
“Pregnancy loss and the death of a baby are not just ‘one of those things’”.
Every year in the UK around 5000 babies are stillborn or die within the first 28 days of life. The reality of these figures and the level of tragedy they represent is truly heart-breaking,
In 2015 the UK Government set targets for halving the number of stillbirths and neonatal deaths by 2025 compared to 2010 levels. Since then there have been a number of independent reviews into maternity care around the UK; including East Kent Maternity Services, the Ockenden Report and the Review of Maternity Services at Cwm Taf.
The charities Sands and Tommy’s have formed a Joint Policy Unit to put in place the key policy changes required to reduce the number of babies dying. On 15 May 2023 Sands & Tommy’s published the first of a series of their Saving Babies Lives 2023 – A report on Progress.
Unfortunately, the report shows that not only has there been insufficient progress to meet the UK Government targets, but there is also a risk of going backwards.
While the UK-level rate of stillbirth has declined overall over the last decade, there has been variable progress across the four nations of the UK.
In Wales, the downward trend between 2010 and 2016 has been reversed, with the highest stillbirth rates recorded in 2020 and 2021. The neonatal death rate in Wales has remained broadly similar between 2010 and 2021. Progress to reduce perinatal mortality in Wales halted in 2018 and rates have worsened each year since.
Inequalities in maternity care
The report states that meaningful action is needed to address stark and persistent inequalities by ethnicity and deprivation.
Stillbirth and neonatal deaths are more common among women from minoritised ethnic groups and those living in the most deprived areas across the UK. The risk of preterm birth and miscarriage is also higher among minoritised ethnic groups. Inequalities are persistent and have shown little change over time.
The difference in stillbirth rates between those living in the least and most deprived areas has increased since 2010. The report states there needs to be a much stronger commitment and long-term funding from government to eliminating inequalities in pregnancy loss and baby deaths.
Systemic issues in maternity and neonatal services
The report highlights that the scale of current pregnancy loss and baby death is not inevitable and we are not on course to meet national ambitions to reduce the occurrence. It states we must look at systemic issues across maternity and neonatal services and identify areas that will make a difference to those outcomes.
Inspections of maternity services suggest that safety and quality of service in England are declining. CQC surveys show that fewer women felt their concerns during labour and birth were taken seriously in 2022 compared to 2017.
“Improving services requires a culture of learning from mistakes, teamwork and collaboration and ongoing learning and development.”
The report highlights that quality and safety ratings are declining despite the introduction of various initiatives designed to improve safety. For people to be able to make meaningful decisions about their care there need to be resources in place to make different options a reality.
The report advises that alongside evidence-based unbiased advice, there is a need for culture change to ensure openness and learning and transparency. We need to move from diagnosing issues with teamwork and culture to introducing effective interventions to address them. Systems must be in place to share learning locally, regionally and nationally with clear actions to address concerns raised.
The CQC publishes data annually on the number of maternity services rated outstanding, good, requires improvement and inadequate. In their 2017 report half of all maternity services were rated “requires improvement” or “inadequate”. By March 2020 this had improved slightly to 39%. In 2022 38% of services were rated “inadequate” or “required improvement”.
The report has considered the previous reports and reviews conducted into maternity care and neonatal safety to identify key themes below:
- Staffing and training
- Culture of safety within organisations
- Organisational leadership
- Personalisation of care and choice
- Data collection and usage
- Learning from reviews and investigations
- Engagement with service users
- Delivering care in line with best practice /national guidelines.
Listening and learning from the experiences of women and birthing people using maternity services is vital to improving care.
The Joint Policy Unit is assessing progress in their key areas and will provide their analysis later in the year.
Identifying when a stillbirth or neonatal death could have been avoided.
In 2021-2022 nearly a fifth of stillbirths were found to be potentially avoidable if better care had been provided.
Personalised care and informed choices have been a recurring theme in recent reviews of maternity services.
Reviews of the care provided are important to identify any issues which may have contributed to a baby’s death.
The report has highlighted there to be variations in the standard of care experienced at each stage of pregnancy, birth and in the neonatal period. Too often avoidable loses continue to occur as a result of care that is not in line with recommendations in NICE and other nationally agreed standards.
Variation in standards of care have been highlighted in previous reviews of maternity services, which have emphasised the need to provide timely and responsive care in line with national guidelines.
The report has highlighted the following common themes which run through the reviews into maternity care:
- Delay in diagnosis or management of problems
- Fetal growth and movement surveillance
- Risk and assessment and impact on birth plan and management
- Management of preterm births
- Fetal and maternal monitoring
Comment
I have sadly dealt with many claims investigating the maternity and neonatal care provided and have found similar themes running through my cases. As the report states none of the individual data is new, however, seeing the statistics contained in one report is truly eye-opening.
There are systemic issues which need to be addressed and we need to ensure that lessons are learnt when babies die. There are simply too many families having to go through the unimaginable pain of baby loss.
If you, or a loved one, have suffered as a result of poor care, please get in touch with our Clinical Negligence solicitors in Cardiff for advice.