The RCM has welcomed the recommendations of an independent review into the rise in maternal deaths between 2009-10 in the capital, published by NHS London today.
The strategic health authority commissioned the report after 42 maternal deaths were recorded during that period, which was higher than the national mortality rate for the same period. In the first six months of 2010, the number of maternal deaths in London was the same as the whole of 2009. This trend has not continued over the past 12 months.
The Centre for Maternal and Child Enquiries review panel found that of the total deaths, 17 were directly related to complications from pregnancy, including haemorrhage, infection and pre-eclampsia, 23 were indirect and two were coincidental.
The review found that 70.6% of the direct deaths and 57.9% of the indirect deaths had avoidable factors. ‘This is broadly consistent with the national and international published literature but does indicate that there are opportunities for improvement,’ said the report.
It also highlighted the complexity of the cases seen by London maternity services. The majority of the women in the review (66%) were in the black and minority ethnic group, which previous research has shown has a five times higher maternal mortality rate than white ethnic groups. And just over half of the women in the review were born outside the UK, and are reported as having higher rates of complications during pregnancy.
Commenting on these findings, NHS London chief nurse Professor Trish Morris-Thompson, said: ‘Although we did not find one specific cause for these deaths, the report did confirm that London cares for many more women with underlying complex health conditions than anywhere else in the country. Also many of the deaths occurred in hard-to-reach groups who sometimes do not contact health services until late in pregnancy. This can add extra risk to mum and baby.’
She added: ‘It is vitally important that we learn from the deaths of these women. I am personally holding London’s NHS trusts and commissioners to account to make sure the improvements recommended in this report are put in place, and that women receive the care they deserve. This includes having more consultant obstetricians on labour wards and greater supervision to support junior midwives.’
Louise Silverton, RCM deputy general secretary, praised NHS London for taking action. ‘The report highlights the capacity pressures in London, the lack of one-to-one care and continuity of care and issues with picking up rarer pre-existing conditions.’
She urged midwives to read the report’s recommendations and pay attention to good risk assessment, knowing how to escalate appropriately and quickly and the importance of training in emergency response.
A review of maternal deaths in London
January 2009-June 2010 makes three key recommendations for London’s maternity services:
• Maternity services should provide a ratio of one midwife to 30 births, as a minimum to give women more personal care
• Women should have 1:1 care during labour by a midwife
• The presence of consultant obstetricians on labour wards, as recommended by the royal colleges of midwives, obstetricians and gynaecologists, anaesthetists and paediatrics and child health, should be achieved to provide senior level of care for women with medical or obstetric complications.
