Expecting a baby can be daunting – with so many unknowns from the changes throughout pregnancy, worries around the mother and baby’s health, new financial considerations and the life-altering transition of adding a baby into the family.
The Maternity and Neonatal Safety Improvement Programme is one of the National Patient Safety Improvement Programmes, established to support the delivery of safer, higher-quality care for women, babies, and families during this period. Within this we are also supporting the Perinatal Culture and Leadership Programme and the Avoiding Brain Injury in Childbirth (ABC) programme.
The Maternity and Neonatal Safety Improvement programme currently focuses on two key workstreams:
There are many reasons that can cause deterioration in pregnancy, including pre-existing conditions that can worsen such as heart and kidney disease, as well as pregnancy specific complications like pre-eclampsia.
As part of the maternal and neonatal deterioration workstream, in the East of England Health Innovation East has been working with health and care systems to ensure that the national Maternity Early Warning Score (MEWS) and Newborn Early Warning Track and Trigger (NEWTT2) tools are implemented within an effective prevention, identification, escalation, and response (PIER) pathway for managing deterioration.
MEWS is a standardised, evidence-based tool that uses a patient’s vital signs to help identify and respond to early signs of clinical deterioration in pregnant women. As of the end of March 2026, MEWS is being used across England to support the assessment and management of deterioration for all birthing women and is used to identify deterioration from conception to four weeks after birth.
In the East of England, the patient safety team at Health Innovation East has supported five sites to implement a digital version of MEWS, while the remaining five sites have adopted the paper-based tool. The team has provided coaching, supported the establishment of local MEWS task-and-finish groups, reviewed and helped update relevant local guidelines, co-designed communication resources, and supported staff training.
To support awareness and consistent use, pocket size MEWS escalation cards were also created to remind staff to use the MEWS chart and highlight key maternal red flags (such as reduced fetal movements, vaginal bleeding, and seizures). The team has also visited hospital sites to help promote MEWS in practice.
Over the past two years, the patient safety team at Health Innovation East has worked closely with hospitals across the region to support the implementation of NEWTT2. This has included embedding the tool within an effective PIER pathway, as well as supporting education, workforce training, governance arrangements, and change management to enable sustainable adoption.
NEWTT2 was co-designed by a national working group established by the British Association of Perinatal Medicine in collaboration with NHS England, with the aim of ensuring that signs of clinical deterioration are recognised early and managed appropriately in every newborn baby.
The NEWTT2 framework is designed for use across postnatal care settings, including delivery suites, postnatal wards, and transitional care units. It provides both a structured framework and a standardised chart to help healthcare professionals identify, monitor, and plan the management of at-risk newborns during the early days of life.
These at-risk infants may include those with respiratory distress, suspected early-onset infection, or jaundice within the first 24 hours after birth. By incorporating parental observations and multidisciplinary team concerns – such as poor feeding, reduced responsiveness, or breathing difficulties – NEWTT2 supports timely escalation of care and aims to reduce preventable morbidity in newborn babies.
To date, 10 trusts in the East of England have implemented MEWS and seven are in the process of adoption. The roll-out of MEWS across the East of England is expected to reduce escalation fatigue among midwives and decrease the number of false alerts for deterioration. It is also anticipated to strengthen and empower midwives in their clinical decision-making, as the tool is underpinned by a robust evidence base. As MEWS continues to be refined and developed, it is hoped that its use will contribute to a reduction in health inequalities across the region by improving the early detection of deterioration across diverse populations.
An evaluation of the national MEWS tool demonstrated that 18% of observations within a healthy population triggered an escalation of care. This compares favourably with higher escalation rates observed using the Irish MEWS (38%) and the Scottish MEWS (32%). A lower escalation rate is advantageous in this context, as it indicates greater specificity – fewer healthy individuals are incorrectly flagged as requiring intervention. In contrast, higher escalation rates may reflect over-trigger, which can lead to unnecessary clinical reviews, inefficient use of resources and increased workload. Importantly, excessive alerts risk contributing to escalation fatigue among midwives, potentially reducing responsiveness to patients that are deteriorating. The 18% escalation rate achieved with the national MEWS aligns with the proportion of observations meeting the NEWS2 threshold – suggesting an appropriate balance between sensitivity and specificity, minimising unnecessary alerts and supporting more targeted, clinical decision-making (1).
In contrast with other tools where escalation rates increased as pregnancy progresses and physiological changes in vital signs become more pronounced, MEWS demonstrated consistent escalation rates among healthy women throughout pregnancy. As the MEWS score increases, so too does the clinical seniority of the professional responsible for monitoring and caring for the pregnant woman. It is thereby supporting the active management of patients at increased risk by directing more senior staff to attend their care – supporting appropriate and proportionate escalation of care.
15 hospitals with maternity units have implemented NEWTT2 on paper in the East of England. The remaining two hospitals are on track to launch digitally by August 2026.
The benefit of using NEWTT2 is all staff working in maternity, caring for newborn infants, have the permission to escalate and respond to concerns through a structured approached.
The Health Innovation East patient safety team will continue to support trusts who have NEWTT2 and MEWS queries and will support with quality improvement initiatives wherever possible. The patient safety team play a key role in sharing learnings data to NHS England to inform wider evaluations of the work and will continue to shape future work regarding digital readiness.
References
(1) Gerry, S., Bedford, J., Redfern, O.C., Rutter, H., Chester-Jones, M. & Knight, M. (2024) Development of a national maternity early warning score: centile-based score development and Delphi informed escalation pathways, BMJ Medicine, 3(1), e000748. doi:10.1136/bmjmed2023-000748.