A service evaluation of Level 2 maternal critical care in a regional maternity unit: challenges and recommendations

Introduction: Childbearing women who become acutely ill during the perinatal period should have access to critical care of an equivalent standard as other sick patients to improve outcomes for this population (Knight et al., 2016, 2023). However, the actual number of women who become critically unwell within maternity services is significantly underestimated (Cranfield et al, 2023). There is therefore a need for the current provision of level 2 Maternal Critical Care (MCC) to be better understood (RCOA, 2018) alongside understanding the needs of the midwifery workforce to meet MCC demands. This study was conducted in the acute settings of a regional maternity unit to appraise the provision of level 2 MCC within a Health and Social Care Trust (HSCT) and the extent to which the demands of the service are aligned with the skills and confidence of the midwifery workforce.

Methods: A service evaluation informed by the Enhanced Maternity Care framework (RCoA, 2018), which included:

1) a 6-month dataset of women receiving level 2 MCC

2) a workforce profile of staffing levels and skills training for MCC

3) an online survey of midwives' confidence in MCC

Findings: Disparities exist between the care settings where deterioration occurs, the midwifery skill mix in these settings and the confidence of staff to provide Level 2 care.

Discussion and conclusion: organisational changes are required to ensure that service demands are aligned with a skilful, confident workforce. Educational research is needed to address the challenge of attaining and maintaining MCC skills in the midwifery workforce.