Improving Maternity Services Across the UK
Three years ago, I was planning my maternity leave and given my experience with my first pregnancy, I was very excited to hear about the Better Births initiative (otherwise known as the Maternity Transformation Plan) that had been announced.
In March 2019 the ‘Better Births Three Years On’ event was held, announcing changes to the current maternity offerings, and fom today, there will be changes to maternity services in my area, as a part of this initiative.
A quick note from me: I make no apologies for the length of this article as like any commentary on aspects of the health sector, it is multifaceted and complicated so a lot of research has gone in to crafting this. We are passionate in trying to make improvements to health systems so please contact us if you think we can help, we'd love to hear your challenge and work with you to find a solution.
Continuity of care
My biggest bug-bear during pregnancy was the lack of continuity of care. In my case I never actually saw the same midwife twice until I was halfway through my pregnancy and at that point; I hadn’t had some blood-work done, which would later prove a crucial oversight, and my appointment with the consultant hadn’t been scheduled when it should have been.
I also had a LOT of scans, all done by different people, and I was never really sure why aside from a vague notion that there was a concern that Baby wasn’t growing the way he should have been. A scary message to any mum let-alone a brand new one with no experience!
You only get a VERY limited time with (extremely busy) healthcare professionals at any one appointment, so getting information about what is going on can be tricky. They are focused on getting the measurements and results they need and sometimes less focussed on the information needs you as the parent have. This is all added to meeting a stranger and having to spend half your appointment time bringing them up to speed on what’s going on – which I think you are beginning to see, I had very little idea about!
I don’t for a minute want to imply that I didn’t receive compassionate and exemplary care from everyone who treated me. I did. It’s just that I was one more body on a busy conveyor belt, and whilst they are all caring professionals, I was a stranger to them, and them to me.
I had never clapped eyes on the midwife who delivered my son until I was admitted, and to be honest, I never saw her again as I was discharged pretty quickly, and she had finished her shift. After my son was born, I never saw the community midwife who looked after me during my pregnancy again either. My home visits were all done by different staff, and as my health visitor retired, we weren’t assigned another – we just went to the baby clinic and saw whoever was available.
This might all have been fine, if it wasn’t for the fact that I had a haemorrhage after Baby was born - remember that test that wasn't done?
I had an amazing baby who slept in 5 hours blocks from birth. I should never have been as tired as I was. I did all the things; I should have produced at least some milk. By nature I have high iron levels. This isn’t something to be concerned about, but it does mean that if I register “low normal”, for me, that is actually in the “anaemic” band.
I can’t help but feel that treatment from a team that knew me, knew all my quirks and medical history, might have led to a safer, more positive and comfortable experience.
Continuity of Information
Continuity of services however is not limited to care. How much easier would all this have been if my healthcare team had, had ready access to ALL my notes? In the area I live in, both three years ago and today, maternity notes are handheld. They are kept in a physical paper booklet that follows you around, gets bits stapled to it, collects many different handwriting samples, and has to be taken to every appointment. When you arrive at the hospital (and I am told, at the birthing centre), you hand over your notes and you never see them again. Why?
You can request to see your notes online, but this seems to be a long process, taking up to 40 days, and then you have to have an appointment to see your records. (I was offered one some 3 months from when I asked and was told that is was the last appointment available. I’d hoped to be able to report on it for this post, but I won’t see them until May.)
The solution to this is surely simply to have maternity notes securely held online? Perhaps in some sort of app that patients can review too - am I crazy here? Why should Dr. Google be my main point of contact for care when Dr Google is often not your friend when you are pregnant and hormonal.
Some areas of the UK are trialling an online system for maternity notes. https://www.pregnotes.net/ (powered by badgernet) is on offer in some parts, but a quick look on Mumsnet gives scathing reviews about it.
“It’s part of a computer system called badger net and the app that you have on your phone will crash constantly and only gives you patient level access which is very limited and very basic and includes things like your blood type and a long list of appointments.”
And the reviews in the app store aren't sparkling either.
Now it's easy when working in a health technology company to be critical of systems that don't operate well or offer the basics like an optimal UX, but this system was rolled out without basic user training, leaving midwives frustrated and desperately trying to work out how to get the information into the system. So going back to one of my earlier points, this wastes precious time in your appointments that neither you or your HCP has.
One Babycentre user had this advice for new mums using the pregnotes app:
“I would insist on paper copies of everything so that you have your own mini folder because any time you go anywhere they will ask you questions about things which you won’t know and they won’t know how to access!”
Sadly though the issue doesn't lie with one system, there are a couple of different systems in use (North Midlands have a different system, as do Peterborough and Stamford; both use the Athena notes system). This means that if you travel, and need to seek medical treatment, the hospital you travel to might struggle to access your notes if they are not using the same system. This is absolutely crazy and yet again assumes that we as patient's rock up to the hospital conscious and health literate, ready to explain our condition, previous conditions, suspected diagnosis and treatment plan.
The paper notes from all systems are eventually transcribed into the master NHS system, but I’ve seen and used this, and it is possibly one of the least user-friendly interfaces in use. Patients also don’t have access to it, so it is useless to you if you get home and your partner asks something specific about your appointment and you can’t remember (pregnancy brain was a real thing for me).
Three Years On...
Across the board, attendees to the Three Years On event were overwhelmingly positive about how well continuity of care improves outcomes for both mums and babies. This is so very welcome, but in my own area, this is going to be limited to the mums who have home-births or use the birthing centre. Those who are birthing at the local hospital are not under community care and therefore won’t benefit just yet. I’d imagine there are other areas in the country that are in the same boat.
I can’t help but think that for a lot of areas, a full conversion to case-loading can never take place; there is too much disconnect between community and hospital systems, and the pressure would be too much on an already overburdened and suffering system.
However, I really do think that a high quality, easy to use and accessible application could help bridge the gap between health systems, HCPs and patients, whilst potentially solving a lot of problems outlined above. From sharing of data and communication, to a personalised and tailored care plan with connectivity to one point of contact all the way through with roll-out training and help centres for midwives the opportunities for improvement are vast and don't need to be costly. They just need to take in to consideration all aspects of the health sector and the needs of the people reliant on these technologies throughout their healthcare journey.