Stillbirth and neonatal deaths have more than halved in the UK from 0.62 to 0.28 per 1,000 total births since 1993, representing a fall of around 220 intrapartum (term) deaths per year, according to new figures published today.
Led by the National Perinatal Epidemiology Unit at the University of Leicester, the MBRRACE-UK report looked at the quality of care for stillbirths and neonatal deaths of babies born at term (after 37 weeks) who were alive at the onset of labour and who were not affected by a major congenital anomaly. This type of death occurred in 225 pregnancies in 2015.
The analysis included a random representative sample of 78 of these babies born in 2015 and aimed to identify potentially avoidable failures of care during labour, delivery and any resuscitation, which may have led to the death.
A key finding was that capacity issues were a problem in over a quarter of the cases. The majority of staffing and capacity problems were related to delivery suite with the remaining issues relating to neonatal care provision.
Furthermore, in 80% of the stillbirths and neonatal deaths analysed, improvements in care were identified which may have made a difference to the outcome of the baby.
Commenting on the findings, Professor Lesley Regan, President of the Royal College of Obstetricians and Gynaecologists, said:
“For the vast majority of women and their babies, the UK is a safe place to give birth. However, despite the fall in stillbirth and neonatal mortality, these deaths remain a major cause for concern.
“The finding that for 80% of babies, different care may have led to a different outcome, echoes the findings from the RCOG’s Each Baby Counts programme. The report also highlights that the majority of these deaths were attributable to multiple factors rather than a single cause. It is crucial that lessons are learnt from each death and that front-line staff are given the resources they need to deliver safe care to every woman and baby.
"Working with the RCM and other partners across the system, the RCOG remains committed to improving maternity safety and continues to drive forward quality improvement to reduce cases of avoidable harm during childbirth.”
Gill Walton Chief Executive and General Secretary at the Royal College of Midwives (RCM) said:
“The RCM welcomes this report and recognises the achievement in an overall reduction in stillbirths and neonatal deaths. There is however much to take away from its findings that will go towards not only helping midwives, but the entire maternity team improve how they deliver the safest possible care for women and their babies.
“It is concerning that the report found that staffing levels and capacity contributed to some of the poor outcomes particularly around the time of labour and birth. The increasing complexity of women being cared for in our maternity services exacerbates this issue. We must ensure we have enough midwives and obstetricians to provide safe care throughout the maternity pathway and adequate facilities in all birth settings.
“The RCM believes that there needs to be a supernumerary labour ward coordinator in place in every single maternity service to have a helicopter view of birth activity in all settings and we have already begun leading on work in partnership with NHS Improvement.
“This report clearly shows that improvements to the quality of investigations are needed. It is only through thorough investigation and implementation of recommendations that lessons can be learned from these tragic events. We must do everything possible to prevent them, and improve care and safety.”
Note to Editors
Each Baby Counts is the RCOG’s national quality improvement initiative to reduce by 50% the number of babies who die or are left severely disabled as a result of incidents occurring during term labour by 2020. The project has had a 100% participation rate with UK NHS Hospital Trusts. https://www.rcog.org.uk/eachbabycounts
Fetal monitoring in labour has been highlighted as significant issue and the RCM/RCOG are committed to supporting improved learning in this area. Earlier this year, the RCM and RCOG published a joint consensus statement: https://www.rcm.org.uk/news-views-and-analysis/news/rcm-and-rcog-publish-joint-statement-on-electronic-fetal-monitoring
Ensuring timely referral has also been recognised and the RCM and RCOG are committed to promoting strong multidisciplinary leadership. Across 2017 the RCM and RCOG have collaborated in developing a multidisciplinary Labour Ward leaders programme for safer care which to date has been hugely successful.
The National Maternity and Perinatal Audit is a national clinical quality improvement programme that aims to improve maternity and neonatal services in Britain. The RCOG and RCM are joint collaborators, along with other leading organisations. http://www.maternityaudit.org.uk/pages/home
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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/.