Pregnancy & Maternal Health

The health and wellbeing of mothers during pregnancy and the early postnatal period are critical determinants of outcomes for both babies and families. Evidence shows that maternal health influences not only birth outcomes but also long-term physical, emotional, and educational trajectories for children (Source: NHS Digital, Mental Health of Women During Pregnancy, 2023). Risks during pregnancy and the first weeks of life include communicable diseases, physical and mental health challenges, and social factors such as loneliness and deprivation.

The latest MBRRACE-UK reports on maternal mortality (2021-2023) highlight that blood clots, cardiac disease, and COVID-19 were the leading causes of death during or up to six weeks after pregnancy, with mental health-related deaths (including suicide and substance use) being the most common cause of death between six weeks and one year post-pregnancy. The reports also reveal persistent and severe inequalities in maternal outcomes, with Black and Asian women and women from the most deprived areas facing significantly higher mortality rates.

Nationally, the prevalence of maternal mental health problems remains a significant concern, with depression and anxiety affecting up to 20% of women during pregnancy or in the first year after birth (Source: NHS Digital, 2024; NICE 2020). These issues are often under-recognised and under-treated, highlighting the importance of routine assessment and support at every contact with health professionals.

Social connection and support are increasingly recognised as vital for maternal wellbeing. Research from Stanford Medicine and the NHS emphasises that strong social networks reduce anxiety and depression and improve self-esteem and physical health (Source: Stanford Medicine 2014 NHS England 2024). Opportunities for social connection during and after pregnancy are essential for both mothers and babies, supporting healthy emotional development and preventing future behavioural and mental health problems.

A continuum of care is required throughout the reproductive years, with early access to high-quality maternity services shown to reduce risks such as pregnancy loss, perinatal death, infant mortality, maternal mortality, and low birth weight (NHS England 2024; ONS 2023). In Lincolnshire, local data shows that while the proportion of full-term babies born with low birth weight remains below the national average, rates of smoking at delivery and maternal obesity are higher than national figures, underscoring the need for targeted interventions.

For many families, pregnancy and new parenthood are times of reflection and positive behaviour change. Evidence suggests that health-promoting behaviours are more likely to be adopted during pregnancy, offering a unique opportunity for public health interventions (McBride et al. 2003). Addressing health inequalities—such as those related to deprivation, housing, education, and income is essential for improving outcomes for mothers and babies across Lincolnshire.

• Three-Year Delivery Plan for Maternity and Neonatal Services (2023) outlines actions for 2023–2026 to improve safety, personalisation, and equity in maternity and neonatal care. Focuses on four themes: listening to families, workforce support, safety culture, and standards.
• Better Births: National Maternity Review (2016) sets out a vision for safer, more personalised, and family-friendly maternity care. It highlights seven priorities, including continuity of care, informed choice, and reducing inequalities.
• Equity and Equality Guidance for Local Maternity Systems (2021) provides a framework for addressing health inequalities in maternity care. Includes evidence-based interventions, metrics, and pledges to improve outcomes for mothers and babies from diverse backgrounds.
• The Saving babies’ lives care bundle (2025) provides evidence-based best practice for providers and commissioners of maternity care across England to reduce perinatal mortality.
• Implementation of the Neonatal Critical Care Review is focused on improving outcomes and equity by enhancing neonatal services, optimising cot capacity, and ensuring babies receive the right care, in the right place, at the right time.
• NICE has produced 30 pieces of guidance relating to pregnancy. Topics include antenatal care, postnatal mental health, diabetes, diet, hypertension, labour, nutrition and postnatal care, as well as NICE Guidance and Quality Standards.
• Additionally, NICE has published guidance on Social and emotional wellbeing: early years [PH40] to demonstrate how the social and emotional wellbeing of vulnerable children aged under 5 years can be supported through home visits, childcare and early education. This is supported by a quality standard, Early years: promoting health and wellbeing in under 5s [QS128].
• NHS England’s Better Births report reviewed maternity services and concluded the importance of the need for women and families to be supported in their maternity care choices. The review found that, despite an increasing number of births and an increasing complexity of cases, the quality and outcomes of maternity services have improved significantly over the last decade.
• The Healthy Child Programme (HCP) is the national public health framework for children and young people aged 0–19 (or up to 25 for those with SEND), spanning preconception through to early adulthood. It provides a universal preventative service, personalised to individual needs, and is delivered through health visiting and school-aged services. The programme includes screening, immunisation, health and development reviews, and is supplemented by advice on health, wellbeing and parenting. The latest guidance emphasises evidence-led approaches to improving child development, identifying families at risk early, and promoting better health outcomes across the life course. Local authorities, NHS partners, and integrated care boards are expected to commission services that are flexible, place-based, and integrated with education, social care, and community services.
• The Giving Every Child the Best Start in Life national strategy sets out a 10-year vision to reduce inequalities from birth, improve family support and health, and ensure that more children achieve a Good Level of Development by the end of reception. Local plans for women and children’s services are part of Lincolnshire’s Joint Forward Plan: Living Well and Staying Well.
• Lincolnshire’s Better Births Plan provides a framework for safe, personalised, and family-friendly maternity and neonatal care, tailored to the individual needs of women and families. It also embeds the local equity and equality strategy to ensure inclusive, high-quality services for all.

Births in Lincolnshire have continued to decline when measured by the crude birth rate. Although the number of live births increased slightly by 0.6%, the overall birth rate continues on a downward trend. The crude birth rate fell from 8.2 per 1,000 population in 2022, to 7.8 in 2023, and 7.7 in 2024, remaining below the England average of 9.6 per 1,000 population in all three years.

The total fertility rate (TFR) in Lincolnshire was 1.35, closely mirroring the national average of 1.41.

Recent Office for National Statistics (ONS) data confirms that while 6,035 births were recorded in 2024 a 0.6% increase on the previous year the crude birth rate decreased further to 7.6 per 1,000 population, again below the national average of 9.6. This reflects a continuing demographic pattern in which the population denominator grows faster than the number of births, resulting in a declining crude birth rate despite a marginal increase in births.

The proportion of full-term babies born at low birth weight in Lincolnshire was 2.4% in 2024, remaining below the national average. Premature births, defined as those occurring before 37 weeks of gestation, have remained stable or below national levels since 2006 (DHSC).

Deliveries to women from ethnic minority groups in Lincolnshire have shown a consistent upward trend, rising from 3.1% in 2013/14 to 8.2% in 2023/24, though still significantly below the national average of 27.9% (DHSC).

Despite a decline in smoking in pregnancy during the last two years, smoking during pregnancy remains a key area of focus in Lincolnshire. In 2024/25, 8.4% of women were recorded as smoking at the time of delivery, which is higher than the national average of 6.1% and above the national ambition of 6%. (DHSC).

Teenage Pregnancy rates remain relatively stable, with the under-18 conception rate in Lincolnshire being 14.3 per 1,000 in 2021, slightly below the national average of 13.9. However, only 42.6% of these conceptions led to abortion, compared to 58.2% nationally, which may indicate barriers to accessing reproductive health services or differences in local support pathways (DHSC).

Health inequalities remain a persistent challenge. Maternal smoking, low birth weight, breastfeeding rates and infant mortality are closely linked to deprivation, housing quality, education, and income. These inequalities are further influenced by maternal age, ethnicity and access to timely, high-quality maternity care (MBRRACE-UK). Addressing these disparities requires targeted outreach and integrated support across health, education, and social care systems, with a focus on early intervention and continuity of care, as outlined in the Lincolnshire Maternity Equity and Equality Strategy.

Community hubs, now Family Hubs, have been developed in Lincolnshire as part of NHS England’s Better Births Maternity Transformation Programme.  Purposefully situated in some of the county’s most deprived communities, the hubs have good footfall into their buildings and strong links are being developed with midwifery and health visiting teams.

GPs, pharmacies and sexual health clinics can offer advice and support to help people prepare well for pregnancy.

Early access to care (before 12 completed weeks of pregnancy) maximises opportunities to support women and their partners during pregnancy. It enables potential problems to be identified using a detailed health and social care assessment of needs, risks and choices.

Detailed information on maternity and newborn services (including self-referral) is available on the Better Births Lincolnshire website.

Continuity of Carer (CoC) and Personalised Care and Support Plans (PCSPs) are central pillars of national maternity transformation, as outlined in the NHS England’s Better Births report and the Three-Year Delivery Plan for Maternity and Neonatal Services (2023). CoC models aim to ensure that women receive care from the same midwife or small team of midwives throughout their pregnancy, birth, and postnatal period. This approach has been shown to improve outcomes, particularly for women from ethnic minority backgrounds and those living in deprived areas, by fostering trust, improving communication, and enabling the early identification of complications. Lincolnshire has four Continuity of Carer Teams in place supporting Lincolnshire women.

Personalised care ensures that maternity services are tailored to the individual needs, preferences, and circumstances of each woman and her family. PCSPs are co-produced documents that support informed decision-making and place women at the centre of their care. They are underpinned by principles of choice, equity, and respect, and are monitored through regular audits and feedback mechanisms. The Lincolnshire Maternity and Neonatal Transformation Group has prioritised both CoC and PCSPs in its ongoing workplan, recognising their role in reducing health inequalities and enhancing the quality of care across the system.

Lincolnshire offers a wide range of mental health support for women, birthing people, and families during the perinatal period. United Lincolnshire Hospital Trust (ULHT) provides access to a Specialist Mental Health Midwife who can create Individualised Care Plans to help maternity teams make reasonable adjustments, ensuring care feels safe and supportive. Additional targeted services, including United Lincolnshire Teaching Hospital Trust (ULTHT) Birth and Beyond supports women and partners who have experienced difficult or traumatic delivery, miscarriage, stillbirth or neonatal death. Lincolnshire Talking Therapies delivers free, evidence-based support for common mental health issues such as anxiety, depression, and trauma. For those with more complex needs, the Perinatal Community Mental Health Team at Lincolnshire Partnership NHS Foundation Trust (LPFT) offers specialist care for individuals experiencing severe mental illness during pregnancy or after birth, including those with pre-existing conditions like bipolar disorder or schizophrenia. LPFT also hosts the Perinatal Trauma and Loss Care Service (P-TLC), a psychology-led service supporting those facing moderate to severe distress or grief following miscarriage, stillbirth, neonatal death, failed IVF, or other forms of perinatal trauma—including those pregnant again after a loss who need additional psychological support.

Launched in early 2023, the NHS specialist tobacco dependency programme now supports all pregnant women who smoke, as part of maternity care provided by United Lincolnshire Teaching Hospital Trust. This integrated approach encourages quit attempts through behavioural support, pharmacotherapy, and access to vapes. Carbon Monoxide (CO) monitoring at every contact reinforces the risks associated with high CO levels and smoking, embedding tobacco dependency care into the maternity pathway. Consequently, the Smoking at Time of Delivery (SATOD) rate in Lincolnshire has declined, helping to narrow the gap between local figures and the national average.

The 0-19 children’s health service offers health visiting ( children aged 0-5) and nurses to look after the needs of school-aged children (aged 6-19).

The Health Visiting offer within the Healthy Child Programme includes a series of universal contacts: antenatal visits, a primary birth visit, a 6–8-week review, an 8–12-month review, and a 2–2½-year review. Families can also access a suite of antenatal education sessions delivered across the county, including in the evenings and at weekends. Families benefit from infant feeding support through drop-in breastfeeding groups across Lincolnshire, follow-up contact at 3–4 weeks, and access to Infant Feeding Champions and specialist lactation health visitors. Perinatal mental health is supported through screening tools (PHQ-9 and GAD-7), referral pathways to LPFT and Parent Trauma Loss Care (P-TLC), and interventions focused on bonding, sensitive parenting, and parental conflict. Video Interaction Guidance (VIG) is available via referral and delivered by trained practitioners either virtually or face-to-face, working closely with Early Years Practitioners and Family Hub teams. Additional support includes ICON messages for safe infant handling, which express that Infant Crying is normal, that Comfort methods can soothe crying, that it’s Okay to walk away if the baby is safe, and Never to shake a baby, Solihull Approach resources, Ages and Stages (ASQ) activity sheets, tailored offers for issues such as toileting, behaviour and sleep, and signposting to local amenities and community services.

The Local Maternity and Neonatal Equity and Equality Strategy 2024–2027 outlines plans to reduce disparities in access and outcomes, particularly for vulnerable groups, including young mothers, ethnic minorities, and those living in areas of deprivation. The strategy was co-developed with stakeholders and service users, with feedback gathered through the Maternity and Neonatal Transformation Board and What Matters to You events.

Lincolnshire’s Start for Life and Family Hubs are a one-stop shop for families, offering support from pregnancy through early childhood with guidance from Family Navigators. The offer includes health visiting, parenting support, infant feeding advice, emotional wellbeing, perinatal mental health, parent-infant relationship programmes, home learning support and more.

The Start for Life website includes information on a range of support available, including:

• Solihull Antenatal Education – From 28 weeks of pregnancy, parents can register interest in this six-week programme designed to provide parents/carers with information around parent and baby relationships, labour and birth, breastfeeding and caring for your baby.
• The Family and Baby (FAB) Team supports families with babies in neonatal care across Lincolnshire, providing early, relationship-based help to improve bonding, infant development, and parental wellbeing, while connecting families to local services.
• Video Interaction Guidance (VIG) – For parents from antenatal to age 5, this programme helps strengthen communication and bonding between a parent/carer and their child by using positive video feedback to build confidence and enhance relationships.
• Parent Carer Panels in Lincolnshire Family Hubs bring parents and carers together to share experiences and co-design services, ensuring family voices shape the Start for Life offer and local support.

The governance of the Local Maternity and Neonatal System (LMNS) is built on collaborative leadership and accountability, with a fundamental emphasis on listening to and acting upon the views of communities, service users, and stakeholders. This inclusive approach ensures that maternity and neonatal services are shaped by lived experiences, local needs, and clinical expertise, driving improvements in safety, equity, and quality across the system. This includes the Maternity and Neonatal Voice Partnership, Lincolnshire NHS Integrated Care Board, United Lincolnshire Teaching Hospital Trust, Lincolnshire Partnership NHS Foundation Trust, East Midlands NHS Neonatal Operational Delivery Network, and Lincolnshire County Council. (About | Better Births Lincs)

Service User Feedback and Engagement

The Involvement Group, a sub-group of the Lincolnshire Maternity and Neonatal System, brings together partners including Lincolnshire County Council 0–19 Services, Family Hubs, ULHT Maternity and Neonatal Services, HWLincs, the Lincolnshire Maternity and Neonatal Programme, Maternity and Neonatal Voices, and Perinatal Mental Health Services. The group is collaboratively mapping and reviewing existing feedback mechanisms to better understand how service user experiences are captured and used across the county.

While a range of feedback channels already exist—such as the Maternity and Neonatal Voices Partnership, targeted engagement activities, Family and Baby Neonatal Workers, PROMS, CQC surveys, and ULHT’s internal mechanisms—there is growing awareness of feedback fatigue among families. The group aims to streamline and strengthen feedback processes to ensure they are inclusive, coordinated, and impactful. Priorities include improving how feedback is collated and reported into governance structures, using insights to inform strategic decisions, and enhancing communication with families through approaches like “You said, we did.”

Preconception health remains a critical but under-connected area in the local maternity and public health system. While services that support healthy lifestyle changes, such as weight management, smoking cessation, substance misuse support, and mental health interventions, are available across Lincolnshire, they are not consistently linked or promoted as part of a coordinated preconception offer. This represents a gap in our approach to early intervention. Strengthening the visibility and integration of these services for women of childbearing age could help reduce cumulative risk factors before pregnancy begins. By proactively engaging women earlier in their reproductive journey, we can support healthier pregnancies, improve outcomes for mothers and babies, and reduce health inequalities. This also aligns with the continuity of carer model, extending the opportunity for trusted relationships and personalised support to begin before conception.

A current priority is to increase the proportion of women who receive care from the same one or two midwives throughout and following their pregnancy and delivery. This is known as ‘continuity of carer’ and will enable women to build a relationship with a familiar professional that grows and deepens over time. This is known to lead to improved health outcomes and, importantly, should support the development of a trusted relationship. The aim is for women to be empowered to share their anxieties and insecurities as well as enjoy the more positive aspects of growing in knowledge and confidence through a supported pregnancy journey.

We know from local service providers and published evidence that issues, including high BMI, are an increasingly important factor in pregnancy (Vats, H. et al. 2021). These issues are closely interrelated and can present a cumulative risk to a mother and baby. We need to understand more about where these risk factors are most prevalent amongst women of childbearing age in Lincolnshire to ensure we target services to prevent and effectively tackle health inequalities.

In line with the ‘Better Births’ maternity transformation programme, there is a need to expand the choices offered to women. Women who deliver in Lincolnshire have a choice of giving birth at home or in a consultant-led obstetrics unit. Midwifery-led units are being developed in Lincoln and Boston.  

Better Births Lincolnshire are looking to further develop Community Hubs, which are a proven and established model for improving care for women and providing care closer to home. Use of digital services, virtual clinics, and technology, such as mobile scanning, should also be explored.

Equity in Maternity Care

Over the next three years, the Lincolnshire Maternity and Neonatal System aim to reduce inequalities in outcomes, access, and experience for pregnant women from at-risk groups – particularly those from Black, Asian and minority ethnic (BAME) backgrounds and individuals living in the most deprived areas. The initial focus will be on the largest groups experiencing the greatest disparities, with a phased approach to include smaller geographic and population groups over time.

This work is underpinned by a commitment to collaboration and co-production, ensuring that services are shaped by those who use and deliver them. Anticipated benefits include improved maternal and infant health outcomes, enhanced staff wellbeing and satisfaction, and more responsive, equitable services. Embedding equity and equality throughout the maternity pathway is expected to yield long-term system-wide benefits, including better health and quality of life for families and reduced demand on health and social care services.

A care pathway is in place for expectant women who are overweight based on the NICE Guideline Weight management before, during and after pregnancy [PH27]. Women are supported to maintain a healthy weight throughout their pregnancy as part of their routine antenatal care.  A focus on pre-conception support and advice through to antenatal, intrapartum and post-natal services forms the foundation of the Lincolnshire Better Births plan.

By proactively engaging women earlier in their reproductive journey, we can support healthier pregnancies, improve outcomes for mothers and babies, and reduce health inequalities. This also aligns with the continuity of carer model, extending the opportunity for trusted relationships and personalised support to begin before conception.