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In progress

Improving escalation in maternity care


This study aims to build the evidence for how to improve escalation of care when healthcare professionals detect that a baby might be in distress during labour. Our previous studies on intrapartum electronic fetal monitoring and the management of impacted fetal head identified a need for clearer processes to escalate concerns when fetal deterioration is suspected.

High-quality guidance on the best ways of calling for help, communicating effectively with those in labour and their birth partners, demonstrating good teamwork, and the appropriate actions to take if concerns about the baby remain will be valuable to maternity staff.

These processes must be explicit, evidence-based, actionable, and equitable. Working with health professionals and for those using maternity services, this study aims to co-design a high-quality escalation approach and supporting resources.


The approach will be co-designed with healthcare professionals, women, and people with recent experience of maternity care.

Using a combination of interviews, consultation events, clinical simulations, and a survey, we will:

  • Identify evidence-based principles for good escalation processes to respond to possible fetal deterioration during labour
  • Co-design a framework for what good looks like in maternity escalation, working with healthcare professionals, women, people with recent experience of maternity care, and others
  • Co-design a package of resources to support good escalation practice

We will use participatory methods to listen to the needs and preferences of a wide and diverse range of people, especially those who work in and those who use maternity services.

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Funding and ethics

This study is funded by the Health Foundation’s grant to The Healthcare Improvement Studies Institute (THIS Institute). It is being jointly led by THIS Institute in collaboration with the PROMPT Maternity Foundation. This study has received ethics approval from the Health Research Authority (IRAS project ID: 237331; Reference:18/WM/0292)

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