Post-pandemic planning for maternity care for local, regional, and national maternity systems across the four nations
Around 10% of pregnant women infected with Covid-19 are at heightened risk of complications (whether symptomatic or not).
Around 10% of pregnant women infected with Covid-19 are at heightened risk of complications (whether symptomatic or not).
However, 100% of pregnant and postpartum women have received modified maternity care services during the pandemic, and we do not know how service reconfiguration has affected outcomes (including costs) in the UK, and how to optimise care post-pandemic. Whilst one in seven people in the UK are women of childbearing age (2019), we have little data on use of Covid-19 vaccines in pregnancy planning, pregnancy, or breastfeeding, and emerging evidence that vaccine hesitancy is high.
In two trusts providing maternity care in south London (Guy’s and St Thomas’ and King’s College Hospital NHS Foundation Trusts), the research team aim to study the impact on women and babies of Covid-19 pandemic-related maternity service configuration (i.e., virtual care, out-of-office monitoring, and vaccination), particularly those from minority ethnic groups or leading socially or medically complex lives.
There are three objectives to be addressed by quantitative, social science, and policy research:
How will the project be carried out?
WP1: Quantitative - describe, quantify, and explain
They will use routinely-collected, linked maternity, mental health, and offspring data from the MRC funded early-LIfe data cross-LInkage in Research platform (˜35,000 records currently) from a diverse area, South London. We will describe and quantify temporal trends in relevant health outcomes and costs, by service reconfiguration and inequalities, using segmented and individual-level multivariate regression. We seek a coherent pattern of results to be interpreted in light of WP2 findings.
WP2: Social science - enrich understanding
They will carry out in-depth interviews with a maximum diversity sample of 105 pregnant/postpartum women, partners, care providers, and policy makers, with lived experience of maternity services during the pandemic. Interview schedules will explore what changed in care, its personal meaning, and confidence about care, analysed qualitatively (eg, thematic framework analysis). Questionnaires administered to maternity service users nationally (˜43,000) via the Covid Symptom Study (CSS) Biobank, recruiting participants from the King’s College London-CSS/ZOE app, to understand vaccine uptake, hesitancy, and side effects, and the impact of the pandemic on early parenting.
WP3: Stakeholder engagement
They will hold regional listening events (‘Imaging our best future’) in each UK nation which will assess WP1 and WP2 findings; brainstorm, shortlist, and prioritise high-impact future actions; and understand relevant facilitators and barriers to implementation. They will hold a National Policy Lab (‘co-production for action’) to explore listening event findings and produce an ‘Imagine our best future’ report for dissemination.
Read further information on work packages
Numerous organisations, charities, and trusts, nationally including: Royal College of Midwifery; Royal College of Obstetrics & Gyaecology; Tommy's Charity; Sands; Birthrights, Fertility Network UK; National Childbirth Trust, Local Maternity Voices Partnership; Covid Symptom Study (CSS) Biobank; Univeristy of Warwick; The Dartmouth Institute; St George's University Hospitals NHS Foundation Trust.
The pandemic has forced NHS maternity services to undergo substantial change. While harms have been evident, there are also potential positives, such as: new ways of working that may facilitate equity of access to care, better targeting of services, cost reduction from health system and patient perspectives (virtual vs. face-to-face care), and acceptability. This is an opportunity to ‘build back better’ while there is political will for reform that is data-driven.
Patient and public involvement and engagement (PPIE) was embedded throughout the project proposal development and will continue throughout the project in the following ways:
Read more about the patient and public involvement group advisory group.
Find out more on Twitter @resilient_KCL
This project is funded by the NIHR Health and Social care Research Delivery Research (HSDR) programme. It was adopted by ARC South London in October 2021 and will be completed by October 2023.