Quality standard

Quality statement 2: Maternal health – potentially serious conditions

Quality statement

Women are advised, at the first postnatal midwife contact, of the symptoms and signs of potentially serious conditions that require them to seek medical advice without delay.

Rationale

Women are at an increased risk of experiencing serious health events in the immediate hours, days and weeks following the birth, some of which could lead to maternal death or severe morbidity. Providing women with information about the symptoms and signs that may indicate a serious physical illness or mental health condition may prompt them to seek medical advice without delay and avoid unnecessary deaths and severe morbidity.

Quality measures

Structure

Evidence of local arrangements to ensure that women are advised, at the first postnatal midwife contact, of the symptoms and signs of potentially serious conditions that require them to seek medical advice without delay.

Data source: Local data collection.

Process

The proportion of women who are advised, at the first postnatal midwife contact, of the symptoms and signs of potentially serious conditions that require them to seek medical advice without delay.

Numerator – the number in the denominator who are advised, at the first postnatal midwife contact, of the symptoms and signs of potentially serious conditions that require them to seek medical advice without delay.

Denominator – the number of women who have given birth.

Data source: Local data collection.

Outcome

a) Incidence of potentially avoidable maternal morbidity and mortality.

Data source: Local data collection. The Healthcare Quality Improvement Partnership's Maternal, Newborn and Infant Clinical Outcome Review Programme (undertaken by MBRRACE-UK) reports on rates of maternal death and severe maternal morbidity.

b) Women who have given birth feel informed about symptoms and signs of potentially serious postnatal conditions.

Data source: Local data collection.

What the quality statement means for different audiences

Service providers ensure that systems are in place for women to be advised, at the first postnatal midwife contact, of the symptoms and signs of potentially serious conditions that require them to seek medical advice without delay.

Midwives advise women, at the first postnatal contact, of the symptoms and signs of potentially serious conditions that require them to seek medical advice without delay.

Commissioners ensure that they commission services that advise women, at the first postnatal midwife contact, of the symptoms and signs of potentially serious conditions that require them to seek medical advice without delay.

Women are given advice by their midwife at their first postnatal contact about the symptoms and signs of potentially serious conditions that should prompt them to seek medical advice without delay.

Definitions of terms used in this quality statement

First postnatal midwife contact

The first postnatal midwife contact should take place within 36 hours after transfer of care from the place of birth or after a home birth. [NICE's guideline on postnatal care, recommendation 1.1.14]

Symptoms and signs of potentially serious conditions

The following symptoms and signs are suggestive of potentially serious physical conditions in the woman:

  • sudden or very heavy vaginal bleeding, or persistent or increased vaginal bleeding, which could indicate retained placental tissue or endometritis

  • abdominal, pelvic or perineal pain, fever, shivering, or vaginal discharge with an unpleasant smell, which could indicate infection

  • leg swelling and tenderness, or shortness of breath, which could indicate venous thromboembolism

  • chest pain, which could indicate venous thromboembolism or cardiac problems

  • persistent or severe headache, which could indicate hypertension, pre-eclampsia, postdural-puncture headache, migraine, intracranial pathology or infection

  • worsening reddening and swelling of breasts persisting for more than 24 hours despite self-management, which could indicate mastitis

  • symptoms or signs of potentially serious conditions that do not respond to treatment.

[NICE's guideline on postnatal care, recommendation 1.2.4]

The following symptoms and signs are suggestive of potentially serious mental health conditions in the woman:

  • severe depression, such as feeling extreme unnecessary worry, being unable to concentrate due to distraction from depressive feelings

  • severe anxiety, such as uncontrollable feeling of panic, being unable to cope or becoming obsessive

  • the desire to hurt others or yourself, including thoughts about taking your own life

  • confused and disturbed thoughts, which could include other people telling you that you are imagining things (hallucinations and delusions).

[Definition adapted with expert group consensus from RCOG's good practice guidance on management of women with mental health issues during pregnancy and the postnatal period, section 5]

Equality and diversity considerations

Communication and information‑giving between women (and their families) and members of the maternity team is a key aspect of this statement. Relevant adjustments will need to be in place for anyone who has communication difficulties, and for those who do not speak or read English. Written and verbal information should be appropriate for the woman's level of literacy, culture and language.