Greater than the sum of the whole – multi-disciplinary research and care for pregnant women with two or more long-term conditions

By Zoe Vowles

I have been part of the MuM-PreDiCT collaboration since 2021. I am a midwife and an Early Career Researcher working at Guy’s and St Thomas’ NHS Foundation Trust in London, and with the NIHR Applied Research Collaboration South London Maternity and Perinatal Mental Health theme.

As a midwife, I provide care to pregnant women with hypertension, renal disease, and complex pregnancies. They are often living with two or more long-term health conditions, including mental health problems such as anxiety and depression. My varied work in research is focused on improving the care and treatment of pregnant women with health or social complexity. I enjoyed working with these families but felt I needed to understand more about how best to care for these women. Health services are designed around single diseases or conditions and so it can be difficult to provide personalised pregnancy care for individuals with two or more long-term health conditions.  

Finding MuM-PreDiCT

I was really excited to find out about the MuM-PreDiCT project and their proposals to improve care for this same group of women. I had already decided to apply for a Pre-doctoral Clinical Academic Fellowship (PCAF) so I could add to my research knowledge and develop a doctoral research proposal on how best to provide midwifery care, as part of a multi-disciplinary team, and I was also able to join the MuM-PreDiCT research team.  

This has given me a wonderful opportunity to be part of research to improve care for pregnant women with two or more long-term conditions, bring a midwifery perspective to the team, develop a network with researchers and clinicians working on this topic and plan my doctoral research building on the work being done.

Evidence on providing quality maternity care

The importance of midwives working collaboratively with women and a wide range of other professionals to provide high-quality maternity care has been highlighted in The Lancet Midwifery series.(1)  Reports into maternal deaths in the UK and recommendations for services for pregnant women with medical conditions also show the importance of high-quality clinical care provided by a multi-professional team for women with pre-existing conditions.(2, 3)

Poor collaboration and teamwork between different professional disciplines has been shown to contribute to poor experiences of maternity care and poor outcomes.(4, 5) Despite national policy recommending joined-up and multi-disciplinary care, there is currently little evidence on how best to provide high-quality care, multi-professional maternity care for pregnant women with two or more long-term conditions.(6)

A skilled and supportive team

Within MuM-PreDiCT I’ve been part of the team looking into the experience of maternity care from the perspective of both women, and the midwives, doctors and other professionals looking after them. MuM-PreDiCT is a very supportive and inclusive environment for Early Career Researchers. I have been encouraged to take up opportunities to develop new knowledge and skills in both quantitative and qualitative research methods. I’ve also had the opportunity to be part of developing a Core Outcome Set for research into Multiple Long-Term Conditions in Pregnancy and join the group looking at pregnancy complications and the possible development of future long-term health conditions. I have learnt a huge amount about good practice and ways to truly involve women with lived experience throughout the research process.

The team has also supported me as I develop my own doctoral research proposal, giving me opportunities to share my ideas and gain feedback in a safe and supportive space either in the wider team meetings or small group forums. Being part of MuM-PreDiCT has meant I have been able to work with people representing parents; with lived experience, and a truly diverse range of clinical and academic disciplines. MuM-PreDiCT has allowed me to see how partnership with women and multi-professional collaboration can be achieved in research and the value this brings.

A life course approach

The work in MuM-PreDiCT highlights to me the importance of a life course approach. This means thinking about an individual’s complete care journey (including before pregnancy) and their longer-term health beyond the sometimes narrow remit of maternity services. This research collaboration draws many parallels for me with good care for women with two or more long-term conditions.

We must all stay focused on keeping the voice of women central to research and care; recognise the need for a range of perspectives, skills, and expertise and the importance of collaboration, communication, and professional respect, and supporting those early in their careers to gain skills and knowledge.

Inclusivity statement

Where the words ‘women’, ‘maternal’, or ‘mother’ are used, these also refer to people who do not identify as women but have been pregnant or may be pregnant in the future.


1.         Shamian J. Interprofessional collaboration, the only way to Save Every Woman and Every Child. The Lancet. 2014;384(9948):e41-e2.

2.         NHS England. Maternal medicine network service specification. 2021 13 October 2021.

3.         Knight M BK, Patel R, Shakespeare J, Kotnis R, Kenyon S, Kurinczuk JJ (Eds.) on behalf of MBRRACE-UK. Saving Lives, Improving Mothers’ Care Core Report – Lessons learned to inform maternity care from the UK and Ireland Confidential Enquiries into Maternal Deaths and Morbidity 2018-20. Oxford: National Perinatal Epidemiology Unit, University of Oxford 2022.

4.         Kirkup B. The Report of the Morecambe Bay Investigation: An independent investigation into the management, delivery and outcomes of care provided by the maternity and neonatal services at the University Hospitals of Morecambe Bay NHS Foundation Trust from January 2004 to June 2013: Stationery Office; 2015.

5.         Ockenden D. Final findings, conclusions and essential actions from the Ockenden review of maternity services at Shrewsbury and Telford Hospital NHS Trust. London: Department of Health and Social Care. 2022.

6.         Alderdice F MR, McLeish J, Roberts N and Rowe R. . What evidence is available about the use and effectiveness of collaborative midwife continuity of care models to improve pregnancy outcomes for women with medical and obstetric complexity? A scoping review. . 2022.

Tags: No tags

Add a Comment

Your email address will not be published. Required fields are marked *

This site uses Akismet to reduce spam. Learn how your comment data is processed.