Post-pandemic planning for maternity care for local, regional, and national maternity systems across the four nations

BACKGROUND One in 10 pregnant women contract COVID, but all are affected by pandemic-associated maternity service reconfiguration. AIMS To study the pandemic impact on maternal and offspring outcomes, focussing on virtual care, out-of-office monitoring, and the evolving vaccination strategy, to strengthen maternity services post-pandemic. OBJECTIVES 1) For all pregnancies, to study the impact on maternity care quality (effectiveness, safety, and acceptability), pregnancy outcomes, and costs within the context of maternity service configurations, particularly virtual consultations, out-of-office monitoring (eg, self-monitored BP), and COVID-19 vaccination (ie, provision, uptake, and adverse events): 2) Explore and describe the perceptions and experiences of pregnant and postpartum women during the pandemic, with a focus on those who: - identify with an ethnic minority group; - have medical or mental health co-morbidities; and/or - live with social complexity, including socioeconomic deprivation. 3) Across the four nations, engage with stakeholders to develop policy interventions for local, regional, and national health systems. METHODS Work Package (WP)1: QUANTITATIVE - describe, quantify, and explain We will use routinely-collected, linked maternity, mental health, and offspring data from the MRC-funded early-LIfe data cross-LInkage in Research platform ( 35,000 records currently) from a diverse area, South London. We will describe and quantify temporal trends in relevant health outcomes and costs, by service reconfiguration and inequalities (as above), using segmented and individual-level multivariate regression. We seek a coherent pattern of results to be interpreted in light of WP2 findings. WP2: SOCIAL SCIENCE - enrich understanding In-depth interviews with a maximum diversity sample of 90 pregnant/postpartum women, care-providers, and policy makers, with lived experience of maternity services during the pandemic. Interview schedules will explore what changed in care, its personal meaning, and confidence about care, analysed qualitatively (eg, thematic framework analysis). Questionnaires administered to maternity service users nationally ( 43,000) via the COVID Symptom Study (CSS) Biobank, recruiting participants from the King's College London-CSS/ZOE app, to understand vaccine uptake, hesitancy, and side effects. WP3: STAKEHOLDER ENGAGEMENT Regional listening events ('imaging our best future') in each UK nation will assess WP1 and WP2 findings; brainstorm, shortlist, and prioritise high-impact future actions; and understand relevant facilitators and barriers to implementation. National Policy Lab ('co-production for action') to explore listening event findings and produce an 'imagine our best future' report for dissemination. TIMELINES 01/Aug/2021 to 30/Jul/2023 DISSEMINATION Will be through established networks of local, regional, and national stakeholders, through engagement events across the four nations, virtual engagement (webinars, social media), academic publications, website, and report. IMPACT will be on: - Patients: improve care quality; - NHS maternity providers: evidence-inform service reconfiguration and vaccine role-out; - NHS Long Term Plan: address maternal and fetal/newborn death and morbidity and support digitally-enabled care implementation; - Society: innovation to commercialise and decrease costs.