Aug 212017

Elinore Macgillivray, National Lead Midwife OBS Cymru

It’s an exciting time in any family’s life when a new baby is expected. With all the assurances of modern healthcare, the expectation is for a pregnancy to end with a healthy mum and baby. Still, for 1 in 20 women obstetric blood loss will be in excess of 1 litre, and for 1 in 200 life threatening bleeding will occur, leading to a number of adverse physical and emotional consequences. Rarely (around once every 3 years in Wales) postpartum haemorrhage (excessive bleeding after childbirth) will result in a baby that goes home without its mother.

Postpartum haemorrhage (PPH) continues to be one of the leading causes that adversely affects maternal well-being (morbidity) in Wales and is in the top 5 quality issues for every maternity unit. OBS Cymru – the Obstetric Bleeding Strategy for Wales is a 3 year national quality improvement project aiming to reduce harm from postpartum haemorrhage. The primary aim of the project is to reduce the number of women suffering a massive obstetric haemorrhage. It also aims to reduce the amount of blood products given, critical care admissions and hysterectomies performed due to PPH.

Over the last 10 years Cardiff and Vale University Health Board has been leading research into understanding the role of blood clotting in PPH. During the sequential research projects undertaken, a reduction in PPH associated morbidity was observed; felt to be not only linked to the impact of the research projects, but to multiple changes in practice.  Following discussion between delivery units across Wales, the themes listed below were identified as crucial to improving mother’s outcomes, and informed the OBS Cymru approach.

How are we going to achieve our aim of reducing harm from PPH?

Wales is in a privileged position of having a dedicated Maternity Network that engages stakeholders from all over country, and provides a forum for sharing ideas, and supporting quality improvement and standardisation nationally. A number of interventions have already been put in place across all Obstetric led labour wards in Wales:

  • Risk Assessment – each woman admitted to an obstetric lead labour ward in Wales will have a standard PPH risk assessment completed, in order to identify those at increased risk.
  • Early identification by means of Measuring Blood Loss – traditionally, we have estimated blood loss following birth, a practice that we are woefully poor at. We are now moving rapidly towards measuring all blood loss following all births, with training supported by the project team.
  • Multidisciplinary Team Working – we have developed a 4 stage PPH management tool which supports a unified approach to multidisciplinary team working. OBS Cymru funds champion teams in each of Wales’ 7 Health Boards consisting of a midwife, anaesthetist, obstetrician and haematologist. These teams have been vital in delivering quality improvement messages.
  • ROTEM point of care testing – machines have been installed in every labour ward in Wales to allow access to rapid coagulation results and guide blood product management.

Of course, in order to demonstrate the positive changes we are expecting, we have a robust system of data collection supported by local OBS Cymru champion teams. This is already beginning to show some positive changes in practice.

Events such as this year’s UK Patient Safety Congress also provide invaluable network opportunities with health professionals all across the UK, and further afield, who share a common interest and commitment to quality improvement in maternity care. These collaborations will allow us to spread improvements across not just Wales, but the rest of the world.

As one of the national midwife leads for OBS Cymru, I passionately believe that this project will have a significant positive impact on reducing harm from postpartum haemorrhage.  After all, no matter what part we play, a healthy mother and baby is what we all strive for.

For more information on OBS CYMRU visit our page

Apr 082016
Claire Roche, Maternity Network Wales manager

Claire Roche, Maternity Network Wales manager

A few weeks have now passed since the “Better Together” conference held on the 17th March in Cardiff which has allowed some time for reflection on our first collaborative national maternity conference in Wales.

As the Maternity Network Manager, it was a real privilege to work in partnership with my colleagues in the Royal College of Midwives and the Royal College of Obstetricians and Gynaecologists. Certainly the months and weeks leading up to the conference were extremely busy and I learnt that organising a large event takes a lot of time, requires a huge amount of planning and most importantly cannot be done in isolation! It requires partnerships and good team work and the hard work of the Programme Support Team in 1000 Lives, RCM colleagues and key network members enabled us to achieve things together.

Essentially, as a conference planning team we were “Better Together”!

During the day, there was a positive energy and a real buzz of enthusiasm and commitment. Many colleagues I talked to on the day valued the contribution of speakers such as Dr Bill Kirkup, Professor Cathy Warwick and Professor Alan Cameron. People spoke to me of the value of hearing colleagues from the RCM and RCOG present the colleges’ collaborative work together and they also valued being at a multi-disciplinary conference where the focus was on maternity care, rather than midwifery or obstetrics in isolation.

Concurrent sessions were delivered by a midwife and doctor; obstetrician or anaesthetist, standing together presenting their work. The presentations were informative, interesting and inspirational. It seemed to me that the presenters were also “Better Together”.

Maternity Network Wales is now over a year old. I feel that the conference was a little bit like our first birthday party with lots of friends! We have developed strong relationships with the RCM, the RCOG, Health Boards, Universities and many other stakeholders involved in maternity services in Wales. We are committed to building and nurturing these relationships and developing new relationships that aim to work together to improve outcomes for mothers and babies in Wales. We know that positive, professional, collaborative partnerships create cultures where patient safety and quality improvement are central to the core value of the service. Without the foundation of a positive culture where different professions value each other, improvements in care will be difficult to achieve.

Let’s build on the values of the conference. Let’s be committed to all working together to create, maintain and nurture positive cultures that will be responsive and ready for quality improvement programmes that focus on patient safety and improved outcomes for mothers and babies. As the network manager, I commit that the network will continue to work in partnership with all those that either use or provide maternity care. Ask yourself, your team, your organisation – what will you commit to?

Remember, we are “Better Together”.

May 082015
Claire Roche

Claire Roche

Two weeks have passed since I attended the International Forum on Quality and Safety in Healthcare (#Quality2015) with colleagues from NHS Wales. It was a Forum packed full of learning and here are some of my highlights from across the three days.


Continue reading »

Apr 242013
Mikaela Alexander

Mikaela Alexander

How do you motivate health care professionals to think innovatively, safely and improve quality? The president and CEO of Institute for Healthcare Improvement Maureen Bisognano did just that at the 18th International Forum on Quality & Safety in Healthcare.

Maureen’s inspirational speech “All teach, all learn” introduced the simple reminder to embrace empathy to accomplish effective, high-quality patient-centred care. Continue reading »