Heavy workloads and training gaps behind UK’s poor maternity care outcomes

Failures to follow guidelines and best practice in hospitals is contributing to incidents of newborn death and brain-damage, a new report claims.

The Each Baby Counts study found nearly three quarters of affected babies might have had a different outcome through the right maternity unit care.

For the study The Royal College of Obstetricians and Gynaecologists (RCOG) examined 1,123 term births in 2016 that ended in stillbirth (124), neonatal death (145) or severe brain injury (854).

Its research found that in almost half (45%) of reviewed cases, guidelines and best practice were not followed.

On average there were seven critical contributory factors per incident that led to a poor outcome.

Reasons for failures include gaps in training, lack of recognition of problems, communication issues, heavy workload, staffing levels and local guidelines not being based on best available evidence.

The report recommends addressing hospital workload issues, creating individualised pregnancy management plans for women and ensuring local guidelines kept in line with national guidance.

It concluded 71% of 955 births in 2016 where sufficient information was available might have had a different outcome if different care had been provided.

Areas requiring improvements include identifying and acting on risk factors, issues relating to monitoring of fetal wellbeing with cardiotocography (CTG) and blood sampling, and education or training.

One charity called the findings “difficult reading” and criticised the lack of progress in avoiding “devastating” outcomes.

Health Minister Jackie Doyle-Price said there was “still more to do” in improving the country’s childbirth outcomes.

The RCOG is now calling for a UK national centre of excellence for maternity care, to help make it “the safest place in the world to have a baby”.

Professor Lesley Regan, president of RCOG, said: “The stillbirth, death of a newborn baby or the birth of a baby with brain injuries are life-changing events that profoundly affect women and their families.

“It is absolutely vital that we sustain the momentum and progress to date to ensure we really make a difference to maternity care in the UK.”

Every year over 1,000 babies die or are left with a brain injury in the UK during term labour.

These incidents are investigated locally by a hospital or maternity unit, with the results compiled at a national level by the RCOG to help improve future care.

The aim of its Each Baby Counts initiative is to halve the number of babies who die or are left severely disabled by 2020.

Since data compilation began in 2015, researchers have recorded improvements in the amount and quality of investigations.

There was a 14% increase in the number of local investigations between 2015 and 2016, with 89% of investigations in 2016 containing sufficient information to help drive improvements.

The number of parents invited to take part in reviews rose from 34% to 41% between 2015 and 2016, but in nearly a quarter of cases parents were not involved, or even aware of, reviews taking place.

Nicky Lyon, a parent representative on the Each Baby Counts Advisory Group and co-founder of the Campaign for Safer Births, said the Each Baby Counts project was providing “incredibly valuable insight and information”.

Her son Harry was born with profound brain damage and died from a chest infection aged 18 months.

Ms Lyon added: “Nothing will change my situation or that of the families who have suffered loss like me, however we now have the knowledge and power to ensure others do not suffer.”

Caroline Lee-Davey, chief executive at premature and sick baby charity Bliss, called for better neonatal input on review panels.

She said: “This report makes for really difficult reading. It is disappointing that there has been so little progress in terms of improving care so that fewer babies suffer a devastating outcome.

“It is also unacceptable that neonatal representation throughout the review process remains inadequate in so many cases.”

Elizabeth Duff, senior policy adviser at parent charity the National Childbirth Trust (NCT) said its own research found half of women reported one red flag event during labour.

She added: “These are indicators of dangerously low staffing levels, such as women not receiving one-to-one care during labour or there being an undue delay in a time-critical activity.

“Maternity providers and policy makers need to take immediate action to improve the quality of care so that all preventable deaths and injuries are avoided.”

Health Minister Jackie Doyle-Price said: “Whilst this report acknowledges that important progress has been made, there is still more to do to ensure every mother and child receives the world-class care they deserve as part of our ambition to halve the rates of stillbirths, neonatal deaths and brain injuries caused during and after birth by 2025.

“We are giving staff the support they need to continue to improve maternity safety and have made the largest every investment in midwifery training to ensure the NHS has the skills it needs.”

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