Each baby counts

Each Baby Counts 2015 | The Royal College of Obstetricians and Gynaecologists.

In the UK, each year over 1000 babies die or are left with severe brain injury because something goes wrong during labour.

Each Baby Counts is the RCOG’s national quality improvement programme to reduce the number of babies who die or are left severely disabled as a result of such incidents occurring during term labour.

The report presents key findings and recommendations based on the analysis of complete data relating to term stillbirths, neonatal deaths and babies with brain injuries born during 2015, the first full year of the programme.

Full report: Each baby counts

 

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Access and quality of maternity care for disabled women

More disabled women are becoming mothers, and yet, their care is rarely the focus of quantitative research. This study aimed to investigate access and quality of maternity care for women with differing disabilities | BMJ Open

Results: Overall, 20‰094 women completed and returned the survey; 1958 women (9.5%) self-identified as having a disability. The findings indicate some gaps in maternity care provision for these women relating to interpersonal aspects of care: communication, feeling listened to and supported, involvement in decision making, having a trusted and respected relationship with clinical staff. Women from all disability groups wanted more postnatal contacts and help with infant feeding.

Conclusion: While access to care was generally satisfactory for disabled women, women’s emotional well-being and support during pregnancy and beyond is an area that is in need of improvement. Specific areas identified included disseminating information effectively, ensuring appropriate communication and understanding, and supporting womens sense of control to build trusting relationships with healthcare providers.

Full reference: Malouf, R. et al. (2017) Access and quality of maternity care for disabled women during pregnancy, birth and the postnatal period in England: data from a national survey. BMJ Open. 7:e016757

 

Reducing baby deaths and injuries

Teamwork in maternity units key to reducing baby deaths and brain injuries during childbirth. Adherence to best practice on fetal monitoring and neonatal care also identified as crucial to improving outcomes

The Royal College of Obstetricians and Gynaecologists has published Each Baby Counts: 2015 Summary Report. The report provides a detailed analysis of all stillbirths, neonatal deaths and brain injuries that occurred during childbirth in 2015 and identifies the key clinical actions needed to improve the quality of care and prevent future cases. These clinical actions include: improving fetal monitoring; enhancing neonatal care; and reducing human factors by understanding ‘situational awareness’ to ensure the safe management of complex clinical decisions.

The full report can be downloaded here

Additional links: Each Baby Counts project | Royal College of Midwives news | BBC News report

Inducing labour in older women having their first baby does not increase the chance of caesarean delivery

Planning to artificially start labour for older women, pregnant with their first child, in the 39th week of pregnancy does not affect the chance of having a caesarean delivery | NIHR Signal

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Image source: NIHR

Older women having a first baby have a higher risk of stillbirth and other complications than younger mothers and inducing labour at or before the due date is thought to reduce this risk. However, there have been fears that inducing labour may raise the risk of a caesarean delivery.

This study found that women aged 35 or over having their first child and who were induced at 39 weeks had no higher risk of a caesarean (32%) than women who had standard wait-and-see care (33%) with intervention if necessary.

It’s important to note that this study did not investigate whether women whose labour was induced had a lower risk of stillbirth. A large trial is in progress to investigate this issue. In the meantime, the findings may reassure some women aged over 35 that labour induction may carry no more risk of having a caesarean than spontaneous labour.

Read the full overview here

Labor or Cesarean for Superobese Women?

Rates of severe maternal and neonatal morbidity were similar among superobese women undergoing primary cesarean delivery versus a trial of labor, most often ending in vaginal delivery | Clinical Anesthesiology

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Researchers say a prospective clinical trial is needed to determine whether one method of birth is superior to the other in mothers who are superobese.

According to Alexander Butwick, MBBS, FRCA, MS, among women who are superobese, rates of cesarean delivery are particularly high (≥50%), but little has been known about how delivery mode affects perinatal and neonatal outcomes. Dr. Butwick, who presented the findings at the 2016 annual meeting of the Society for Obstetric Anesthesia and Perinatology (abstract 01-02), is associate professor in the Department of Anesthesiology, Perioperative and Pain Medicine at Stanford University School of Medicine, in California.

Over the years, clinicians have observed that obesity is associated with an increased risk for obstetric, perinatal and anesthetic morbidities. Obese pregnant women are at an increased risk for gestational diabetes, preeclampsia, operative delivery, postpartum infection and venous thromboembolism.

Read the full article here

Saving Babies Lives

NHS England’s National Clinical Director for the Maternity Review and Women’s Health evaluates the Saving Babies’ Lives Care Bundle for reducing stillbirths | NHS England

It has never been safer to give birth in this country, but there is more that we can do and reducing stillbirth continues to be a priority for the NHS.

There are currently around 665,000 babies born in England each year. But there are over 3,000 stillbirths. While the majority of women receive high quality care, there is around a 25 per cent variation in the stillbirth rates across England. This presents us with an opportunity to make improvements.

In March last year a new set of guidance called the Saving Babies’ Lives Care Bundle was launched by the NHS England Maternity Transformation Programme, as part of a drive to halve the rate of stillbirths from 4.7 per thousand to 2.3 per thousand by 2030 – potentially avoiding the tragedy of stillbirth for more than 1,500 families every year.

The package was developed by groups brought together by NHS England, including midwives, obstetricians and representatives from stillbirth charities.

It brings together four elements of care identified by best available evidence and good practice to help reduce stillbirth rates. These include:

  1. Reducing smoking in pregnancy
  2. Risk assessment and surveillance for fetal growth restriction
  3. Raising awareness of reduced fetal movement, and
  4. Effective fetal monitoring during labour.

Read more via NHS England

UK maternity care

MBRRACE-UK has published Saving Lives, Improving Mothers’ Care: Surveillance of maternal deaths in the UK 2012–14 and lessons learned to inform maternity care from the UK and Ireland Confidential Enquiries into Maternal Deaths and Morbidity 2009–14.

The report presents the findings of maternal mortality surveillance 2012 to 2014 in the UK and the lessons learned from the confidential enquiries into maternal deaths from cardiovascular causes, blood pressure disorders of pregnancy, early pregnancy causes together with messages for critical care.

MBRRACE-UK Maternal Report 2016 – Full Report

MBRRACE-UK Maternal Report 2016 – Lay Summary

Additional link: RCOG press release