Doubling of maternal death rate blamed on shortage of midwives
Jeremy Laurance is a writer on health issues. He is former health editor of The Independent and the i and has covered the specialism for more than 20 years. He thinks the harm medicine does is under-appreciated, the harm it prevents over-rated, and that cycling works better than most drugs. He was named Specialist Journalist of the Year in the 2011 British Press Awards.
Monday 30 April 2012
More than 100 mothers have died in childbirth in London in the last five years, twice the rate in the rest of the country, exposing a crisis in maternity care in the capital.
The maternal death rate in the capital has doubled since 2005 and demands "urgent attention", specialists say. There were 11 deaths in 2005-6, compared with 29 in 2010-11. Births in London have soared by 27 per cent in the last decade from 106,000 in 2001 to 134,000 in 2011, but numbers of midwives and doctors have not kept pace.
Cathy Warwick, president of the Royal College of Midwives, said yesterday: "London still has some of the worst shortages of midwives across the country. There are more women facing more complex pregnancies creating a difficult situation. We need to target resources at women who need more support."
Two inquiries have been held into the high maternal death rate in London in the last four years and both have found maternity services wanting compared with the rest of the UK. Younger midwives cannot afford to live in the capital and older, more senior ones move out.
The latest figures were obtained by Susan Bewley, professor of complex obstetrics at Kings College London and Angela Helleur of NHS London and published in The Lancet. The maternal death rate in London has risen from 9.1 per 100,000 maternities in 2005-6 to 21.6 per 100,000 in 2010-11.
Speaking to The Independent, Professor Bewley said that the number of deaths was small relative to the number of births, but maternal mortality was a sensitive measure of healthcare quality. Risks were higher in older mothers, and linked with obesity, poverty, ethnic minorities, immigration and twin pregnancies (following IVF), all of which were more common in London.
"What we don't know is if the rise in maternal mortality is a measure of illness in the population or the response of the medical services to it. It is possible that more women are falling through the net because they are iller," she said.
In 2008, the Healthcare Commission found maternity provision in the capital was poor by comparison with the rest of the country. In 2010, a review by the Centre for Maternal and Child Enquiries into the deaths of 42 mothers in London over 18 months found 76 per cent might have been avoided with better care. Staff on the frontline in maternity services were working harder and harder to stand still, Professor Bewley added.
"There are improvements in some parts of the health service – we have made incredible strides in heart disease and stroke – but worrying trends in others. Maternal mortality is a public health issue: we have to take a twin approach which means educating women about the risks associated with obesity and delaying childbirth as well as improving the health service. "
Pregnancy was a lot safer than in the past and there had been a hundred-fold drop in maternal death rates since the beginning of the last century. For every woman who dies in childbirth today 100 women are saved who would have died without medical intervention.
But Professor Bewley said there were still risks. "Pregnancy is more dangerous than jumping out of a plane or riding a bicycle without a helmet."
Tony Falconer, president of the Royal College of Obstetricians, said improving safety meant concentrating maternity services in fewer, larger hospitals.
"There is a need for significant change to the way NHS women's health services are structured. Hospitals will need to be configured to provide more midwifery-led care and 24/7 medical obstetric services for women on fewer sites."
Trish Morris-Thompson, Chief Nurse at NHS London and a practicing midwife, said: "The majority of births in London are healthy and happy occasions, but having a baby can be a difficult process. The number of maternal deaths in the capital has decreased over the past year, from 31 in 2010/11 to 22 in 2011/12 – but every preventable death is one too many.
"There are 1,000 more midwives working in the capital compared to five years ago and we have also increased funding to train 1,000 more over the past two years. We have also put in place a new worker training scheme to support midwives in their daily and demanding jobs."
Case study: 'We should not have mothers and babies dying on wards'
When Sareena Ali, a healthy 27-year-old mother, died with her baby in January last year following an emergency caesarean at Queen's Hospital in Romford, Essex, the family's solicitor, Sarah Harman, described the tragedy as the "worst case I have been involved with".
Ms Harman said: "In the 21st century we should not have mothers and babies dying on hospital wards."
Queen's Hospital is part of Barking, Havering and Redbridge NHS Trust, which was under investigation by the health watchdog at the time of Mrs Ali's death. The Care Quality Commission (CQC) ordered the trust to improve staffing and the availability of equipment, and warned that it would be liable to prosecution if it did not comply.
Mrs Ali was taken to the hospital for a planned induction. Her husband, Usman Javed, said that soon after it began she was in "unbearable pain" and he pleaded with midwives to help her. But she had been admitted to the ante-natal ward and was left unattended for more than two hours.
By the time doctors saw her, she had suffered a cardiac arrest and a ruptured womb and they were forced to perform an emergency caesarean. Her baby was stillborn and Mrs Ali died five days later. Speaking last year, Ms Harman said: "I've been rocked by this case. You don't expect an intelligent and glamorous young woman, slim as a reed, to die."
Two midwives at the hospital were suspended and Barking, Havering and Redbridge NHS Trust apologised and admitted liability.
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