About

Summary

In the UK today, one in every 10,000 women dies during pregnancy or in the six weeks after giving birth. However, we know that for every woman that dies, more than 100 experience a health complication which can result in lifelong health problems. Sadly, women who are Black, Asian or mixed race, and women who live in poorer areas are more likely to die or have one or more of these severe complications. The government made a commitment ten years ago to halve the number of women who die in and around pregnancy, but despite this, the numbers have continued to rise.

We want to build a better way to understand national trends in pregnancy complications by using data captured in patient care records. With this newly-developed system, we will be able to monitor these harmful events in real time. This data system will allow us to have much greater understanding of health and disease in pregnancy, due to powerful new ways of linking datasets together, giving us a much greater understanding of the pathways and causes of harm. We will be able to use this system to gain an understanding of why some groups of women are more likely to die or experience severe harm, so that we can work to specifically reduce this unequal risk, improving outcomes for women and their babies.

The government has asked policy makers to urgently develop a new set of care standards, in an intervention known as a 'care bundle'. This bundle is aimed at tackling some of the major underlying causes of harm in pregnancy. It will standardise clinical protocols and reduce variation in the care women receive in the NHS. All women having antenatal care in the NHS from April 2026 will receive care in this new care bundle. We are currently supporting policy makers to develop this care bundle by reviewing the science behind what strategies can help reduce harm to women the most. In this programme we want to examine certain aspects of the care bundles to understand what works well for women, staff and the health care system. We also want to understand how women feel about experiencing aspects of care in the bundle. It is important to find out about any challenges, and if there are any unexpected or knock-on consequences. This will help us to develop the bundles in such a way that they improve outcomes for women and babies the most.

Using this powerful new data platform, we will understand how the new care bundle intervention is working, whether women are getting fair and equal access to care, and that the NHS is not experiencing knock-on effects that were not intended (for example, it only working for certain groups, or increases in areas of care that we did not expect). Our new data collection system will be able to monitor the impact of this intervention on pregnancy outcomes, how care is used, and the consequences for certain patient groups. This will make sure that we understand important trends in pregnancy outcomes so that we can act quickly to benefit women and babies, and to make sure that policy makers can target key challenges in the future.

Aim of this research

To improve clinical outcomes for women and babies receiving NHS maternity care through a new “bundle” of interventions to prevent and treat maternal complications underpinned by a new national system of ongoing monitoring of maternal and neonatal morbidity.

What is the research question?

Does an evidence-based nationally implemented Maternal Care Bundle reduce maternal morbidity?

Can established sub-national Secure Data Environments (SDE) provide a national mechanism for the flow and linkage of individual patient data on maternal and neonatal health and care, to provide robust and timely evidence on maternal morbidity in England?

Objectives

1. To review the research evidence to support the development of new or adapted interventions to be included in the bundle, including conducting feasibility work;
2. To study the bundle of interventions in 'champion sites' to understand how it is implemented and the resource and conditions required to achieve change;
3. To develop a new rapid data collection mechanism to monitor and study patient outcomes, using linked, individual patient data;
4. To assess the clinical and cost effectiveness of the Maternal Care Bundle, its implementation, and its impact on maternal health inequalities;
5. To establish a mechanism to provide ongoing robust evidence on national trends in maternal morbidity and maternal inequalities, enabling policymakers and trusts to develop ongoing actions needed to improve maternal outcomes in NHS maternity care.