 700,000 women giving birth in the UK annually, mental health problems affect 1 in 5 women during pregnancy. According to the latest MBRRACE-UK report suicide is the leading cause of death during the first year after pregnancy. Women are more likely to be affected by mental illness during pregnancy and the postnatal period than at any other time of their lives, even those who have not experienced mental health problems previously.
Hope for many couples as progesterone shown to reduce risk of miscarriage in some women
The PRISM trial, funded by the NIHR and co-ordinated in the University of Birmingham in collaboration with Tommy’s National Centre for Miscarriage Research, is the largest ever trial of its kind and involved 4,153 pregnant women who presented with early pregnancy bleeding.
The women were randomly assigned by computer into one of two groups – one group of 2,079 women were given progesterone, while the other group of 2,074 women were given a placebo.
While the research did not show statistically strong enough evidence to suggest that progesterone could help all women who are suffering early pregnancy bleeding to go on to have a baby, importantly the results did show the hormone benefited those who had early pregnancy bleeding and had previously suffered a miscarriage.
The overall live birth rate was 75% (1513/2025) in the progesterone group and 72% (1459/2013) in the placebo group. That 3% difference in live birth was not ‘statistically significant’ – meaning that the difference could have been due to chance.
However, when the results were split by the number of previous miscarriages that the participants had suffered, the analysis showed that:
• No previous miscarriages: the live birth rate was 74% (824/1111) in the progesterone group and 75% (840/1127) in the placebo group, i.e. no benefit
• 1-2 previous miscarriages: the live birth rate was 76% (591/777) in the progesterone group and 72% (534/738) in the placebo group, i.e. some benefit
• 3 or more previous miscarriages: the live birth rate was 72% (98/137) in the progesterone group and 57% (85/148) in the placebo group, i.e. substantial benefit