This is a qualitative study using in-depth semi-structured interviews. This study will explore pregnant women with two or more long-term health condition's (MLTC) experience of midwifery care and midwives and health professionals experience of providing midwifery care and multidisciplinary maternity care. This will be considered in relation to Treatment Burden and Minimally Disruptive Healthcare theories. This will be followed by co-design of guidance for midwifery care of pregnant women with MLTC. The aim is to develop a rich understanding of the topic and participant's lived experiences, to enable development of a resource which is meaningful to the key stakeholders. The study is part of a wider mixed methods study.

Inclusion Criteria:

Interviews

Women and birthing people

• Women and birthing people with two or more pre-existing long-term health conditions (see appendix one) who are pregnant or postnatal or have given birth in the last 2 years
• Able to provide consent
• Able to participate in English or through an interpreter
• Age 18 or over Midwives and maternity health care professionals NHS maternity staff including midwives and healthcare professionals who provide or manage care for women with two or more long-term health conditions e.g., obstetricians, obstetric physicians, medicine, perinatal mental health, and primary care.

Co-design meetings

• Women and birthing people with two or more long-term health conditions who are pregnant or postnatal or have given birth in the last 3 years (to include those who have given birth in the last 2 years at the beginning of the study who participated in an interview
• Partners/supporters/significant others of women with two or more long-term health conditions who are pregnant or postnatal or have given birth in the last 3 years
• Able to provide consent
• Able to participate in English or through an interpreter
• Age 18 or over
• NHS maternity staff including midwives and healthcare professionals who provide care or manage services for women with two or more long-term health conditions
• Members of the Patient and Public Involvement and Engagement Group and Project Advisory Group
• Representatives from the study third sector partners (Maternal Mental Health Alliance, Action on Pre-eclampsia and Social Action for Health)
• Representatives from other relevant third sector organisations
• Health policy makers and commissioners

Exclusion Criteria:

Interviews Women and birthing people

• Women and birthing people without two or more pre-existing long-term health conditions
• Those who are not pregnant or have not given birth in the last two years
• Those who refuse or are unable to give consent
• Age under 18
• Age over 60

Midwives and maternity health care professionals NHS maternity staff including midwives and healthcare professionals who do not provide or manage care for women with two or more pre-existing long-term health conditions Co-design meetings

• Those who refuse or are unable to give consent
• Age under 18

Interviews: Women and staff with a range of physical and mental health long term conditions. Midwives and maternity healthcare professionals who provide care for women with MLTC such as obstetricians, obstetric physicians, or those in medicine, perinatal mental health and primary care.

Co-design meetings: Some participants will be purposefully sampled from those who participated in interviews. If the desired sample size is not met through those participating in interviews, a further purposive sample will be recruited through third sector and professional networks and direct approach of potential participants at each site.