Maternity Matters
To continue to improve patient safety and the patient experience (SaTH, 2007)
What is Maternity Matters?
• The new DOH Maternity Strategy has been developed in
close consultation with key professionals from the Royal
College of Midwives, the Royal College of Obstetricians and
Gynaecologists, other Royal Colleges and the voluntary
• Published in April 2007
• To be achieved by end of 2009
Maternity Matters
There are 4 National Choice Guarantees described:
1. Choice of how to access maternity care
2. Choice of type of antenatal care
3. Choice of place of birth
• Homebirth
• Birth in a local facility including a hospital under the care
of a Midwife
• Birth in a hospital supported by a local maternity care
team which includes Midwives, Anaesthetists and
Consultant Obstetricians
4. Choice of place of postnatal care
Maternity Matters
In addition to these choices:
• A woman may choose to access maternity services outside
her area with a provider that has capacity
• Every woman will be supported by a midwife she knows
and trusts throughout her pregnancy and after birth
Main themes of Maternity Matters
Choice of how to access maternity care
• When women discover they are pregnant they should be
able to go straight to a Midwife if they wish
• In Shropshire, most mothers access maternity care via their
• Bridgnorth, Ludlow and Oswestry offer pregnancy tests and
direct access to a Midwife
Main themes of Maternity Matters
Choice of type of antenatal care
• Women and their partners will be able to choose between
midwifery care or care provided by a team of maternity
health professionals
• In Shropshire, most mothers have a choice of shared
antenatal care or Midwife led care
• Antenatal care is offered by Midwives in the following
settings: All Midwife Led Units, GP Surgeries, RSH and
PRH, Children’s Centres and at home
Main themes of Maternity Matters
Choice of place of birth
In Shropshire, the following options for place of birth
are offered to women:
• Home
• The Midwife Led Units in Bridgnorth, Ludlow, Oswestry,
Shrewsbury and Wrekin
• The Consultant Unit at Shrewsbury
• Waterbirth is also available in the Low Risk Units and can
be provided in individual homes
Main themes of Maternity Matters
Choice of place of postnatal care
• After going home women will have a choice of how and
where to access postnatal care
• In Shropshire postnatal care occurs in a variety of settings,
including: RSH Consultant care, midwifery care at the 5
Low Risk Midwifery Units, home and Children’s Centres
Main themes of Maternity Matters
Continuity of care
• Maternity matters supports patterns of care where mothers
have a known Midwife caring for her during her pregnancy
and postnatal period and individual support throughout
• Although the above type of care is not currently
commissioned in Shropshire, we do strive for continuity of
carer antenatally and postnatally, and one to one care in
Maternity Matters: Commissioner Led
The Self Assessment
• A tool has been designed to assist Commissioners to complete a self
• Part of DOH Annual Health Check
Maternity Joint Commissioning Group developing a
Maternity Strategy
• Chaired by Cathy Smith – Head of Midwifery
• 20 members includes Public Health, PCT Commissioners, Children
Centre Leads, Domestic Violence Leads, Breastfeeding Leads,
Mental Wellbeing Leads, SaTH Contract Officer
To improve partnership working and delivering a coherent vision for the
future of health and social care in Shropshire (SaTH, 2007)
Actions towards achieving Maternity Matters
A number of actions have already been decided and include:
• Promoting direct access to Midwife for antenatal care
• Review the system for allocating appointment times
• Access demand and feasibility for holding evening
obstetric clinics
• Agree actions required to support mothers with mental
health problems
• Develop join care pathways with adult mental health
• Develop a drug awareness manual for GP’s, Health
Visitors and Midwives
Actions towards achieving Maternity Matters
• Agree actions required to support mums suffering domestic
violence (care pathways, guidelines and training)
• Establish system for translation of written information into
foreign languages as required
• Use the new midwifery IT system to monitor first antenatal
appointments, identify immigrants, travellers and asylum
seekers and track outcomes, review how other areas
support this group of patients
Maternity Matters: Statement or Question
• West Midlands Region has the highest perinatal mortality
rate in England, and the gap is widening
• 1.0% above the England rate in 1993, 1.9% above in 2005
P erin atal M o rtality
P e rina ta l M o rta lity R a te 2 0 0 3 -5
C rude R ate
0 .1 1 1
0 .1
0 .0 8 6
0 .0 8 4
0 .0 5 6
0 .1 6
0 .1 1 1
0 .1
0 .0 8 6
0 .0 8 4
(4 )
(3 )
(2 )
(2 )
(6 )
D e p riva tio n
D e p riva tio n S c o re (IM D 0 4 )
32. 2 to 52 .2 (6)
21. 8 to 32 .2 (7)
16. 4 to 21 .8 (9)
10. 7 to 16 .4 (8)
Maternity Matters: Statement or Question
• Higher than average death rates occur amongst babies born
in black and ethnic minority populations; babies of teenage
mothers; babies registered at birth by one parent rather than
• Some areas have very high levels of deprivation
• Babies born in the most deprived areas of the country are 6
times more likely to die in infancy.
Maternity Matters: Why?
• The Confidential Enquiry into Maternal Deaths showed
women living in families where both partners are
unemployed, many with features of social exclusion are 20
times more likely to die as a result of childbirth than women
in advantaged groups
• Single mothers are 3 time more likely to die than those in
stable relationships
Maternity Matters: Why?
• Women living in the most deprived areas have a 45%
higher death rate compared to those living in other areas
• 30% of domestic violence starts or escalates during
• High rates of miscarriage, low birth weight, premature birth,
fetal injury and fetal death
• 16% of all women (many under 18 years of age) delay
seeking maternity care until they are five or more months
Maternity Matters
• Maternity care provides a unique opportunity for health care
professionals to meet and support women, partners and
their families who might otherwise never or rarely access
health services
• Healthy mothers tend to have healthy babies
• A mother who has received high quality maternity care
throughout her pregnancy is well placed to provide the best
possible start for her baby

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