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Safety in NHS services

Safety in NHS services

NHS logo This document outlines some recent NHS initiatives aimed at maximising safety, whilst keeping quality of care at the centre of maternity services. This will help you understand how care is designed and how you can seek more support.

NHS Long Term Plan (2019) aims to:

  • Improve access to support for mental health with the same urgency as physical health for birthing people, their partners and families. Look out for local information in the app or speak to your healthcare professional.
  • Improve safety for baby through the NHS England Saving Babies’ Lives Care Bundle standards, by:
  • 1. Offering choice and personalised care with respect for autonomy and decisions.
  • 2. Offering support to reduce smoking.
  • 3. Undertaking risk assessment and appropriate management of babies who might be at risk of growth restriction (slow growth).
  • 4. Informing pregnant people of the importance of promptly reporting a reduction in baby’s movements.
  • 5. Undertaking effective monitoring of the baby’s wellbeing during labour and birth.
  • 6. Reducing the number of preterm births and optimising care when preterm delivery cannot be prevented through:

a) Prediction

  • Undertake a risk assessment and refer to the low, intermediate or high-risk pathway and develop a personalised care plan for the birthing person.

b) Prevention

  • Assess if aspirin is required from 12 weeks of pregnancy.
  • Support to stop smoking.
  • Offer a urine test at the first antenatal appointment (Booking appointment) to screen for urine infection. If treatment is indicated, a repeat urine test should be taken to ensure infection has cleared up.

c) Preparation

  • Optimise place of birth to ensure that birth occurs in a maternity unit that has the appropriate neonatal care services to support your baby.
  • Birthing people are offered corticosteroid injections between 24 and 33+6 weeks, optimally at 48 hours before birth. This is to reduce the risk of your baby having breathing difficulties, gut problems, or bleeding in the brain.
  • Birthing people who are in established labour, or who are having a planned preterm birth within the following 24 hours, are offered magnesium sulphate infusion between 24+0 and 29+6 weeks of pregnancy (or considered for this infusion between 30+0 and 33+6 weeks of pregnancy) to reduce the risk of cerebral palsy in babies.
  • Improving general health outcomes for you and your baby. NHS England is funding a 6-8 weeks mother’s health check with your General Practitioner (GP)in addition to the baby check to assess your ongoing health and wellbeing needs.

Ockenden Report (2020)

This report aims to improve safety for you through pregnancy and post-birth through:
  • Enhanced safety in maternity units by undertaking a risk assessment at each contact with the birthing person to ensure that care is tailored to your needs.
  • Maternity services must ensure that birthing people, their partners and their families are listened to.
  • Care in complex pregnancies is managed with appropriate expertise and discussion and referrals made to specialist centres where necessary.
  • Maternity services follow best practice in monitoring of the baby in labour.
  • Provide access to accurate information to facilitate informed choice of intended place of birth and type of birth.
  • Ensure there is access to translation services if communication in English is difficult.

Shared decision making

  • All professionals should support you to make informed, value-based decisions by:
    • introducing you to the options available, including their advantages and disadvantages
    helping you to explore these in the context of your preferences
    empowering you to make decisions – all professionals should support you to make informed, value-based decisions by:
  • Ask yourself these three questions:
    • What are my options?
    What are the pros and cons of each option for me?
    How do I get support to help me make a decision that is right for me?
Questions and advice in pregnancy
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Planning contraception after birth

Planning contraception after birth

Close up of laughing couple hugging It may seem strange to be thinking about and planning contraception whilst you are pregnant. However, research has shown that many couples start having sex within six weeks of the birth of their baby. Did you know that it is possible to become pregnant when your baby is only 21 days old and before your menstrual period returns? Effective, safe contraception is available at your maternity unit and can be started as soon as you give birth. This means you don’t need extra appointments at your GP or sexual health clinic to start contraception. This is particularly helpful at a time when you will be busy looking after a newborn baby and yourself. Take some time to speak to your midwife or doctor about the options available to you, some of which may be available immediately after the birth of your baby. Planned pregnancies with an interval of at least one to two years are associated with a healthier pregnancy for you and your baby. Pregnancy spacing of greater than one year reduces the risk of pre-term birth, low birth weight and neonatal death. It also reduces the risk of complications in a future pregnancy particularly if you have given birth by caesarean section, because it allows the scar on your womb to fully heal. Effective contraception puts you in control of deciding when and if you would like to have another baby and can have some beneficial effects on your periods and long term health. You will be asked about your plans for contraception during antenatal appointments. Take some time to think about the different options and what might be right for you. Talk to your midwife or doctor and ask for any further information you may need. Once you have made a choice it can be entered into your personalised care and support plan and provided to you after birth.

Which form of contraception is right for me?

The most effective options for contraception are usually those that last for a few years and you do not need to remember to take every day. These are called Long Acting Reversible Contraception (LARC) and include a progestogen or hormone coil, copper coil or progestogen implant. Short-term methods (those that you need to remember to take every day) include the contraceptive injection (known as Depo-provera or ‘depo’), progestogen only pills (POP or ‘mini pill’) and combined oral contraceptive pill (COCP). Permanent family planning methods are sterilisation, where the fallopian tubes (tubes connecting the ovaries to the womb) are clipped or cut and for male partners, vasectomy. It is important to remember that none of these methods protect against sexually transmitted infections. If you are at risk from infection, for example when having sex with a new partner you should also use a barrier method or condom. Find out more about all the options available in the link below.  Most can be provided as soon as you have given birth. Just ask and remember to make a note of what you would like in section 16 of your Health and wellbeing in pregnancy personalised care and support plan.
Resuming sex and contraception
Which method of contraception is right for me?
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Antenatal classes: Videos

Antenatal classes: Videos

Video screen showing Part 1 of the NHS North West London Maternity Services Birth Preparation Course These short videos have been designed to help those women and their partners who are unable to attend antenatal classes in person.
The Birth Preparation Course Part 1
The Birth Preparation Course Part 2
The Birth Preparation Course Part 3
Birth Choices
Home Birth
Breathing
Early Days Part 1
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Introducing a sibling to your new baby

Introducing a sibling to your new baby

Smiling young boy holds a new born baby There are no rules about when you tell an older child that a new baby is on the way, but opinion suggests it is wise to do so when you tell others so they hear it from you directly. A small child will find it difficult to visualise what this will mean for them so using books or pictures can help, or by reference to other friends who may have had a new brother or sister recently. Provide whatever information is needed within the child’s level of understanding. As the pregnancy grows, spending time to “talk” to the baby together enables the older child to make a connection and feel the baby kick (“talk back”). Bringing home a newborn is a little different the second time around. With your first child, you’re focused on figuring out how to care for a baby. With the second baby, you’re likely to wonder how your older child will react to having a new sibling. The links below offer useful advice on how to handle this transition.
Dealing with challenging behaviour when a new baby arrives Children and new siblings
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Stopping work/slowing down

Stopping work/slowing down

Heavily pregnant woman asleep on a sofa When you choose to stop work is a matter of personal preference, but it is worth considering your commute, your working environment, your proximity to your maternity unit and allowing time to prepare for your baby’s arrival. You can discuss this with your midwife or doctor. Towards the end of pregnancy you may feel quite tired and uncomfortable, and therefore may need help from friends or family to get things done, particularly if you have other children. It’s important to stay active but to also make time for rest, particularly if you aren’t sleeping too well.
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Perineal massage

Perineal massage

Diagram demonstarting hand positions when performing perineal massage Massaging the perineum (the area between the vagina and anus) in the later weeks of pregnancy has been shown to reduce the likelihood of tearing during birth, and of needing stitches or an episiotomy. You can start this from when you are 34 weeks pregnant and practice it daily/every other day until the birth of your baby. How to massage your perineum:
  • wash your hands
  • sit comfortably with your legs bent at the knees so you can reach your perineum easily. Use a mirror if you wish
  • massage oil (preferably vegetable-based) into the skin of the perineum using fingers and thumbs
  • place one or both thumbs inside your vagina and press downwards towards the anus. Move to each side in a U-shaped stretching movement. This may give a tingling/burning sensation
  • aim to massage the area inside the vagina, not necessarily just the skin on the outside
  • aim to apply the massage for five minutes.
Perineal massage Perineal massage for reducing perineal trauma
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Your baby’s movements

Your baby’s movements

Pregnant woman with a happy surprised expression looking down at her bump From 16-24 weeks on you should feel the baby move more and more up until 32 weeks, then stay roughly the same until you give birth. Take time to become familiar with your baby’s normal pattern of movements. You should continue to feel your baby move regularly right up until you give birth to him or her. The movements your baby makes offer reassurance that he or she is well, and therefore if you notice these movements change or reduce from what you are used to, it is important to call your midwife or attend the maternity unit urgently.
The importance of monitoring fetal movements
This video is available in many languages. Click on this link and scroll down to view the videos in English and other languages: The importance of monitoring fetal movements in 20 languages including sign language Reduced fetal movements videos
Portal: Your baby’s movements
Contact my maternity unit
Baby movements in pregnancy Your baby’s movements Why movements matter? Feeling your baby move is a sign that they are well Babies’ movements – MAMA Academy
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Getting to know your baby during pregnancy

Getting to know your baby during pregnancy

Pregnant woman smiling and holding a pair of baby shoes Taking time as part of your daily routine to think about and bond with your unborn baby is known to release oxytocin, a hormone which can help your baby’s brain to develop. Babies need adults to nurture and support their development during pregnancy and their speech, language and communication beyond birth. There is lots of helpful information to support you with chatting to your bump during pregnancy and talking, singing, playing and reading with your baby after birth. You can try:
  • talking, singing, playing and looking at books with your baby, and encouraging your partner/family/other children to do the same
  • gently massaging your bump
  • having a bath
  • trying pregnancy yoga
  • practising hypnobirthing
  • playing music to your baby
  • writing a letter to your baby
  • using an app to help you understand how your baby is growing and developing, such as the Baby Buddy App.
Building a relationship with your baby
UNICEF UK Baby Friendly Initiate, Building a happy baby leaflet Baby buddy app Talking to your baby (Hungry Little Minds) I CAN’s Talking Point for parents
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Work, maternity/paternity leave and money

Work, maternity/paternity leave and money

Woman holding a mobile phone to her ear with one hand and carrying a clip board in her other hand After your 20 week ultrasound scan, you can ask your midwife or GP for a MATB1 form. This form entitles you to statutory maternity pay from your employer or maternity allowance from Jobcentre Plus. During pregnancy/after birth you are entitled to:
  • paid time off for your antenatal appointments
  • maternity pay or maternity allowance
  • maternity leave
  • protection against unfair treatment, discrimination or dismissal.
Working partners are entitled to one or two weeks paternity leave and together you may be able to take shared parental leave. If you are not working, or you/your household is on a low income you may be entitled to maternity benefits and allowances. If you are employed, you must inform your employer that you are pregnant at least 15 weeks before your baby’s due date. When you tell your employer they must perform a risk assessment, which ensures any necessary adjustments can be made to your working environment or pattern. It is worthwhile speaking to your company’s human resource department and accessing the policy on pregnancy and maternity leave. More information on maternity/paternity leave, work, child or other benefits and money can be found in these related links:
Government advice Advice on your maternity rights The Money Advice Service Pregnancy, breastfeeding and health and safety