On 21 March NHS England produced new guidelines to support endeavours to reduce by half the rates of stillbirth by 2030 and by 20% by 2020.
The guidelines called ‘Saving Babies’ Lives’ follow on from a number of reports highlighting the ongoing concerns about stillbirths and perinatal deaths.
Publication of the ‘care bundle’ brings together both evidence-based and best practice observations during pregnancy, leading up to and during delivery but with particular attention paid to the following:
Reducing smoking during pregnancy
Smoking during pregnancy is seen as a particular risk factor not just for stillbirth but for other problems including premature delivery, miscarriage, low birth-weight and Sudden Infant Death Syndrome (SIDS). By effective use of assessment of maternal smoking status, including the use of a Carbon Monoxide test at the booking appointment, maternal smoking can be identified leading to appropriate advice and support.
Risk assessment and surveillance for fetal growth restriction
Assessing the risk of fetal growth restriction is important . Training which enables staff to detect the signs antenatally enables decisions to be made to deliver the baby early, reducing the risk of stillbirth.
Raising awareness of reduced fetal movement
Education of pregnant mothers to recognise and act on the signs of reduced fetal movement is important and it is noted that provision of information by a leaflet by 24 weeks is helpful together with appropriate training of staff to deal with this problem when it arises.
Effective fetal monitoring during labour
The importance of up to date training for those caring for women in labour is stressed by the new guidance with the standard being that:
- ‘No member of staff should care for women in a birth setting without evidence of training and competence within the last year.’
- A further recommendation is to have a ‘buddy’ system in place and a protocol to ensure that concerns can be appropriately escalated.
The new guidance also refers to recent studies and research projects which are currently underway and envisages further evaluation of best practice to keep the guidance current as new developments emerge.
Where technology may provide future solutions eg interpretation of CTG decision support software this will be evaluated and the guidance revised as appropriate.
In his introduction, Dr Matthew Jolly, National Clinical Director for Maternity and Women’s Health NHS England says:
One of the striking observations of the recent MBBRACE perinatal confidential enquiry is just how frequently undetected poor fetal growth is a factor in stillbirth. It also highlighted the lack of progress in this area since the last national enquiry 15 years ago.’
David Richmond, President of the Royal College of Obstetricians and Gynaecologists said:
A great step towards implementing “airline levels of safety” is a common-sense and well-considered element of the fetal monitoring section. The RCOG believe that it is a reasonable expectation of women in labour that no healthcare professional should provide intrapartum care on either a labour ward, midwifery led unit or at home without up to date training and competence in fetal monitoring. Achieving training and competence in fetal monitoring demonstrates a real commitment to improving the safety of our maternity systems.’
The Government has shown a commitment to improvement in this area and, if properly supported with funding, it has the potential to improve outcomes for stillbirths and birth injury generally. If improvements are made on the scale envisaged and hoped for then, this will avoid untold misery for thousands of families. It also has the potential to save significant sums which are currently required to support children who are born following a brain injury during delivery.
Please read our other related blogs:
- Long Awaited report on Maternity care
- Report identifying Improvements in Maternity Care
- Hunt targets Maternity care
If you or a member of your family has been affected by stillbirth or injury during labour, please contact a member of our Medical Negligence Team who have a vast range of experience in handling cases relating to birth injury. Our contact details are 0800 316 8892