The purpose of this study is to learn about the implementation of NHS England's Saving Babies Lives Care Bundle Version 2 to reduce perinatal mortality.

It will explore whether the care bundle is effective at reducing stillbirth rates, neonatal death rates and preterm births in England. It will also explore the lived experiences of women's maternity care and their babies neonatal care, and the views and experiences of healthcare professionals who are involved in delivering the care bundle.

The main questions it aims to answer are:

• Does the care bundle reduce perinatal mortality rates?
• What are women's views and experiences of their maternity and neonatal care?
• What are the barriers around delivering the care bundle and how can this be improved?
• How do health inequalities affect the care women receive?
• How does the workforce culture affect how healthcare professionals use the care bundle?

Perinatal mortality rates and other pregnancy outcomes will be obtained from national data sources. Women and healthcare professionals will be asked to complete a survey and we will interview select groups of participants to further explore their experiences.

Mortality rates will be compared before and after the implementationof the care bundle where data allows. Data from the surveys will be descriptive. Data from the interviews will be analysed using thematic analysis to determine patterns and recurring ideas in the data.

In April 2022, NHS England commissioned the University of Manchester to conduct an independent evaluation of the effectiveness of the Saving Babies' Lives Care Bundle Version 2 (SBLCBv2) on reducing perinatal mortality in England. The study was commissioned in two phases.

Phase 1 comprises a national (service) evaluation of the impact of the SBLCBv2 on perinatal mortality rates, associated clinical outcomes, and any unintended consequences using routine data derived from national databases. Phase 2 comprises a qualitative evaluation to further understand the impact on maternity services, women and their families.

Phase 2 will be conducted in a cohort of maternity units across England using a mixed-methods approach. The views and experiences of women and healthcare professionals towards maternity care in relation to the SBLCBv2 will be sought using surveys and interviews. Additionally, this study will interview organisational leads to assess how resources, leadership and governance may affect implementation in diverse hospital settings.

Phase 1:

All births in England.

Phase 2:

Inclusion Criteria:

• women who have given birth in the last 12 months
• women who can understand English
• healthcare professionals involved in delivering the care bundle

Exclusion Criteria:

• women who gave birth more than 12 months ago
• women who cannot understand English
• women without access to the internet for online survey completion
• healthcare professionals not involved in delivering the care bundle

Phase 1: births in England.

Phase 2: women who received their antenatal care, labour and birth in 28 participating NHS maternity Trusts in England. Healthcare professionals currently employed in these 28 Trusts.

If requested, site-specific data from the questionnaires may be shared with participating NHS Trusts. This data will be provided in an anonymous aggregated format, with only that specific site identified. No identifiable data will be shared with participating NHS Trusts (i.e. names and email addresses will not be shared with NHS sites).

Following completion of the study, with consent a fully anonymised aggregated dataset [e.g. including anonymous aggregated questionnaire responses] will be deposited in Figshare at the University of Manchester library, which is an open data repository where it will be permanently stored. Researchers at other institutions and others can access the anonymised data directly from the repository and use it for further research or to check our analysis and results. Individual NHS Trusts will not be identified.