New figures reveal no significant reduction in the number of women who died during or after pregnancy between 2013 and 2015, according to the latest report from MBBRACE-UK. The overall death rate in the UK is now 8.8 per 100,000.
The MBRRACE-UK report, led by the National Perinatal Epidemiology Unit at the University of Oxford, includes data on women who died during or up to one year after pregnancy between 2013 and 2015 in the UK.
It also includes an analysis of the care of women who died between 2013 and 2015 from a range of conditions and complications, as well as the care of women with morbidity due to uncontrolled epilepsy and those with severe postpartum mental illness.
In total, 556 women died during or up to one year after the end of pregnancy between 2013 and 2015. In addition, the care of 124 women who died and 46 with severe morbidity were reviewed.
Detailed reviews concluded improvements in care may have made a difference to the outcome of 41% of women who died – 52% of women with epilepsy and 26% of women with severe mental illness.
The report makes a number of recommendations to improve care for women with epilepsy, stroke, mental health problems, haemorrhage and amniotic fluid embolism.
Commenting in response to the report, Professor Lesley Regan, President of the Royal College of Obstetricians and Gynaecologists, said:
“Thankfully it remains extremely rare for women in the UK to die during or shortly after childbirth, but every death is a tragedy for those families, and particularly for the children left without a mother. The RCOG is committed to supporting the recommendations in this report to reduce maternal deaths and provide the best possible care for all women.
“In most cases, the women who died had a pre-existing medical condition, such as epilepsy, cardiac disease, or a mental health condition – and it’s extremely disappointing that for 4 in 10 women who died, improved care might have resulted in a different outcome.
“While the report focuses on deaths from a range of conditions and complications, one dominant theme has emerged: opportunities are being missed to reduce women’s risks of complications in pregnancy and the care of women with known pre-existing medical and mental health problems.
“What is clear from this report is that treatment and support are available for women with these pre-existing conditions, and that doctors and midwives must work together to provide coordinated and timely care. Women must receive appropriate specialist advice and forward planning of antenatal, intrapartum and postnatal care, and effective advice on planning for future pregnancies.”
Gill Walton, Chief Executive and general Secretary of the Royal College of Midwives, said:
“Every death is a heart-breaking tragedy that leaves families devastated, and even more so when a death could possibly have been avoided. Given the pressures on maternity services across the UK it is encouraging to see that the situation has not worsened since the last report but much more still needs to be done.
”There are lessons here for all health care professionals involved in women’s maternity care. Paramount is the need for much better communication between maternity professionals, and those in other disciplines, so that if a midwife or doctor spots something is not right for a woman they can share the problem with the right colleagues so that the right actions can be taken in good time.
“We need to see improvements to support women who have pre-existing conditions such as epilepsy, mental health and cardiac problems in forward planning for pregnancy and throughout their antenatal care. This will need better access to antenatal care for all women and better continuity of carer so that a woman sees the same midwife, or small group of midwives throughout and after her pregnancy. This will help to improve communication with the woman and also crucially with other health professionals.
“I hope this report will focus minds on the problem of maternal death and galvanise efforts to reduce them, because standing still is not good enough.”
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MBRRACE-UK Saving Lives, Improving Mothers’ Care - Lessons learned to inform maternity care from the UK and Ireland Confidential Enquiries into Maternal Deaths and Morbidity 2013–15.
Earlier this year, the RCOG published a survey ‘Maternal Mental Health – Women’s Voices’ of women’s experiences, highlighting the urgent need to improve maternal mental health.
In 2016, the RCOG published a Green-top guideline and patient information on epilepsy in pregnancy, calling for pregnant women with epilepsy to have specialist care to reduce preventable deaths:
About the RCOG
The Royal College of Obstetricians and Gynaecologists is a medical charity that champions the provision of high quality women’s healthcare in the UK and beyond. It is dedicated to encouraging the study and advancing the science and practice of obstetrics and gynaecology. It does this through postgraduate medical education and training and the publication of clinical guidelines and reports on aspects of the specialty and service provision. https://www.rcog.org.uk/
About the RCM
The RCM is the only trade union and professional association dedicated to serving midwifery and the whole midwifery team. We provide workplace advice and support, professional and clinical guidance and information, and learning opportunities with our broad range of events, conferences and online resources. For more information visit the RCM website at https://www.rcm.org.uk/.