Quality standard

Quality statement 2: Composition of the multidisciplinary team

Quality statement

Pregnant women with existing medical conditions are cared for by a multidisciplinary team that can access expertise in managing the medical conditions in pregnancy and is led by a named healthcare professional.

Rationale

Specialist advice is important to ensure the best intrapartum care for a pregnant woman with existing medical conditions. Having a multidisciplinary team that can access expertise in managing the medical conditions during pregnancy means this advice is readily available when needed. More than 1 expert may be involved if a woman has more than 1 medical condition. Designating a named healthcare professional to lead the team supports coordination of expertise and continuity of care. This promotes planning of personalised, holistic care during labour and birth to help reduce the risk of adverse outcomes for the woman and her baby.

Quality measures

Structure

a) Evidence that multidisciplinary teams caring for pregnant women with existing medical conditions can access expertise in managing the medical conditions in pregnancy.

Data source: Local data collection, for example, service protocols and local network agreements.

b) Evidence that a named healthcare professional is available to lead the multidisciplinary team caring for pregnant women with existing medical conditions.

Data source: Local data collection, for example, service protocols, local network agreements, maternity records and staff rotas.

Process

a) Proportion of pregnant women with existing medical conditions cared for by a multidisciplinary team that can access expertise in managing the medical conditions in pregnancy.

Numerator – the number in the denominator with a multidisciplinary team that can access expertise in managing the medical conditions in pregnancy.

Denominator – the number of pregnant women with existing medical conditions.

Data source: Local data collection, for example, audit of maternity records, emails and records of phone calls demonstrating that expertise in managing the existing medical conditions during pregnancy was accessed by the multidisciplinary team.

b) Proportion of pregnant women with existing medical conditions who were cared for by a multidisciplinary team that was led by a named healthcare professional.

Numerator – the number in the denominator who had a multidisciplinary team that was led by a named healthcare professional.

Denominator – the number of pregnant women with existing medical conditions who were cared for by a multidisciplinary team.

Data source: Local data collection, for example, audit of maternity records, emails and records of phone calls demonstrating leadership of a multidisciplinary team by a named healthcare professional.

Outcome

a) Incidence of maternal morbidity associated with an existing medical condition.

Data source: Local data collection, for example, audit of maternity records. The MBRRACE-UK Confidential Enquiries into Maternal Deaths and Morbidity reports on maternal morbidity.

b) Incidence of maternal mortality associated with an existing medical condition.

Data source: Local data collection, for example, audit of maternity records. The MBRRACE-UK Confidential Enquiries into Maternal Deaths and Morbidity reports on maternal mortality.

c) Incidence of neonatal mortality in babies of women with existing medical conditions.

Data source: Local data collection, for example, audit of maternity records. The MBRRACE-UK perinatal mortality surveillance report presents data on perinatal deaths of babies.

What the quality statement means for different audiences

Service providers (NHS hospital trusts) ensure that protocols are in place for pregnant women with existing medical conditions to be cared for by a multidisciplinary team that can access expertise in managing the medical conditions in pregnancy. They ensure that there are rotas and systems in place for the staff with expertise to be available to give advice when needed, and for a named healthcare professional to be available to lead the team.

Healthcare professionals (such as midwives, obstetricians and obstetric anaesthetists) take part in multidisciplinary meetings to plan intrapartum care for pregnant women with existing medical conditions. They ask for input from an obstetric physician or clinician with expertise in caring for pregnant women with the medical condition by phone or email if expertise is needed. A named healthcare professional takes responsibility for leading the multidisciplinary team.

Commissioners (clinical commissioning groups) ensure that services have protocols in place for multidisciplinary teams planning intrapartum care for pregnant women with existing medical conditions to access input from obstetric physicians or clinicians with expertise in managing the medical conditions during pregnancy. They also ensure that services have arrangements so that the staff with expertise are available to give advice when needed, and for a named healthcare professional to lead the multidisciplinary team.

Pregnant women with medical conditions are cared for by a team that can get advice from healthcare professionals who are experts in the medical conditions during pregnancy. The team is led by a named healthcare professional.

Definitions of terms used in this quality statement

Existing medical conditions

Medical conditions within the scope of this quality standard include:

  • heart disease

  • asthma (dependent on severity)

  • bleeding disorders

  • neurological conditions

  • obesity (BMI [kg/m2] 30 or over)

  • acute kidney injury or chronic kidney disease.

[NICE's guideline on intrapartum care for women with existing medical conditions or obstetric complications and their babies, evidence review B and expert opinion]

Multidisciplinary team

For pregnant women with existing medical conditions, the multidisciplinary team may include, as appropriate:

  • a midwife

  • an obstetrician

  • an obstetric anaesthetist

  • an obstetric physician or clinician with expertise in caring for pregnant women with the medical condition

  • a clinician with expertise in the medical condition

  • a specialty surgeon

  • a neonatologist

  • a critical care specialist

  • the woman's GP

  • allied health professionals.

The team is led by a named healthcare professional who is responsible for facilitating communication and coordinating care.

[Adapted from NICE's guideline on intrapartum care for women with existing medical conditions or obstetric complications and their babies, recommendations 1.2.1 and 1.2.2, evidence reviews A and B]

Equality and diversity considerations

Pregnant women with existing medical conditions should be provided with information to support intrapartum care planning that they can easily read and understand themselves, or with support, so they can communicate effectively with the multidisciplinary team. The information should be accessible to women who do not speak or read English and it should be culturally appropriate. Women should have access to an interpreter, link worker or advocate if needed. The interpreter, link worker or advocate should not be a member of the woman's family, her legal guardian or her partner, and they should communicate with the woman in her preferred language.

For women with additional needs related to a disability, impairment or sensory loss, information should be provided as set out in NHS England's Accessible Information Standard.