The NHS Long-Term Plan (LTP) aims to reduce stillbirth, maternal mortality, neonatal mortality, and serious brain injury by 50% by 2025. To achieve this there is a vital need to address these health inequities among women from vulnerable groups.
To improve outcomes among women from BAME and disadvantaged groups the LTP aims for 75% of women from BAME communities and a similar percentage of women from the most deprived groups to receive continuity of care from their midwife throughout pregnancy, labour and the postnatal period by 2024.
Perinatal mental health care in the Long Term Plan
- By 2023/24 access to perinatal mental health services aims to benefit an additional 24,000 women per year
- Care provided by specialist perinatal mental health services will be available from preconception to 24 months after birth
- Maternity outreach clinics will integrate maternity, reproductive health and psychological therapy for women experiencing mental health difficulties directly arising from, or related to, the maternity experience
Despite these aims set out in the Long Term Plan, we do not know how effective the continuity model of care is for these groups of women.3 In addition, there is a limited understanding of the care pathways and contextual factors surrounding severe maternal morbidity and mortality among women with serious mental illnesses.
Aims of our research
The overarching aim of our research is to have a positive impact on women and families in the local community by increasing the detection, monitoring and healthcare management of women at risk of severe morbidity and mortality during the perinatal period.
In line with national priorities and the NHS LTP, we aim to:
- Evaluate the impact of place-based models of maternity care for women living in areas of ethnic diversity and social disadvantage
- Investigate the factors surrounding severe obstetric complications and near fatal perinatal self-harm among women with mental illness
How our work is addressing multimorbidities and inequalities
Women with multiple physical and mental morbidities and social complexity are at greatest risk of death during pregnancy or in the year following birth. Our research theme aims to address these inequalities by:
- Using linked healthcare records from maternity, mental health and hospital admissions data to map care pathways and birth outcomes for women from BAME groups and those at risk of perinatal mental illness in south London;
- Evaluating the impact of a placed-based model of maternity care targeted at vulnerable and disadvantaged women living in Lambeth;
- Investigating the complex contextual factors surrounding severe maternal morbidity and mortality among women with mental illness in south London.
We are part of the King’s Health Partners Institute for Women and Children’s Health and the Section of Women’s Mental Health at the Institute of Psychiatry, Psychology and Neuroscience, and collaborating with a variety of groups and services, including:
- Maudsley Biomedical Research Centre (BRC) and Guy’s and St Thomas’ Biomedical Research Centre (BRC) Women and Children’s theme
- MRC-funded eLIXIR (early-LIfe data cross-LInkage in Research) research group
- Local maternity systems and services in south London e.g. LEAP Lambeth
- Mary Newburn - Patient and Public Involvement (PPI) Consultant and ARC theme PPI lead
- ARC West Midlands and ARC North East and North Cumbria
How we are involving patients, services users, carers and public
Our research has been informed by discussions with our local PPI group and ARC theme PPI lead, National Maternity Voices, Tommy’s, Action on Pre-eclampsia (APEC), The Parenting Science Gang, and Maternal Mental Health Alliance.
We are addressing challenges identified in national policies, which have been informed by public and patient priories. In the first year of the research programme we will develop a stakeholder engagement strategy to inform and develop the ongoing research of the theme.
As part of our stakeholder engagement strategy, we have consulted patients and key stakeholders including NHSE. Mary Newburn, our PPI lead, is convening a project PPI group and this will ensure that voices of women and families are central to our work from design through to dissemination. We also have a dedicated Facebook group and a Twitter account @arc_S_Lppi and are active engaging local communities.
1. Knight M, Bunch K, Tuffnell D et al (2019) MBRRACE‐UK Lessons learned to inform maternity care from the UK and Ireland Confidential Enquiries into Maternal Deaths and Morbidity 2015-17. Oxford: University of Oxford; 2019.
2. NHS England. The NHS Long Term Plan: Maternity and neonatal services 2019 Date accessed: January 6, 2020