Implementation support toolkit
Introduction
With around 600,000 births in England and Wales each year, the antenatal period is an excellent opportunity to provide support and information to pregnant women and pregnant trans men and non-binary people (and their families) about pregnancy-related health and care topics, birth, and the postnatal period, and to assess their risk of complications. Even if someone is fit and healthy during their pregnancy, concerns and complications can still happen. Good quality antenatal care is vital to identify and deal with potential problems and reduce the chance of poor outcomes for both the woman or person giving birth, and their baby.
NICE has published several key pieces of guidance in relation to pregnancy and antenatal care (see the NICE topic page on pregnancy). This includes, NICE guidelines on:
The guidelines provide evidence-based advice for the provision of high-quality individualised care for women and their families and empower them to make informed choices about their care. Implementation strategies aim to help ensure that disparities in outcomes and experiences of mothers and their babies are reduced and that maternity services can deliver the best possible care in what are often very difficult and challenging working environments.
Marie Anne Ledingham, Consultant Clinical Advisor, NICE, Consultant Obstetrician, NHS GGC
What we have done
We have reviewed the data associated with the uptake of its quality standard on antenatal care. This quality standard describes 5 priority areas for quality improvement in antenatal care and consists of a prioritised set of specific, concise, and measurable statements. It draws on existing NICE guidance that provides an underpinning, comprehensive set of recommendations.
The 5 priority areas for improvement in antenatal care are as follows.
In the antenatal period, women and pregnant people:
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are supported to access antenatal care by 10 weeks of pregnancy
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have a risk assessment at routine antenatal appointments
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have coordinated care from a small team of midwives
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are offered vaccinations at routine antenatal appointments
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if they or their partners smoke, are referred for stop-smoking support and treatment at routine antenatal appointments.
Data and system intelligence showed notable variation in the following areas:
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Attendance at the first antenatal ("booking") appointment by 10 weeks of pregnancy.
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The recording of recommended risk assessments in the first, and subsequent, antenatal appointments.
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Carbon monoxide testing of women and pregnant people at their 10 and 36 week antenatal appointment.
The data and system intelligence also reinforced the existence of, and ongoing need to address, a known unacceptable level of health inequalities experienced by some ethnic groups across maternity and neonatal care.
We have developed this toolkit in collaboration with system partners. It provides implementation advice, support and resources that may be useful to support commissioners, providers and practitioners to implement NICE guidance.
For targeted support on how to try and reduce the unwarranted variation in these identified areas, see the sections on routine antenatal appointments, ethnic health inequalities and smoking.
Contact details
If you have any feedback on this toolkit, please email the National Implementation Team: nationalimplementation@nice.org.uk
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