NHS maternity safety: Ministers announce review to stop baby deaths during childbirth

National review of practice and safer staffing could prompt major reforms to stop deaths and brain injuries

Shaun Lintern
Health Correspondent
Sunday 04 July 2021 00:04
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<p>Ministers are investing more money to improve the safety of maternity services after repeated scandals</p>

Ministers are investing more money to improve the safety of maternity services after repeated scandals

Experts are to carry out a multimillion-pound review of maternity care across the NHS in a bid to prevent babies from dying and suffering brain injuries during birth, The Independent can reveal.

In a move that could lead to a major shake-up of maternity practice in the health service, ministers announced that the Royal College of Obstetricians and Gynaecologists (RCOG) will lead an investigation into how infants can be identified more quickly as being in distress.

The announcement comes days after The Independent reported that dozens of babies had died at one of the UK’s biggest hospitals, and ahead of an MPs’ report next week which may be highly critical of maternity services throughout the NHS.

There will also be fresh government funding for work to develop a new safer staffing tool, to make sure that enough doctors are always available when women and babies need them.

In 2019, The Independent, alongside charity Baby Lifeline, launched a campaign to improve maternity safety after revealing the full scale of the events that occurred at the Shrewsbury and Telford Hospital Trust and led to the largest such scandal in NHS history.

Now safety minister Nadine Dorries has announced the cash injection in the wake of the latest revelations, and ahead of a report expected this week from the Commons Health and Social Care Committee into maternity safety in the NHS.

Health leaders hailed the move as a significant step in improving the quality of maternity care within NHS hospitals.

Ms Dorries told The Independent: “I am determined to make sure as many mums as possible can go home with healthy and happy babies in their arms.

“This new programme aims to spot warning signs earlier and save lives, preventing families and their babies from facing the horrific ordeal of a life-changing brain injury, and will help us deliver on our ambition to halve brain injuries during birth by 2025.

“Having the right maternity staff in the right place at the right time means they can learn from one another, give the best care for mums and babies, and build a safe and positive environment for both staff and pregnant women in maternity teams across the country.”

Under the new plans, RCOG has been given £2m to investigate the best and quickest ways of identifying when babies are in distress. The work will start with a review of current practices.

The college has also been given £449,000 to develop a tool, which will be made available free of charge to NHS trusts, to calculate how many doctors each unit needs.

There is a currently a national shortage of both midwives and obstetricians across the country, with nine out 10 junior doctors working in obstetrics and gynaecology reporting rota gaps in their units.

NHS England has already announced a separate £96m plan to increase the number of midwives and provide safety training for staff, to try to reduce errors following the publication of the first report of the inquiry into the Shrewsbury and Telford Hospital Trust, which is being led by midwife Donna Ockenden. She is reviewing almost 1,900 cases of poor care.

Maternity negligence claims account for more than half of all damages paid by the NHS, with a single case of a baby suffering brain damage costing millions of pounds. Last year The Independent revealed that one family was awarded £37m in compensation to support their disabled son for the rest of his life, after errors at Guy’s and St Thomas’ NHS Foundation Trust in London.

The Avoiding Brain Injuries in Childbirth review by RCOG will be completed by the end of this year, and will include a survey of maternity staff and interviews with parents, as well as testing best practices for monitoring and responding to a baby’s wellbeing during labour. It will also examine how complications in a baby’s positioning during caesarean section are managed.

Working with the Royal College of Midwives and the Healthcare Improvement Studies Institute at the University of Cambridge, the review will establish an agreed approach for how to monitor the condition of a baby, as well as how to record readings, and at what point midwives should escalate concerns.

A repeated finding in maternity scandals has been the failure to escalate concerns when women and babies get into difficulties, along with poor interpretation of heart-rate traces, and delays in recognising when something was wrong.

During the next 12 months, the RCOG will examine data from the NHS in order to design the new staffing tool for doctors, which will set out the number, grade and skills each unit needs.

It will also take into account local factors such as birth rates, population age and socioeconomic status.

RCOG president Dr Edward Morris said: “We’re delighted to receive funding for a new workplace planning tool and project to reduce brain injuries in childbirth. This investment will go a huge way to improving the quality of care provided to pregnant women and their babies.

“We recognise that appropriate maternity staffing is fundamental to providing safe care for women, and we hope this tool will give maternity units in England a clear guide to determine how many medical staff they require in their specific setting.

“The new project to avoid newborn brain injury in childbirth aims to address the challenges around effective fetal monitoring, building on the great work already being done in this area. We understand that the impact of avoidable newborn brain injury is profound, and we want to do everything we can to ensure no family has to experience it.”

Gill Walton, chief executive at the Royal College of Midwives, said: “Every avoidable brain injury leaves families devastated, and affects midwives and maternity staff. For the vast majority of women and their babies, the UK is a safe place to give birth. However, tragically avoidable brain injuries do happen. It’s imperative we work together in maternity services to do all we can to reduce avoidable brain injuries during birth.”

She added: “Far too many maternity reviews have cited understaffing and the impact that has on safety in maternity services. The development of such a tool will bolster safety and improve on the current maternity staff skill mix, which is key to delivering safe, high-quality maternity care.”

The government’s maternity safety ambition is to halve the 2010 rates of stillbirth, neonatal and maternal death, and brain injuries that occur during or soon after birth by 2025.

While progress has been made on reducing deaths, the brain injury rate fell to 4.2 per 1,000 live births in 2019 after rising from 4.2 to 4.7 per 1,000 births between 2012 and 2014.

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