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Barking, Havering and Redbridge University Teaching Hospital

Below is one of the case studies written by contributors to the Each Baby Counts project.

Barking, Havering and Redbridge University Teaching Hospital: Introduction of a Bereavement Clinic and Intrapartum CTG Midwife – Each Baby Counts initiatives to reduce intrapartum stillbirths, severe brain injury and improve patient-centred care

Celia Burrell, Each Baby Counts Reviewer
Richard Howard, Each Baby Counts Lead Reporter
Zofia Kropiwnicka, Senior Trainee
Tracy Dilger and Wunmi Wickliffe, Maternity Clinical Governance Team
Elizabeth Dorey and Claire Waters, Bereavement Midwifery Team
Sibo Marufu, CTG Midwife

Barking, Havering and Redbridge University Teaching Hospital NHS Trust (BHRUT) is committed to the Each Baby Counts national initiative to reduce intrapartum stillbirth, early neonatal death and severe fetal brain injury by 50% by 2020. At the Each Baby Counts Clinical Engagement Forum (June 2016), BHRUT highlighted improvements in service delivery with the introduction of:

  1. Bereavement Consultant Clinic (Poster presentation), and
  2. CTG Specialist Midwife (Oral presentation).

Our bereavement clinic improves patient communication with a more patient-centred care, as women are reviewed in a specialist clinic after a fetal loss for debriefing and offered a personalised management plan for any subsequent pregnancies.

The Maternity Clinical Governance Team have also adopted the Each Baby Counts key messages into routine practices with:

  • Comprehensive review of fetal loss and neonatal deaths
  • Patients’ participation in fetal loss reviews and serious incidents (SIs)
  • Being Open meetings
  • External review panel members
  • SI investigations with systematic recommendations and action plans.

In addition, CTG misinterpretations, substandard intrapartum care and unexpected fetal outcomes including term SCBU admissions (head cooling and HIE grade 2 & 3) are reviewed at the Serious Incidents Group (SIG) meetings. In cases of service or delivery problems, an SI and root cause analysis investigation is launched. Lessons learnt are widely disseminated at the Perinatal Morbidity and Mortality meetings, in risk newsletters, at our Clinical Governance Conference, in the message of the week newsletter and in “Near Miss” meetings.

To make improvements in teaching, in October 2016 BHRUT held a Clinical Governance Conference which highlighted the Each Baby Counts report key messages and lessons learnt. BHRUT also held a Fetal Loss Study Day for all staff also in October 2016.

Since the Each Baby Counts report launch, the bereavement team has reviewed its pathways and introduced standardised letters to invite patients to submit questions in advance of a bereavement clinic appointment. A local proforma was also developed to review fetal loss cases. BHRUT is pleased with the progress so far and data showed that there were no SI declared due to CTG misinterpretation over the six month period of September 2016 – February 2017.

BHRUT continues to make significant improvements in patient care as the trust was recently taken out of special measures by the Care Quality Commission (CQC) inspection in March 2017.