To mark World Patient Safety Day, Professor Alan Cameron gives his reflections on safety in maternity care. Alan is Clinical Lead for Obstetrics with Healthcare Improvement Scotland.

In maternity care, safety is all about the safe delivery of a baby and a healthy mother. These cannot be achieved without a team working together effectively. The team involved can consist of midwifery, obstetric and neonatal staff – and, depending on the complexity of a pregnancy, specialist midwives and subspecialists in maternal fetal medicine may also be involved.

A good example of where combined care is needed is when a mum to be has diabetes. Here, input is required from specialist midwives, maternal fetal medicine consultants, diabetic specialist nurses, diabetes consultants and dieticians. All of these staff need to work together to make sure mum and baby are as healthy as possible.

The Essentials of Safe Care

To support teams in maternity services to work together to deliver safe care the SPSP team recently developed the Essentials of Safe Care. This is an evidence-based package of guidance and support designed to enable health care professionals to deliver safe care. Embedding the Essentials of Safe Care provides an opportunity to accelerate the sharing of learning and improvement within and between teams in maternity services.

The importance of continuous improvement

Despite tremendous efforts of all clinical staff who care for pregnant mums and their babies, there are still a small number of families who experience a poor outcome in their pregnancies.

This can be either the devastating loss of a baby after 24 weeks, a stillbirth, or the loss of a newborn baby in the first 28 days of its life, a neonatal death. Also distressing for families is where a baby requires intensive care in a neonatal unit due to complications arising before or during labour. In addition, some mums may require high dependency care following the delivery of their baby. The most common reason for this is post-partum haemorrhage, which is severe blood loss after childbirth. 

Although the rates of these complications are thankfully very low there remains a need for all staff involved in maternity care to practice safe care, using a multitude of guidelines and tools developed by SPSP MCQIC and recognised bodies such as the Royal College of Obstetricians and Gynaecologists (RCOG) and Mothers and Babies: Reducing Risk through Audits and Confidential Enquiries across the UK (MBRRACE-UK).

To support safety in pregnancy and childbirth, Healthcare Improvement Scotland has developed various packages of support using Quality Improvement (QI) to aid staff working in maternity care to reduce the rate of stillbirth and post-partum haemorrhage (PPH). These include resources to help reduce stillbirth and the four stage approach to recognising, responding to and managing PPH.

Although the guidelines and tools have been created specifically for Scotland, we know that they will be of use to maternity care staff across the world. In fact, we already know that our work in Scotland has international interest. To mark World Patient Safety Day and its focus on maternity care, I’d encourage those involved in maternity care across the world to learn from our work and to share it as widely as possible, so that all babies and mothers can benefit.

The work that we do at Healthcare Improvement Scotland is work that I I continue to be very proud of to be part of. We’ve achieved many successes and it’s great to be part of a team with the knowledge and expertise to continue to make more improvements for babies and mothers across Scotland.

Professor Alan Cameron is Clinical Lead for Obstetrics with Healthcare Improvement Scotland.

More information

More examples of the work of SPSP MCQIC and resources to help make maternity care as safe as possible are available on our website: