For expectant parents, there can be no greater trauma, mental or physical, than to lose a baby close to term or to experience complications during birth resulting in death or injury of mother or child.
The 2011 Lancet stillbirth series ranked the UK 33 out of 35 high-income countries for stillbirth rates. Since then, many clinical leaders have been driving improvements in NHS maternity care, but it is clear more must be done to reduce cases of injury and perinatal mortality. The MBRRACE-UK Perinatal Confidential Enquiry into term, singleton, normally-formed, antepartum stillbirths that occurred in 2013 found that 60 percent of these deaths could potentially have been avoided if existing guidance had been followed. The recent announcement by the Secretary of State for Health, setting out a new ambition to halve the rates of stillbirths, neonatal and maternal deaths, and intrapartum brain injuries in babies by 2030, is therefore extremely important.
Every maternity service in the country has its part to play. We cannot achieve this ambition unless we substantially reduce variations in the quality of care across all geographies and demographies. It should be a matter of great concern to all of us that perinatal death rates are higher among black and minority ethnic (BAME) communities. There is no place for this disparity in modern society and there is clearly work to do, not just in improving quality of care but raising awareness within and between communities of the risk factors associated with stillbirth and neonatal death.
The Kirkup Report into maternity service failings at Morecombe Bay has been a significant influence on the scope of this announcement. The lack of multidisciplinary team working and poor communication observed between midwives and obstetricians in Morecombe Bay resonates strongly as we seek improvements throughout the health and care system. Systematic, multidisciplinary approaches to maternity care, particularly for high-risk women, can identify potential warning signs earlier and should be adopted in every maternity service.
Collaborative working has already been shown to have a significant impact beyond our borders – both Scotland and Sweden have demonstrated effective care models with impressive mortality reductions. In Scotland, the setting up of a Maternity and Children’s Quality Improvement Collaborative in 2012 led to new awareness schemes around smoking and smoking cessation. Work on detecting growth restricted babies earlier also assisted in the delivery of timely care and treatment to avoid further complications down the line.
Meanwhile, Sweden’s ‘Safe Delivery Care’ project, launched in 2007, took a highly focused look at the strengths and weaknesses of 46 maternity service providers, supporting them to design new ways of working, redeploying services and commissioning new equipment and training where applicable. The involvement of professionals across medical disciplines (obstetrics, paediatrics and midwifery) was – and remains – a vital component in the project’s success in achieving a significant reduction in intrapartum brain injuries in babies through greater cooperation and system improvements.
So what are we doing to kick-start our own ambitions to reduce mother and baby mortality and injury in this country? NHS trusts will be receiving a share of over £4m of government investment to buy state-of-the-art digital equipment and training to support not just midwives and obstetricians but the wider maternity workforce across the country. This includes £2.4m to support trusts to buy cutting edge monitoring, training and resuscitation equipment and over £1m for training to improve safety. This is in addition to the £75million NHSE money already announced for improving perinatal mental health services – a reminder that the support needed for mothers (and families) is not – and should never be – purely focussed on physical health.
The announcement dovetails with our existing patient safety campaign ‘Sign up to Safety’ which shares the goal of reducing avoidable harm and seeks to save 6,000 lives through locally facilitated improvement programmes.
If we are to achieve our stated ambitions it is no good us trying to design a detailed programme from Whitehall. It will need the best ideas from home and abroad, including exposure to learning from teams across the country. It will mean absorbing the learning from the current National Maternity Review when it is published shortly. It will mean the development of new learning networks and a fresh spirit of openness between professionals and with patients. It will mean a revolution in the way we use and learn from data. It will mean deep listening to families, on an ongoing basis, as they describe their needs and experiences. It will mean a renewed commitment from every professional to the very best continuing professional development, supported by their employer. And finally, it will mean a huge sense of collective professional satisfaction as we avoid harm, save lives and move up the European table to where the NHS and England belongs - as a harbour of best practice other countries want to learn from.
When it comes to maternity care, this is not only achievable, it is essential.
