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Eight in ten stillbirths might have been avoided

Obstetricians and midwives welcome expansion of Each Baby Counts programme

Louise Prime

Tuesday, 28 November 2017

Obstetricians and midwives have welcomed the health secretary’s announcement today that the government is to expand The Royal College of Obstetricians and Gynaecologists’ (RCOG) Each Baby Counts programme, as an official report has revealed that in eight out of ten cases in the UK, the deaths of babies during labour, close to their due dates, might have been prevented with better care. It also found that inadequate staffing or resources was a problem in over a quarter of cases.

Led by the National Perinatal Epidemiology Unit at the University of Oxford, the MBRRACE-UK report examined the quality of care for stillbirths and neonatal deaths of babies born at term (after 37 weeks) who were alive at the onset of labour and who were not affected by a major congenital anomaly. The new figures show 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.

In 80% of the stillbirths and neonatal deaths analysed, improvements in care were identified that might have made a difference to the outcome of the baby. The report found that most deaths were attributable to multiple factors rather than a single cause, and said the link between antenatal care and intrapartum outcomes emphasises the need to improve the identification of reduced foetal growth, the management of reduced foetal movements and maternal diabetes, and efforts to support women to stop smoking. It also called for improvements in how maternity teams monitor the progress of labour and foetal wellbeing.

One of the report’s key findings is that capacity issues were a problem in more than a quarter of the cases; the majority of staffing and capacity problems were related to delivery suite, with the remaining issues relating to neonatal care provision. The foreword noted: “Heavy workload and staff capacity issues can affect the care provided, leading to delays in transfer to the obstetric unit, plans for induction of labour being postponed and difficulty in providing some elements of advanced life support when a baby requires resuscitation after being born.”

This morning, Jeremy Hunt unveiled the government’s new maternity strategy. He said that families who suffer stillbirth or life-changing injuries to their babies will be offered an independent investigation to find out what went wrong and why, and full-term stillbirths will be investigated by coroners. Hundreds of stillbirth, early neonatal death and severe brain injury cases each year will be referred to the Healthcare Safety Investigation Branch, which will standardise investigations of cases so that the NHS learns as quickly as possible from what went wrong and shares the learning to prevent future tragedies. He added that the government is bringing forward, from 2030 to 2025, the ambition to halve rates of stillbirths, neonatal and maternal deaths, and brain injuries occurring during or soon after birth, which would save more than 4,000 lives.

RCOG president, Professor Lesley Regan, commented: “We are delighted that the government has agreed to expand the RCOG’s Each Baby Counts programme, which has been hugely successful in securing the trust of both the midwifery and obstetric communities, with 100% of trusts involved in providing maternity services engaging in this important work. The RCOG in partnership with the RCM believes that we can build on this buy-in from frontline clinical staff by providing them with the support they need to translate lessons learned into improvements in everyday care.

“We are committed to sharing the expertise we have gained from Each Baby Counts, and our understanding of the complex interplay of factors that lead to stillbirths, neonatal deaths and brain damage during term labour, to work with partners such as NHS Improvement to expand the work and reach of the Maternal and Neonatal Safety Collaborative and the Healthcare Safety Investigation Branch as they undertake their investigations.

“Expansion of the national strategy to include a focus on preterm birth and brain injury will likewise help provide a more complete picture of maternity safety, strengthening our evidence base to help us deliver ever more effective care.”

The Royal College of Midwives (RCM) pointed out that there is already a range of initiatives to improve maternity care, and that the revised strategy will encourage a focus on what has worked well, and what more needs to be done. Gill Walton, RCM’s chief executive officer and general secretary, said: “Midwives are in a unique position to help achieve this, as they are the one healthcare professional whom all women will see during their pregnancy and birth, and therefore have a clear role in ensuring care is coordinated, safe and, most importantly, personal.”

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