Better Births

Better Births
Name	Better Births
Type	national maternity strategy
Country	United Kingdom
Published	2016
Author	NHS England
Area	Public health, Maternal health, Neonatology
Status	implemented

Better Births

Better Births is a 2016 national maternity strategy published by NHS England that set out recommendations to transform maternity services across the United Kingdom. The document aimed to improve safety, personalization, and continuity of care for pregnant people and newborns by proposing workforce reforms, service integration, and data-driven quality improvement. It influenced commissioning by Clinical Commissioning Groups, informed local maternity systems, and became a reference point in debates involving Royal College of Obstetricians and Gynaecologists, Royal College of Midwives, and patient advocacy groups.

Background and Rationale

Better Births was developed against a backdrop of high-profile inquiries and reports including the Kirkup Report, the Morecambe Bay Investigation, and recommendations from National Institute for Health and Care Excellence guidance on intrapartum care. Concerned stakeholders—NHS England, Health Education England, Care Quality Commission, Department of Health and Social Care, and professional bodies such as Royal College of Paediatrics and Child Health and Royal College of Obstetricians and Gynaecologists—contributed evidence highlighting variations in outcomes between trusts such as Airedale NHS Foundation Trust and St Thomas' Hospital. The policy sought to address persistently uneven metrics reported by Office for National Statistics maternity data and international comparisons involving World Health Organization perinatal indicators.

Policy and Program Components

The strategy set out key actions: promote continuity of carer, strengthen workforce planning by Health Education England, expand choice of birth setting including alongside midwifery units and home birth support, and implement nationally consistent safety standards endorsed by Care Quality Commission. It advocated creation of local maternity systems coordinating across NHS Trusts, Clinical Commissioning Groups, and ambulance services like London Ambulance Service. Better Births emphasized data collection through linked maternity and neonatal datasets aligned with standards from Public Health England and the NHS Digital programme, and recommended adoption of quality improvement methods used by Institute for Healthcare Improvement and Avedis Donabedian-style frameworks. Workforce measures referenced professional training institutions including Queen Mary University of London, University of Oxford, and University of Edinburgh for scaling midwifery education and obstetric training.

Implementation and Service Delivery

Implementation relied on local maternity systems led by integrated teams involving midwifes, obstetricians, neonatologists, general practitioners from Royal College of General Practitioners, and allied professionals such as Health Visitors. Pilot programmes in trusts including Bristol Royal Hospital for Children, Nottingham University Hospitals NHS Trust, and Guy's and St Thomas' NHS Foundation Trust trialled models of continuity of carer and multidisciplinary hubs. Delivery mechanisms included updated clinical pathways reflecting National Institute for Health and Care Excellence guidelines, coordination with Ambulance Services for emergency transfers, and adoption of electronic maternity records interoperable with systems used by Health and Social Care Information Centre. Training partnerships were formed with universities and trusts to expand midwifery capacity and align curricula with standards from Royal College of Midwives and Royal College of Obstetricians and Gynaecologists.

Outcomes and Impact

Evaluations of Better Births cited mixed results: improvements in reported patient experience in some areas such as Birmingham Women's Hospital and Cambridge University Hospitals NHS Foundation Trust contrasted with ongoing variability in clinical outcomes like perinatal mortality measured by Office for National Statistics. Several trusts reported increased rates of continuity of carer and reduced intervention rates following implementation, echoing findings from studies associated with Cochrane Collaboration systematic reviews on midwife-led continuity of care. The strategy stimulated innovation in data linkage projects with NHS Digital and collaborations with research bodies such as National Institute for Health Research and academic units at Imperial College London and University College London. Better Births also catalysed workforce initiatives by Health Education England to increase midwife recruitment, though persistent vacancies remained a concern in areas served by trusts like Blackpool Teaching Hospitals NHS Foundation Trust.

Criticisms and Challenges

Critics argued that Better Births underestimated resource constraints and underestimated the scale of workforce shortages flagged by Health Education England and the Maternity Safety Improvement Programme. Trade unions such as Royal College of Midwives and professional groups including Society for Maternity and Neonatal Services raised concerns about implementation variability across trusts and the capacity of smaller providers like Torridge Hospital to meet continuity targets. Reviews following failures highlighted in the Morecambe Bay Investigation and Kirkup Report stressed that culture change and governance within large organisations such as NHS England and Care Quality Commission were harder to achieve than technical recommendations. Data quality limitations in national datasets curated by NHS Digital complicated robust outcome measurement and cross-trust comparisons.

International Adoption and Comparisons

Elements of Better Births—especially continuity of carer and integration of maternity networks—resonate with initiatives in countries such as Netherlands, New Zealand, Australia (including programmes in New South Wales), and models promoted by World Health Organization guidance. Comparative analyses referenced perinatal outcome datasets from Organisation for Economic Co-operation and Development and policy evaluations by Health Foundation and KPMG international health teams. While some jurisdictions like Finland and Spain have adopted midwife-led continuity approaches at scale, differences in workforce credentialing (for example between the Nursing and Midwifery Council framework in the UK and regulatory regimes in Canada and United States) shape transferability of Better Births reforms.

Category:Maternity care