The Tommy’s National Centre for Maternity Improvement: How are we transforming maternity care in the UK?

We are developing a digital tool that will improve maternity care across the UK by better assessing a woman’s risk of pregnancy complications, with a focus on reducing stillbirth and premature birth.

The Tommy’s National Centre for Maternity Improvement is bringing together experts from around the country to develop The Tommy’s Pathway – an online medical tool that will help healthcare providers identify the pregnant women who are most at risk of giving birth prematurely or of developing complications that can lead to stillbirth. By using clinically-validated machine learning algorithms to process all the information gathered at a woman’s antenatal appointments, a risk score will be generated that will indicate her chances of experiencing complications. The tool will give personalised care recommendations in line with national guidelines and should ensure that pregnancy complications do not develop unnoticed, therefore reducing the risk of potentially avoidable preterm birth or stillbirth. 

The Tommy’s Pathway will have a dual interface, meaning that it can be accessed by pregnant women and maternity staff. The plan is that all maternity staff will be able to access a woman’s risk assessment and care plan through an online portal, ensuring continuity of care. Women would also have access to their records through a smartphone app that would provide tailored advice, helping them to be more engaged in their care.  

What have we done so far?

After receiving feedback on a basic version of The Tommy’s Pathway, our team developed an updated version that has now been registered with the Medical and Healthcare products Regulatory Agency (MHRA), meaning that it can be used within the NHS. The Pathway has now been launched in four early adopter maternity sites in England (Sheffield, Bolton, Ashford and St Peter’s, Lewisham and Greenwich), and our team have ensured that staff at these sites have received comprehensive training so that they can use the Pathway in clinical practice. Prior to the launch, the team worked closely with local Maternity Voices Partnerships (NHS working groups of women, their families, commissioners and maternity staff) at each early adopter site, to make sure that they fully understood the purpose of the tool and felt able to promote it.

Our team have been continuing to gather feedback and will refine the Pathway where necessary so that it meets the needs of both pregnant women and healthcare professionals. Our digital team have developed a way in which users can provide feedback from within the Pathway itself, and our patient and public involvement team have also carried out workshops to find out women’s views, such as their thoughts on the language used within the Pathway.

What are the next steps?

Our ultimate aim is for The Tommy’s Pathway to be rolled out nationally so that it can be used by all pregnant women in the UK. To do this, our team will first carry out a study that will evaluate the use of The Tommy’s Pathway at the four early adopter sites. They want to find out what women, midwives and doctors think of the Pathway, and see how it is used in the real world. In particular, our team want to know if there are any barriers that are stopping women or healthcare professionals from using the Pathway. They also want to make the Pathway accessible to more women by translating it into 23 different languages and by allowing healthcare providers to set up an account for a woman if she is unable to do it herself. Once this stage has completed, the plan is to roll out the Pathway further and assess its impact at 25 maternity units in the UK.

As well as this work, the team want to add new elements to The Tommy’s Pathway. For example, the Pathway will be adapted for use in early pregnancy, meaning that it could be used to facilitate improved miscarriage care in line with national treatment guidelines. A postnatal mental health questionnaire will also be added, which can flag whether a woman may benefit from additional mental health support after the birth of her child. Similarly, the team want to add a section that gives postnatal health advice and support to women who suffered from either diabetes or high blood pressure during pregnancy, as these women are at greater risk of developing these conditions in the future.