NHS overhauls clinical standards to reduce maternal deaths

Every maternity service in England will need to meet new clinical standards, set out by the NHS, to significantly reduce the number of women who die each year during or after pregnancy.   

All pregnant women will be offered an early risk assessment for venous thromboembolism – blood clots that form in deep veins and are now the leading cause of maternal mortality – before their first antenatal appointment. Anyone identified as high risk will be offered thromboprophylaxis (blood thinners to prevent clots) within 72 hours.

Every woman with epilepsy will have access to a local specialist team for managing epilepsy in pregnancy and will be offered a tailored plan to help control seizures, including timely access to medications that are safe to use in pregnancy.

Women will also be routinely assessed for their mental health with a consistent set of questions and a report provided at their antenatal appointment and referred to specialist NHS perinatal mental health if needed so they can get the right support.

Between 2022 and 2024 maternal suicides remained the leading cause of maternal death occurring between 6 weeks and 1 year after the end of pregnancy, with deaths from psychiatric causes accounting for 33% of deaths in this period.

Women experiencing a haemorrhage or significant bleeding after birth will receive care from specialist obstetricians and anaesthetists sooner, with new guidelines and thresholds for significant blood loss to be escalated earlier.

Full roll out of these national measures by March 2027 is expected to reduce the number of deaths caused by blood clots, strokes, cardiac disease, suicide, sepsis, obstetric haemorrhage and pre-eclampsia, which account for 52% of maternal deaths.

Progress against each clinical standard must be presented to NHS trust boards with escalation to regional and national level if local delivery does not meet expected plans.

Though maternal mortality in England is rare, the majority of all maternal deaths are caused by medical conditions that pre-date or develop during pregnancy – such as blood clots and strokes (17%) and cardiac disease (15%) – that can be missed or misattributed to pregnancy.

The latest official data found there were 252 maternal deaths from 2022 to 2024, compared with 257 between 2021 and 2023.

Of all women who died during or after pregnancy from 2021 to 2023 research shows improvements in care may have made a difference to the outcome for almost half (45%).

Kate Brintworth, Chief Midwifery Officer for England said: “Every death during or after pregnancy is a tragedy especially when differences in care may have changed the outcome.

“We still see symptoms of serious medical problems being missed, especially for Black and Asian women.

“By setting out these clinical standards and holding hospitals to account we can significantly reduce avoidable deaths and prevent future tragedies.

“1 in 5 women will have a medical issue during pregnancy, yet many of these aren’t caught early enough – these measures, including more risk assessments in early pregnancy, will ensure no stone is left unturned.”

The new best practice standards form part of the NHS’s maternal care bundle, developed with frontline clinicians, women and families, and partner organisations including Royal Colleges, regulatory bodies, professional societies and charities.

They cover 5 areas of clinical care associated with the leading causes of maternal deaths, as identified by MBRRACE-UK reports.

As part of the measures, facilities within maternity services will be upgraded with direct telephone lines to maternity staff to help ambulance crews transfer pregnant women to labour wards quickly and implement new monitoring for pregnant women so any deterioration can be acted on quickly. Up to £5 million has been allocated to NHS trusts this year to buy equipment and implement the maternal care bundle.

This announcement comes on the back of the roll out of a new national signal system to stop and spot emerging safety concerns in maternity wards.

The Maternal Outcomes Signal System (MOSS) is digital tool which rapidly analyses data being routinely recorded by maternity teams on wards to spot whether there are potential emerging safety issues which need urgent attention and action.

The NHS is committing to publishing the findings from MOSS every 6 months, to ensure steps are taken to reduce safety concerns in trusts which flag them up.

The new clinical standards strengthen the role of 17 maternal medicine centres – centres of excellence established by the NHS across England – to help women with pre-existing medical conditions, or conditions that arise during pregnancy to quickly get the extra care they might need.

Each specialist hub is led by a dedicated multidisciplinary team, including at least 1 obstetric physician – doctors who are specialists in medical problems and treatments during pregnancy.

Networks linked to these centres ensure that access to expert maternal care is available to all women and that every maternity department is aware of key ‘red flag’ symptoms in pregnancy and have measures in place so women can be properly assessed.