NHS rolls out specialist medical care centres for women during pregnancy

Pregnant women with serious medical problems will now have access to specialist treatment centres across the country.

The 17 new centres of excellence will help women with pre-existing medical conditions, or conditions that arise during pregnancy to quickly get the extra care they might need.

As part of the NHS commitment to halve the maternal mortality rate by 2025, a wide ranging team will be on hand to provide specialist medical advice before during and after pregnancy, bringing together expert physicians, obstetricians, midwives, nurses and other clinicians in one place.

There is at least one centre in every region of the country, including at Guy’s and St Thomas’ and St Georges in London, Oxford University Hospitals, and across Liverpool, Manchester and Newcastle.

Networks linked to these centres ensure that access to expert maternal medicine care is available to all women. They also ensure that all maternity services and emergency departments are aware of key ‘red flag’ symptoms in pregnancy and have measures in place so that pregnant women can be appropriately assessed by a specialist physician or obstetrician.

Though maternal mortality in England is very rare, the majority of maternal deaths are caused by medical conditions that pre-date or develop during pregnancy – such as cardiac disease (23%), blood clots (15%) and epilepsy and stroke (13%) – that can be missed or misattributed to pregnancy.

The NHS is ensuring that each specialist hub is led by a dedicated multidisciplinary team, including at least one obstetric physician – doctors who are specialists in medical problems and treatments during pregnancy.

Professor Jacqueline Dunkley-Bent, England’s Chief Midwifery Officer, said: “We know that pre-existing medical problems are a significant factor in the variation in rates of mortality for Black and Asian women.

“The establishment of these maternal medical networks will improve every woman’s access to specialist care for medical problems in pregnancy and will play an important part in our wider efforts to improve care for women and babies right across our maternity services.”

Figures show one in five women will have a medical issue during pregnancy, and every network will ensure women who need specialist care receive medications and procedures that are safe in pregnancy, from an expert team who can advise on how to optimise those treatments.

Most conditions, like well-managed diabetes, can be safely managed locally. Some women may be sent for an initial assessment at one of the centres, where they will be set up with a personalised management plan that they can continue at home, with support from their local maternity team.

The most serious cases will be treated at these 17 centres, where they will be closely monitored and provided with specialist treatment throughout their pregnancy.

Dr Matthew Jolly, National Clinical Director for Maternity and Women’s Health, said: “For a number of years too often we have seen symptoms of serious medical problems being missed or misattributed to pregnancy.

“Maternal Medical Networks and their specialist centres are a vital step in improving the identification and management of potentially fatal medical conditions in pregnancy, wherever a woman receives care, and to ensure England continues to improve in its position as one of the safest countries in the world to give birth.”

While maternity providers already offer services ranging from midwife-led diabetes clinics, to joint clinics with physicians from particular specialties – the new Maternal Medicine Networks will work with local GPs, emergency departments, and community midwifery services to ensure all pregnant woman can access these services when needed.

Previously, there were fewer than 10 obstetric physicians in the country, but the NHS has already funded the training of a further six consultants, with three more due to start by the end of next year, as part of the commitment to have obstetric physicians in place in every maternal medicine centre and, in line with Donna Ockenden’s Final Review, establish a sustainable training pathway for them with the Royal College of Physicians and Health Education England.

Lucy MacKillop, Consultant Obstetric Physician at Oxford University Hospitals and Regional Obstetric Medicine Lead and Chair for the Thames Valley Maternal Medicine Network, said: “I am very proud to chair the Thames Valley Maternal Medicine Network, a group of dedicated health professionals helping to ensure that women and families get the personalised care and support they need at such a special time in their lives.

“We serve a population of around three million people, with around 40,000 births a year in our geographical footprint, and it is vital that we support everyone with significant medical conditions that pre-date or arise in pregnancy so they have equal access to timely specialist care and advice.

“We support people with complex medical needs before, during, and after their pregnancy, and our aim is to give them and their babies the best care and safest experience possible.

“As President of the MacDonald Obstetric Medicine Society, we welcome the recognition of the vital role Obstetric Physicians can play in these networks, and the recent investment in training these specialists to care for pregnant people with the highest risks of complications during or soon after pregnancy.”

Minister for Mental Health and Women’s Health Strategy Maria Caulfield said: “We’re working hard to make sure giving birth in the UK is as safe as possible – including for anyone with pre-existing medical conditions.

“Specialist treatment centres provide access to medical care for conditions that exist before, or arise during pregnancy. Working with other health professionals, the centres will ensure maternity and medical staff can provide the right support as soon as its needed.

“We are improving the quality of NHS care for mothers and babies and have invested £127 million to grow the workforce and improve neonatal care.”

The NHS is investing £165 million annually for maternity services across England, to help ensure services are providing safer and more personalised care for women and their babies.

While the Long Term Plan committed to halving maternity-related deaths, stillbirths, neonatal mortality and serious brain injury by 2025.

Gill Bennett, aged 42, from Buckinghamshire, developed complications three months into her second pregnancy with her daughter Emily. She began experiencing severe dizzy spells, but it wasn’t until a routine midwife appointment that she was referred to a cardiologist and diagnosed with arrythmia – a potential cause for concern for both mother and baby.

Gill was prescribed medication and her symptoms improved periodically but then the dizzy spells started again, and she reached a point where she didn’t feel safe to be at home alone.

One afternoon it became so bad that she went to her local hospital Stoke Mandeville. They sent her straight to Wycombe’s cardiology unit who then rushed her to the John Radcliffe Hospital in Oxford in an ambulance, where she spent the week in the cardiac critical care unit. Gill said: “It was extremely frightening, I could sense the urgency and seriousness of the situation and at 28-weeks pregnant, I thought I may not make it.”

Since then Gill has been cared for under the specialist maternal medicine centre at the John Radcliffe. Gill said: “The care I’ve received at the John Radcliffe has been phenomenal and my family and I are so grateful to the teams who have treated me. I was looked after by specialists in both cardiology and obstetrics for the last two months of my pregnancy and I felt in very safe hands. They stabilised my heart and made sure that my baby was okay and my obstetrics care was then moved to the ‘Silver Star Unit’, the John Radcliffe’s specialist maternal medicine team, and Emily was born safe and healthy at the hospital in June at 39 weeks by caesarean section.”

“The communication between teams at the John Radcliffe and my local hospitals Stoke Mandeville and Wycombe has been great – from getting me to the John Radcliffe so quickly that night to working together to determine how best to care for me and my baby. They clearly have a really strong network of specialists, who it seems are always talking to each other to work out what’s best for their patients, and they have always been so responsive to my needs.

“I had no idea I had a heart condition until my second pregnancy, and it’s scary to think that my daughter Emily and I may not be here today if it hadn’t been for the specialist care I’ve received at the Radcliffe – I can’t thank them enough for everything they’ve done and for their ongoing support and care.”