Apr 052019

Midwifery is renowned for being one of the most rewarding professions there is; however as so many midwives will testify it is also at times one of the most challenging. It is however incredibly rare to be given the opportunity to take part in quality improvement projects which not only see almost immediate benefits to the women we care for; but which also shape the profession and wider clinical practice. OBS Cymru – the Obstetric Bleeding Strategy for Wales- has been one such project. OBS Cymru is the result of research which began in Cardiff over 10 years ago, and developed over time into an evidence based, highly effective strategy for managing Postpartum Haemorrhage. This approach has now been rolled out to every health board in Wales and has significantly changed practice, seemingly overnight (no mean feat as I’m sure you’ll agree).

Each Consultant Led Unit’s (CLU) OBS Cymru Champion Team have overseen the implementation of the project. I have had the honour of being one of the Champion Midwives in Ysbyty Glan Clwyd in North Wales and I can honestly say it has been more rewarding and equally more influential to my practice than anything I’ve been a part of previously. Simple evidence based interventions with an emphasis on early recognition of PPH through Risk Assessment and measuring blood loss rather than estimating it. This was a major change in practice but one which was adopted by all staff and with remarkable results. Change is inevitable in Maternity care but it is not always so easily achieved!

As Champion Midwives we have encouraged truly multidisciplinary team working and training, generating remarkable and undeniable results for women in our care. The success for OBS Cymru in our unit has been largely due to the engagement of the support workers and midwives. They led the change to measuring blood loss and instigating early recognition and management of PPH.

OBS Cymru as a QI project has now drawn to a close. However, I don’t see this as signifying the end of the OBS Cymru work. Rather, primarily it is an opportunity to reflect on just how far we have come as a nation that is leading the way in effective management of PPH. But in addition it is an opportunity to look to the future and plan our own strategies for ensuring this invaluable work continues and embeds even further into everyday practice.

I feel fortunate to have worked with such an enthusiastic, motivated and knowledgeable team who will help this work continue and who will drive forward change to achieve the best for the women in our care. For us OBS Cymru is here to stay!

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