Scale of the problem:
- RCOG Each baby Counts and MBRRACE have reported that hundreds of stillbirths and brain injuries each year are potentially avoidable (1)
- Regular newspaper reports of babies harmed/dying in maternity wards
- Value of litigation relating to obstetric mistakes: Maternity claims remain the highest area in financial cost, said to equate to £1 billion in 19/20 (2)
- The UK has poor stillborn rates – 24th out of 49 similar high income countries (3)
- Various reports have found significant variation in outcomes across hospital Trusts (4)
- Having a baby through the night or at the weekend is associated with a 45% increased risk of neonatal death due to oxygen starvation during the birth. This is thought to be due to poor staffing and junior doctors being left alone, even though 70% of babies are born through the night (5)
Issues:
- Shortages of midwives, obstetricians and neonatal staff (6)
Overstretched maternity wards having to turn women away – An RCM report found more than half of NHS trusts had to close their door an average of seven times a year (7) - Lack of Consultant cover –Royal College of Obstetricians and Gynaecologists (RCOG) agree that 24/7 consultant cover is required urgently
- Hospitals not consistently following national NICE (National Institute for Health and Care Excellence) guidelines – procedures and staffing levels
- Lack of quality control and monitoring both internally and externally and lack of Coroner involvement – Coroners are involved in all deaths that are sudden, unexpected or due to neglect, except for babies dying at birth – why?
- Hospitals not disclosing their mistakes and therefore not learning
Changes needed:
- Increased Consultant cover – ideally 24 hours a day to oversee labour wards
- Midwife numbers – be sufficient to give good care and to keep pace with the rising birth rate.
- For improvements in care to reduce stillbirths, including full implementation of the Saving Babies Lives Care Bundle (v2)
- Improved monitoring, measurement and Coroners involvement. In other countries thorough and honest investigations when problems happen have meant problems are understood, improvements implemented and stillbirth rates reduced
- Candour by all organisations and individuals
References
(1) RCOG Each Baby Counts reports and MBRRACE Confidential Enquiries Published 2015 & 2017
(2) NHS Resolution Annual Report and Accounts 19/20
(3) Lancet Stillbirth Series 2016
(4) MBRRACE Perinatal death reports & National Maternity and Perinatal Audit
(5) 38 D Pasupathy, A Wood, J Pell, H Mechan, M Fleming, GCS Smith. Time of birth and risk of neonatal death at term: retrospective cohort study, BMJ 2010
(6) NHS HEE Maternity Workforce Strategy Report 2019
(7) Royal College Midwives: State of Maternity Services Report, 2012