Answers to frequently asked questions about the Each Baby Counts project
Which cases should be reported?
Notifiable cases include term deliveries (≥37+0 completed weeks of gestation) following labour that resulted in one or more of the following three outcomes:
1. Intrapartum stillbirth: when the baby was thought to be alive* at the start of labour but was born with no signs of life†; this includes cases in which:
- Labour was diagnosed by a health professional; this includes the latent phase of labour, i.e. less than 4cm dilatation
- The woman called the unit to report any concerns of being in labour, for example (but not limited to) abdominal pains, contractions or suspected ruptured membranes
- The baby was thought to be alive at induction of labour
- The baby was thought to be alive following suspected or confirmed premature rupture of membranes (PROM)
2. Early neonatal death: when the baby died within the first week of life (i.e. days 0–6) of any cause.
3. Severe brain injury diagnosed in the first seven days of life. These are any babies that fall into the following categories:
- Was diagnosed with grade III hypoxic ischaemic encephalopathy (HIE)
- Was therapeutically cooled (active cooling only)
- Had decreased central tone AND was comatose AND had seizures of any kind
*As assessed by any means, including but not limited to: Pinard stethoscope, handheld Doppler, CTG, bedside ultrasound, assessment of fetal movements, or assumed to be alive without confirmation.
† Exclude macerated stillbirth if confirmed by post mortem.
Why is your definition of an intrapartum event different from other standard definitions?
As our notifiable cases outline, our definition of an intrapartum stillbirth is not aligned with other guidelines/ definitions, e.g. NICE. We are including cases where the baby was thought to be alive at the start of labour. This includes cases in which the woman suspected she was in labour but labour was not confirmed by a health professional.
To distinguish between those events that may have been intrapartum and those that were definitely intrapartum, we are including a question (Q5a on the online reporting platform) which asks whether the baby was “confirmed to be alive at the onset of professional care in labour”.
- A primiparous woman attended her GP surgery for a sweep. She had been having regular contractions for 3 days and nights. On examination her midwife found her to be 2 centimetres dilated with a high head and some bloody show, a further sweep was performed and she was sent home. She attended later to the obstetric unit, the CTG was pathological and an emergency caesarean section was performed. At caesarean there was copious free fluid and evidence of obstructed labour. The baby had severe HIE and died. This is a notifiable case because labour was diagnosed by a health professional, even though she was less than 4cm dilated.
- A woman called her obstetric unit at 39 weeks with abdominal pain and bleeding, she said she had waves of pain and thought she was in labour. There was no midwife available to take the call, but a junior doctor reassured her and asked her to call again when the contractions were more frequent. She presented a day later with a stillbirth. This is a notifiable case because the woman called to report concerns of being in term labour.
Who’s responsible for reporting events?
All UK trusts and health boards have been asked to nominate a lead reporter. The lead reporter will be responsible for reporting events when they occur, and will also be the main contact points for the RCOG project team. Clinical Directors will ultimately be responsible for ensuring data is submitted for eligible cases in each trust or health board.
Cases should be reported by the Hospital or Unit in which the birth took place. If the mother was transferred in labour, you will be asked to specify the location of the onset of care in labour. Babies that are transferred between institutions after birth, and subsequently die or are diagnosed with a severe brain injury within 7 days, should be reported by the Lead Reporter of the Trust in which the baby was born.
How will you check that all cases have been reported?
At regular intervals, the data submitted to Each Baby Counts will be cross-checked against other national sources of data to ensure that all notifiable cases have been reported. Cases of intrapartum stillbirth and early neonatal death will be identified from MBRRACE-UK data, and cases of severe neonatal brain injury will be identified through the National Neonatal Research Database (NNRD). We will contact Lead Reporters if we become aware of any notifiable cases that have not been reported.
Who’s leading this project?
This project is being led by the Royal College of Obstetricians and Gynaecologists (RCOG) and is governed by an Independent Advisory Group. For more information view the project governance page.
What will the RCOG do with the data?
All data submitted will be held on a secure server and accessible only to members of the project team. You can also review your own data and make changes if necessary.
By bringing this data together for the first time, we will be able to identify common themes across the country which relate to these events and share the lessons learned to improve future care. We will also be able to advocate for national change, where appropriate, as well as local service improvements.
Why are you only interested in events during term labour?
Eligible cases are currently restricted to term infants (>37 weeks) who were alive at the onset of labour in order to concentrate on those areas where most improvement can be made, and to avoid duplicating work being carried out by other national projects.
Are you collecting patient identifiers?
No, we will not be collecting any patient identifiers as part of Each Baby Counts. We recommend that lead reporters maintain a local log of Each Baby Counts IDs and the baby’s NHS number and date of birth to assist with any queries that may arise. However, this log should be kept locally and not sent to the Each Baby Counts team under any circumstance. All investigation reports should be anonymised prior to upload.
Could reporting these events trigger a CQC inspection?
According to the RCOG’s Clinical Governance Advice document Improving Patient Safety: Risk Management for Maternity and Gynaecology , all Each Baby Counts cases should already be subject to a thorough internal investigation. The cases identified through this project should also already be events that CQC are aware of through current analyses. CQC analyses HES data as well as data from STEIS and NRLS for use in its Intelligent Monitoring, Outliers and Inspection programmes. The maternity outliers programme uses HES data to analyse perinatal mortality.
The data submitted to Each Baby Counts will be held on a secure server accessible only to the project team and will not be shared with third parties. Individual trusts/health boards will not be identifiable in any public document.
Is there a recommended tool I should use to complete investigation reports?
We recommend the use of the Perinatal Mortality Review Tool (PMRT) when reviewing cases of stillbirth and neonatal death.
The PMRT is a free, web based tool available to all NHS maternity and neonatal units across England, Wales & Scotland. The tool has been designed with user and parent involvement to support high quality standardised perinatal reviews on the principle of ‘review once, review well’. We ask that Lead Reporters should upload the PMRT technical report to the Each Baby Counts portal, not the printout of the PMRT form.
To register to use the tool please email email@example.com
How long should a baby be actively therapeutically cooled to qualify as an eligible case?
We ask that all cases be reported to us that are term deliveries, where the mother laboured and the baby was actively therapeutically cooled for any amount of time. Please note that babies that are passively cooled only are not eligible for Each Baby Counts.