RCOG President Dr Eddie Morris and Royal College of Midwives CEO Gill Walton talk about the announcement this weekend by maternity safety minister Nadine Dorries of £2 million funding for the first phase of a programme to avoid brain injuries in childbirth.
How many parents-to-be, when asked about the sex of their baby, answer: “We don’t mind as long as it’s healthy”? That’s their hope and their expectation – and it’s the outcome for the almost all parents. Sadly for some, though, complications during labour and birth can result in newborn brain injury, leading to potentially life-limiting conditions or, in rare circumstances, neonatal death.
The impact of avoidable newborn brain injury is profound: on the newborn, on the family, and on the midwives and obstetricians involved. It can affect our practice, perhaps making us second guess ourselves or causing us to be overly defensive, both of which can also have adverse implications for safety. And, while no-one can put a price on human life, avoidable newborn brain injury has a significant impact on NHS finances. Though just one in ten claims settled by NHS Resolution in 2018/19 were for maternity cases, they accounted for half of the compensation awarded.
All of us as healthcare professionals do what we can to avoid harm, and to ensure that outcomes for mother and baby are as positive as possible. But it’s naïve and wrong to think that accidents and mistakes do not happen. We also know that we need to move beyond describing the problem when mistakes happen, to investigating how best we can provide personalised support and care for women in labour. We need to learn from these events and to apply that learning to future care, and we need to do so openly.
Both the Royal College of Midwives and the Royal College of Obstetricians & Gynaecologists are committed to working together, openly, honestly, and collaboratively, to do just that. We already do so on a number of initiatives, including Each Baby Counts + Learn and Support and the forthcoming collaboration with birth charity Tommy’s to identify and support women with higher risk pregnancies. Today, we want to share with you a new initiative that will look specifically at avoiding newborn brain injury in childbirth.
First of all, we acknowledge that there’s already a dizzying array of initiatives in maternity care, and that there’s often a risk of ‘initiative-itis’. For our part, we want to ensure that each of these dovetails with the others to provide midwives and obstetricians the right training, guidance and support to improve outcomes. In the prevention of newborn brain injury, good communication between staff and with the family, alongside understanding when to escalate and when to act, are fundamental, just as they are in the prevention of other harm.
This project, which is being run jointly by the two Colleges and The Healthcare Improvement Studies (THIS) Institute, and is funded by the Department for Health & Social Care, aims to address the challenges around effective fetal monitoring. We’re not starting from a blank sheet of paper - we know that there’s great work being done in units across the country. We want to capitalise on that, to learn from it and see whether and how it can be applied more widely, together with the new research we have too.