The Health Secretary today announced that every woman who suffers a stillbirth, or life changing injuries to her newborn baby, will be offered an independent investigation to find out exactly what happened, and why. The Government also proposes that first time, full-term stillbirths should be covered by coronial law (i.e. a coroner would lead the investigation).
According to the NHS, there are currently around 3,600 stillbirths in the UK each year. Eleven babies are stillborn every day, making it 15 times more common than cot death. With effect from April 2018 every stillbirth, early neonatal death and severe brain injury case will be referred to the Healthcare Safety Investigation Branch, the new NHS safety investigator led by safety experts.
The news coincides with the release of a report from the MBRRACE-UK confidential enquiry into term stillbirths and neonatal deaths, which found that stillbirth and neonatal deaths have more than halved in the UK from 0.62 to 0.28 per 1,000 total births since 1993, representing a fall of around 220 intrapartum (term) deaths per year, according to the new figures published today. The report’s key finding is that in 8 out of 10 deaths different care might have saved the baby. This finding is against the backdrop of a growing number of women being cared for, who have risks of things going wrong in pregnancy and childbirth and the potential for resources to be stretched. In at least 1 in 4 deaths, the enquiry found there were problems with adequate staffing and resources to provide safe care.
In a joint statement from the Royal College of Midwives and the Royal College of Obstetricians and Gynaecologists, Gill Walton, Chief Executive and General Secretary at the Royal College of Midwives (RCM) said “The RCM welcomes this report and recognises the achievement in an overall reduction in stillbirths and neonatal deaths. There is however much to take away from its findings that will go towards not only helping midwives, but the entire maternity team improve how they deliver the safest possible care for women and their babies. It is concerning that the report found that staffing levels and capacity contributed to some of the poor outcomes particularly around the time of labour and birth. The increasing complexity of women being cared for in our maternity services exacerbates this issue. We must ensure we have enough midwives and obstetricians to provide safe care throughout the maternity pathway and adequate facilities in all birth settings. The RCM believes that there needs to be a supernumerary labour ward coordinator in place in every single maternity service to have a helicopter view of birth activity in all settings and we have already begun leading on work in partnership with NHS Improvement. This report clearly shows that improvements to the quality of investigations are needed. It is only through thorough investigation and implementation of recommendations that lessons can be learned from these tragic events. We must do everything possible to prevent them, and improve care and safety.”
Professor Lesley Regan, President of the Royal College of Obstetricians and Gynaecologists, added “For the vast majority of women and their babies, the UK is a safe place to give birth. However, despite the fall in stillbirth and neonatal mortality, these deaths remain a major cause for concern. The finding that for 80% of babies, different care may have led to a different outcome, echoes the findings from the RCOG’s Each Baby Counts programme. The report also highlights that the majority of these deaths were attributable to multiple factors rather than a single cause.”
Responding to the report, Doula UK applauds the overall decline in neonatal deaths and stillbirth, but calls once again for the recommendations made in Baroness Cumberlege’s Better Births report (among others) to be implemented, to ensure that every woman receives continuity of care through childbirth, thus reducing the risk of negative outcomes.
Our doula members can and do support women through a variety of birth experiences, and through subsequent pregnancies following traumatic birth. The support doulas offer through birth and postnatally focuses on a mother’s well being, and we believe that continuity of care is intrinsically linked to ensuring the best possible outcome for every woman.
Links and resources:
Each Baby Counts is the RCOG’s national quality improvement initiative to reduce by 50% the number of babies who die or are left severely disabled as a result of incidents occurring during term labour by 2020. The project has had a 100% participation rate with UK NHS Hospital Trusts. https://www.rcog.org.uk/eachbabycounts
Fetal monitoring in labour has been highlighted as significant issue and the RCM/RCOG are committed to supporting improved learning in this area. Earlier this year, the RCM and RCOG published a joint consensus statement: https://www.rcm.org.uk/news-views-and-analysis/news/rcm-and-rcog-publish-joint-statement-on-electronic-fetal-monitoring
Ensuring timely referral has also been recognised and the RCM and RCOG are committed to promoting strong multidisciplinary leadership. Across 2017 the RCM and RCOG have collaborated in developing a multidisciplinary Labour Ward leaders programme for safer care which to date has been hugely successful.
The National Maternity and Perinatal Audit is a national clinical quality improvement programme that aims to improve maternity and neonatal services in Britain. The RCOG and RCM are joint collaborators, along with other leading organisations. http://www.maternityaudit.org.uk/pages/home