51cg

We aim to refine and feasibility test the theoretically-informed implementation of a care bundle for pregnant women with multiple long-term health conditions (MLTC) and develop tools to assess its impact in a future trial.

More pregnant women (hereafter women) in the UK are living with MLTCs including mental health conditions. They often experience poor maternity care without the information and support they need. This can affect their pregnancy, their future health and their baby's health. We have interviewed women with MLTC, their partners and maternity staff about this. We found that 'good' care coordinated by the NHS, involved the same staff who communicated clearly, provided expert help to make medication choices and had a clear postnatal handover to GPs and wider care teams. We used our findings in workshops to develop a proposed 'care bundle' to improve maternity care for these women.

We will share our findings with parents, health professionals and NHS managers. We will write articles for groups and charities, publish in academic journals and speak at events run by professional organisations.

In two UK maternity units we will refine and pilot test the use of a care bundle which includes:

1) early expert support about medication use in pregnancy

2) an accessible and up-to-date summary of care including problems to look out for

3) continuity of midwifery care during pregnancy and early parenthood

4) a named care coordinator within the care team

5) a structure postnatal handover to GPs and other care providers

The bundle will be further tested in these and another two UK maternity units (n=4) providing care to women from a range of backgrounds. This is called the pilot and feasibility phase. 

Women with MLTC will be allocated a named care coordinator from within their exisiting care team. This person will be responsible for ensuring good support to make medication decisions, keeping accurate records which are available to the whole care team, checking up on things such as appointments, tests and scans, and providing information for the handover of care after birth. These women will also receive care from the same midwife or team of midwives during pregnancy and after birth.

Our research team will host discussions and workshops to find out how staff think the care bundle could work and changes in resources might be required. We will also look for earlier research on what has helped or hindered similar changes in maternity care so we can improve our plans Once the bundles is in use we will explore how it is working, including any changes that are made to better support women who find it hard to access or get the best from NHS care. In a previous project, called MuM-PreDiCT, we developed a core outcome set for women with MLTCs and their babies. These outcomes make it easier to compare different pieces of research. We will collect information on these outcomes in newly developed tools for collecting information to compare care with and without the bundle. In the pilot testing, we will collect information on whether women received all parts of the bundle, health outcomes for women and their babies and the NHS costs or savings of using the bundle. We will invite women to complete a survey about their experiences of care. 

Our MuM-Predict group of mothers with MLTCs shaped this proposal. Some will stay involved and new members with recent pregnancy will join. We will work with local public partners in each site.

Content to follow.