Improving Care for Women at Risk of Early Birth
- The Female Body
- Mar 29
- 4 min read
Premature birth remains a significant challenge in maternity care, with 8% of babies in the UK born before 37 weeks. These infants face an increased risk of serious health complications and, in some cases, life-threatening conditions. To address this issue, the NHS introduced the Saving Babies’ Lives Care Bundle, a framework designed to identify, prevent, and prepare for early births.
Since the initiative’s introduction in 2016, the number of preterm birth clinics in England has risen from 30 in 2017 to 78 in 2021. However, a new study published by the National Institute for Health and Care Research (NIHR) in February 2025 reveals inconsistencies in the implementation of these pathways, highlighting areas for improvement. The study suggests that better risk assessments, specialist training, and continuity of care could significantly enhance support for those at risk of preterm birth.
The Study: Evaluating the Early Birth Pathway
The research team conducted an extensive review of 29 studies on early birth prevention and assessed current practice across 96 hospitals in England. The analysis was further strengthened by in-depth evaluations at three hospitals, where researchers:
Observed 87 maternity care appointments
Interviewed 11 women and 13 healthcare professionals
Examined local hospital guidelines and policies
Their findings revealed gaps in staff training, delays in referrals, and inconsistencies in specialist care, all of which could impact early birth prevention.
Key Findings and Recommendations
Improving Risk Assessments and Referrals
A structured approach to risk assessment is critical to identifying those at risk of preterm birth and this must be early enough for effective intervention. However, researchers found widespread confusion among healthcare professionals about risk factors and referral procedures.
Some staff lacked confidence in assessing early birth risk, leading to missed or delayed referrals.
Junior staff often had their decisions unnecessarily double-checked, slowing down patient care and reducing efficiency.
Outdated hospital IT systems made risk assessments cumbersome, increasing the likelihood of human error.
To address these issues, the study recommends:
Enhanced staff training on early birth risks and intervention strategies.
Digital integration of risk assessment tools, such as checklists embedded into hospital systems.
Clearer referral pathways, supported by prompts and reminders for healthcare professionals.
A stronger culture of learning, where junior staff feel supported in making clinical decisions.
By streamlining assessments and empowering staff, maternity teams can identify high-risk pregnancies earlier and provide timely interventions to improve outcomes.
Strengthening Specialist Preterm Birth Clinics
Dedicated preterm birth clinics play a crucial role in early birth prevention, providing specialist care to those at higher risk. The study found that hospitals with named preterm birth consultants and midwives were more effective in delivering consistent, high-quality care.
In hospitals where specialists were embedded in maternity teams, staff trusted each other’s expertise, and variation in care was minimised.
However, many hospitals relied on a single staff member with specialist training (such as measuring the cervix via ultrasound), leading to gaps in service when that person was unavailable.
The study suggests that to improve consistency in care, hospitals should:
Establish specialist multidisciplinary teams to ensure expertise is always available.
Conduct regular team meetings and audits to monitor and improve care pathways.
Work within regional networks to share resources, guidelines, and expertise.
Align clinic schedules, so staff from different hospitals can support each other and share best practices.
By strengthening the structure of preterm birth clinics, hospitals can provide more reliable, evidence-based care for those at risk.
Providing Continuity of Care and Emotional Support
For those at risk of early birth, the emotional and psychological impact can be profound. Many women in the study described feeling anxious, isolated, and defined by their high-risk status.
Key findings included:
Seeing different healthcare professionals at each visit led to inconsistent messaging and increased stress.
Conversations focused solely on risks rather than providing reassurance and practical guidance.
Many lacked access to support services such as peer networks and relevant charities.
To improve the experience of those at risk of early birth, the study recommends:
Assigning a named lead healthcare professional to provide consistent care and build trust.
Shifting the focus to what individuals can do, rather than solely discussing limitations.
Signposting to support services such as Tommy’s, a charity offering guidance on preterm birth.
Seeking regular feedback from those receiving care, ensuring services meet their needs.
Greater continuity of care not only improves clinical outcomes but also reduces anxiety and fosters a sense of control throughout pregnancy.
Recent Changes and Next Steps
Since the publication of this study, several changes have already taken place:
The widely used Foetal Fibronectin biomarker swab (used to assess the risk of preterm delivery within 7 to 10 days) has been withdrawn from the market, and hospitals have switched to alternative tests (Actim Partus and PartoSure).
The research team has launched two follow-up studies, one examining the role of preterm birth midwives and another conducting a national survey on early birth prevention practices.
Why This Matters
Preterm birth is a leading cause of new-born complications, yet many cases may be preventable with the right interventions. This study highlights the urgent need for better risk assessments, well-supported specialist teams, and continuity of care. Crucially, many of the proposed changes, such as better training, digital risk assessment tools, and structured support systems, do not require additional funding but could make a significant impact on outcomes.
By addressing these gaps in care, hospitals can take meaningful steps to reduce preterm births and improve care pathways, ensuring that those at risk receive the support they need when it matters most.
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