NHS England’s new Maternal Care Bundle: strengthening safety through improved VTE and haemorrhage care

In January 2026, NHS England introduced the Maternal Care Bundle (MCB), a nationally mandated set of best practice standards designed to reduce maternal mortality, severe morbidity, and persistent inequalities in maternity outcomes across England.

The bundle responds to the latest MBRRACE‑UK findings, which show a significant rise in maternal deaths and confirm that improvements in care may have prevented harm in almost half of cases reviewed.

The MCB sets clear expectations for NHS providers and commissioners across five high‑risk clinical areas:

1. venous thromboembolism (VTE);
2. pre-hospital and acute care;
3. epilepsy in pregnancy;
4. maternal mental health; and
5. obstetric haemorrhage;

This article will focus on changes to VTE and obstetric haemorrhage guidance, as two of the leading, yet largely preventable, causes of maternal death.

Why the MCB matters

Maternal mortality in the UK has increased by over 20% compared with the period between 2009 and 2011, with stark and persistent inequalities. Black women are more than twice as likely to die during pregnancy or the postnatal period than white women, while women living in the most deprived areas face almost double the risk of maternal death.

The new bundle aims to address these challenges by:

• standardising high‑quality care across all NHS maternity services;
• supporting earlier identification of risk and deterioration;
• improving escalation, multidisciplinary working, and response times;
• reducing unwarranted regional variation and inequality in care delivery.

New venous thromboembolism (VTE) guidance

Venous thromboembolism (including deep vein thrombosis (DVT) and pulmonary embolism (PE)) remains one of the leading direct causes of maternal death in the UK, accounting for 16% of maternal deaths between 2021 and 2023. A significant proportion of VTE‑related deaths occur early in pregnancy, often before women have their first formal antenatal appointment.

The MCB introduces a step‑change in how VTE risk is identified and managed, including:

• Universal early VTE risk assessment – all women should be risk‑assessed for VTE at the earliest possible opportunity, including in primary care and emergency settings – not just at booking appointments. The MCB introduces a national self-assessment questionnaire on VTE risk at the first NHS care contact with a positive pregnancy test.
• Rapid access to thromboprophylaxis – women identified as high risk must have timely access to low molecular weight heparin (within 72 hours), without unnecessary delays such as waiting for ultrasound confirmation of a viable pregnancy, with follow up within four weeks in secondary care.
• Clear cross‑system referral pathways – the guidance strengthens expectations for collaboration between GPs, maternity teams, emergency departments and specialists, ensuring urgent obstetric advice is accessible across care settings.
• Equitable implementation – the bundle highlights the importance of consistent application of VTE prevention measures to reduce disproportionate risk among women from ethnic minority groups and those experiencing social deprivation.

Together, these measures aim to significantly reduce avoidable early‑pregnancy VTE events and prevent fatal delays in care.

Updated obstetric haemorrhage protocol

Obstetric haemorrhage was the eighth leading cause of maternal mortality in the UK between 2021-2023 and is one of the most common complications during birth. Reviews of maternal deaths frequently highlight delays in escalation, inconsistent thresholds for action, and poor multidisciplinary coordination.

The MCB introduces standardised, system‑wide expectations for preventing and managing obstetric haemorrhage, including:

• Early recognition and response – clear criteria are set for identifying excessive bleeding and maternal deterioration, supported by systematic observations and escalation triggers.
• Lower thresholds for escalation – the guidance emphasises earlier senior clinical involvement, including obstetric, anaesthetic, and haematology input where appropriate, to prevent avoidable harm:
  • by 500ml loss and ongoing bleeding, escalation and help should be sought for community births, with plans made for immediate transfer to secondary care; in secondary care, the midwife in charge and the first-line obstetric and anaesthetic staff should be alerted;
  • by 1,000ml loss, a senior midwife, obstetrician (ST3 equivalent or above) and anaesthetist should all be present and managing as an obstetric emergency;
  • by 1,500ml loss, consultant obstetricians should be informed, with attendance required if bleeding is ongoing, unstable or deteriorating;
  • standardising reporting of PPH at 1,500ml.
• Multidisciplinary emergency preparedness – maternity services are expected to maintain clearly defined haemorrhage pathways, regular multi‑professional simulation training, and rapid access to blood products and interventional support.
• Learning and review – ongoing multidisciplinary review of haemorrhage cases is required, strengthening organisational learning and quality improvement across maternity services.

Implementation and accountability

All NHS trusts providing maternity services are expected to fully implement the MCB by March 2027, with progress monitored through trust boards and national oversight mechanisms. By prioritising preventable causes of maternal death, particularly venous thromboembolism and obstetric haemorrhage, NHS England aims to deliver safer, faster and more equitable care for women, babies, and families across England.