A new study has revealed key steps for hospitals to improve care for pregnant mothers and babies.
It follows an investigation by a team of experts into 133 cases of stillbirth in 2013 -- and found that national guidance was not followed by hospitals in the majority of cases and identified 'missed opportunities' which could have potentially saved babies lives.
In the UK today, almost one in every 200 babies is stillborn and one third of these occur when the pregnancy has reached full term. A team of academics, clinicians and charity representatives, called MBRRACE-UK, has looked at how care for these mothers and term babies can be improved.
The report, commissioned by the Healthcare Quality Improvement Partnership as part of the Maternal, Newborn and Infant Clinical Outcome Review Programme, is led by a team from the University of Leicester. It is launched on 19 November at The Royal College of Obstetricians and Gynaecologists.
In its latest report, the group has examined stillbirths born at term who were singletons (sole births) and not affected by a congenital anomaly. These occur in over 1000 pregnancies a year in the UK.
A random representative sample of 133 of these babies who were stillborn in 2013 was selected. The pregnancy notes were assessed for all 133 and 85 were reviewed in detail against national care guidelines by a panel of clinicians, including midwives, obstetricians and pathologists who considered every aspect of the care.
The expert enquiry found:
The experts have identified key areas for action including:
Professor Elizabeth Draper, Professor of Perinatal and Paediatric Epidemiology at University of Leicester, said:
"The panel has identified a number of areas where improvements of care are required which, if implemented, could lead to an overall reduction in this type of stillbirth, representing missed opportunities in the provision of antenatal care.
"However not all findings were negative. We found examples of excellent bereavement care where midwives had provided long term support for families in a way that surpassed normal expectations, high quality interpreter services when these were needed as well as a high standard of post mortems."
Professor Jenny Kurinczuk, Director of the National Perinatal Epidemiology Unit and National Programme Lead for MBRRACE-UK, said:
"The findings from this enquiry are important because they provide clear pointers as to how care can be improved. The guidelines are clear and individual practitioners and maternity units need to ensure that the guidelines are implemented and every opportunity is taken to prevent a stillbirth occurring. There is no panacea in this situation; we have to prevent stillbirths one by one to ensure that as a nation we are able to reduce our stillbirth rate to those rates experienced by our European neighbours and avoid the terrible heartache experienced by three families every day across the UK."
Health Minister, Ben Gummer, said: "This is further evidence of the urgent need for change -- we need to do everything we can to reduce the number of families going through the heartache of stillbirth and ensure the NHS is one of the very best and safest places to have a baby across the world.
"Last week we launched our ambition to halve stillbirths, neonatal deaths, maternal deaths and neonatal brain injuries, through cutting-edge technology and multi-disciplinary training. The MBRRACE-UK recommendations will help the NHS to further improve and shape future, safer care.
"With greater transparency and more than 1,800 additional midwives since 2010, as well as 6,600 currently in training, we will support local maternity services to make sure every baby receives consistently high quality care, 24 hours a day, seven days a week."
Cathy Warwick, Chief Executive of The Royal College of Midwives (RCM), said: "The RCM welcomes this important report. It is imperative that it does not sit on the shelf but instead is translated into practice and service change. We owe it to women and their families to do everything we can to prevent avoidable antenatal stillbirths. The findings and recommendations from this report are critical in helping us to do just that. The RCM will work with others to do everything we can to ensure implementation."
Dr David Richmond, President of the Royal College of Obstetricians and Gynaecologists (RCOG), said: "We welcome this comprehensive report by the MBRRACE team and the clear recommendations of key actions required at all levels of the health service to reduce the number of stillbirths and improve the care given to women and their babies.
"Although fewer babies in the UK are stillborn today, it's desperately disappointing that the four recommendations from this report remain exactly the same as when the last confidential enquiry into these stillbirths took place over 15 years ago. Today's report suggests six in 10 of these stillbirths are potentially avoidable. We can and should do better by the 1,000 families affected by stillbirths that occur before a woman goes into labour each year in the UK.
"The RCOG does not accept that stillbirths are unavoidable tragedies so last year we launched Each Baby Counts, a complementary programme to MBRRACE which aims to reduce by 50% the number of babies who die or are left severely disabled as a result of incidents occurring during term labour."
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