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More training needed to reduce accidental injuries in maternity care

Junior doctors and inexperienced midwives feature in legal claims cases

Caroline White

Friday, 26 October 2012

More training, development, and support for clinical staff could help to stave off injuries sustained by mums and babies while under NHS maternity care, says a report from the NHS Litigation Authority, which manages legal claims made against the NHS in England.

Unsupported junior doctors and inexperienced midwives tended to feature in cases where claims were made, says the report, which examines 10 years of maternity care data.

The report shows that of the 5.5 million births in England between April 2000 and the end of March 2010, 5087 claims for injury were made, totalling more than £3 billion.

That’s equivalent to less than one claim per 1000 births, says the report, but because of the potential for these injuries to be serious, it is important that the NHS learns from these claims, it adds.

Most claims arose out of pregnancies and labours considered to be low risk by those caring for the mothers, indicating a need for effective monitoring of all deliveries, says the report.

The most common causes of claims were for management of labour, caesarean section, and cerebral palsy. The 542 claims for cerebral palsy amounted to £1.3 billion, reflecting the lifelong cost of future treatment and care.

The four primary areas of risk, which comprised 70 per cent of the total value of claims, included antenatal ultrasound investigations, cardiotocographic intepretation in labour, failiure to recognise the extent of perineal trauma and repair it adequately, and uterine rupture.

Most failures to detect anomalies from antenatal ultrasound investigations were due to human error, highlighting a need for improved and regular training, and multidisciplinary team input, says the report. In some cases national guidance had not been followed by staff.

Scanned images made during pregnancy were only saved in half of the claims cases, making it difficult to establish whether fetal anomalies were visible at the time of the scan and had been overlooked, or if they were not visible on the scan.

National standards introduced in 2010 state that all images should now be captured, stored, and archived.

The report found that in the 5087 claims cases, junior doctors and inexperienced midwives were often involved in the management of labour without adequate assistance from senior clinicians.

Having more senior staff available during labour, together with a better understanding among junior staff about when to ask for help might help stave off potential problems, says the report.

Effective multidisciplinary team working is also essential for safe maternity care, it emphasises.

The Authority’s chief executive Catherine Dixon emphasised that giving birth on the NHS “remains very safe.” But she added: “Because maternity claims are so serious, it’s vital that we learn and share lessons from them so that professionals can improve their clinical practice.¨

David Richmond, Vice President (Clinical Quality) of the Royal College of Obstetricians and Gynaecologists, who contributed to the report, said that the college’s own evidence made a strong case for the NHS to move to a consultant-delivered service so that trainee doctors received adequate support and women had access to qualified specialists throughout the day and night.

The Chief Executive of the NHS Confederation Mike Farrar added: "We are fortunate in this country that maternity care is relatively safe, but to keep it that way the NHS has got to keep learning and improving.

We must in particular learn from the occasions where things have gone very badly wrong. You cannot turn back the clock on a tragedy but you can do everything possible to prevent recurrence by focusing relentlessly on minimising risks. “

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