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Article History

Received: 7 November 2017

Accepted: 3 August 2018

First Online: 13 August 2018

Ethics approval and consent to participate

: This Quality Improvement project was reviewed by NHS Health Research Authority in October 2016 and approved as a service evaluation (Ref 60/86/81).As it was a service evaluation we approached the relevant R&D departments of each unit and obtained relevant local approvals from each unit; namely: Bedford Hospital, Birmingham Women’s Hospital, Calderdale Royal Hospital, Chelsea & Westminster Hospital, Epsom General Hospital, Milton Keynes University Hospital, Nottingham University Hospital, Poole Hospital, Queen Elizabeth University Hospital, Royal Gwent Hospital, Royal United Hospital Bath, Saint Mary’s Hospital, St Richard’s Hospital, St John’s Hospital, University Hospital of North Tees and Warrington Hospital. We also obtained Caldicott Guardian Approval from each of these units for the clinical data we receive.Only named members of the Project Team have access to the data. They have completed mandatory Information Governance training and are aware of the requirements of confidentiality and understand that any breach will be reported.The RCOG and LSHTM are registered under the Data Protection Act and are fully compliant with the NHS Information Governance Toolkit for Hosted Secondary Use Teams. All participants (women and clinicians) who took part in qualitative research activities provided their verbal consent to do so and were made aware that they could withdraw this at any time.

: Not applicable.

: NS is the director of London Safety and Training Solution Ltd., which provides patient safety advisory and training services on a consultancy basis to hospitals in the UK and internationally. NS’ research is supported by the National Institute for Health Research (NIHR) Collaboration for Leadership in Applied Health Research and Care South London at King’s College Hospital NHS Foundation Trust. NS is a member of King’s Improvement Science, which is part of the NIHR CLAHRC South London and comprises a specialist team of improvement scientists and senior researchers based at King’s College London. Its work is funded by King’s Health Partners (Guy’s and St Thomas’ NHS Foundation Trust, King’s College Hospital NHS Foundation Trust, King’s College London and South London and Maudsley NHS Foundation Trust), Guy’s and St Thomas’ Charity, the Maudsley Charity and the Health Foundation. The other authors have no competing interests to declare. The views expressed are those of the authors and not necessarily those of the Health Foundation, the NHS, the NIHR or the Department of Health.

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