The Scalpel's Blog

26.09.19

Working together to provide the best care and support within maternity and neonatal care

Professor Gillian Leng, deputy chief executive and director of health and social care, introduces the National Institute for Health and Care Excellence’s (NICE) latest impact report on maternity and neonatal care.

During 2017/18, there were more than 626,000 births in the NHS. With around 100,000 neonatal admissions to hospital every year, it is important that babies, mothers and their families are provided with high quality care and support by services across the country.

One of NICE’s key priorities is advising on best practice in service delivery through the guidance and resources that we produce. Since 2003, when we published our first maternity guideline, we have produced a suite of maternity and neonatal related advice.

To highlight key recommendations, NICE has now published an that focuses on how NICE’s evidence-based guidance contributes to improvements in maternity and neonatal care. The report draws on our previous maternity impact report, published a year ago, and provides updates and identifies areas where more progress is needed.

One issue that we revisit from the first maternity impact report is around how NICE guidance is being implemented to improve outcomes for multiple pregnancies. The Twins and Multiple Births Association (TAMBA) has completed a 3 year maternity engagement project and has published 40 positive findings as a result of following NICE guidance, including a reduction in the rate of neonatal admissions and emergency caesarean section for multiple pregnancy.

We also highlight the impact of implementing NICE guidance on high-throughput non invasive prenatal testing (NIPT) for fetal rhesus D (RHD) genotype. We have seen a significant increase in the number of trusts providing NIPT for fetal RHD genotype to women since the publication of the first maternity impact report, from 40 to 54 trusts across the country, and an increase in the number of tests being carried out. This continues to increase and is shown in the  .

Whilst we see that there have been promising improvements in some areas, there are other areas that require more attention. In the latest report, we look further into improvements needed within the specialist care of newborns, including breastfeeding, maternity and mental health, and the prescribing of valproate in women and girls.

The NICE quality standard on neonatal specialist care stresses the importance of mothers who are receiving specialist neonatal care being supported to start and continue breastfeeding. However, in a survey of women’s experiences of maternity care, an audit, published in 2018 by the Care Quality Commission’s (CQC) revealed that up to 39% of babies were still not receiving their mother’s breast milk, particularly in babies born pre-term. This indicates that women surveyed in the CQC audit reported receiving little change in active support and encouragement.

Valproate prescribing is another important area where we know some improvements are required. In our updated guideline and quality standard on antenatal and postnatal mental health, we state that valproate must not be used by any woman or girl able to have children unless there is a pregnancy prevention programme (PPP) in place. This is due to the high risk (up to 4 in 10 babies) of having developmental problems and birth defects. Data from NHS Business Services Authority shows a positive trend in a reduction of valproate being prescribed to women and girls aged 14 to 45 in England, (from 22,000 women and girls in 2017 to 16,000 in 2019), but there is still more to do in order to reduce this risk.

To address the risk from prescribing valproate, we have brought together existing information and advice on safe prescribing from a number of sources, including MHRA safety alerts, BNF information and information from the Driver and Vehicle Licensing Agency in a summary sheet, with easy to access and practical recommendations supported by a visual summary.

It is clear from the impact report that the system is making many improvements in providing better support and efficient care for mothers and their babies. To continue to make improvements, services need to prioritise their efforts in implementing NICE guidance and quality standards. To support this, the NICE Field Team works locally to provide additional support for implementation and signposting to useful resources.

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