Latest report launched by MBRRACE-UK

By Julie Griffiths on 29 November 2017 MBRRACE Stillbirth Neonatal Death Intrapartum care

The third Perinatal Confidential Enquiry report issued by the MBRRACE-UK collaboration has been published.

According to the report’s figures, stillbirth and neonatal deaths have more than halved in the UK from 0.62 to 0.28 per 1000 total births since 1993, representing a fall of around 220 intrapartum (term) deaths per year.

Led by the National Perinatal Epidemiology Unit at the University of Oxford, the report looked at the quality of care for stillbirths and neonatal deaths of babies born at term, who were alive at the onset of labour and who were not affected by a major congenital anomaly. This type of death occurred in 225 pregnancies in 2015.

The analysis included a random representative sample of 78 of these babies born in 2015 and aimed to identify potentially avoidable failures of care during labour, birth and any resuscitation, which may have led to the death.

A key finding was that in over a quarter of the cases capacity issues were a problem. The majority of staffing and capacity problems were related to delivery suite with the remaining issues relating to neonatal care provision. Heavy workload contributed to delays in induction in one third of women being induced.

The panel enquiries also found that for most babies where resuscitation was attempted it was delivered effectively by clinical staff present at the delivery based on the Neonatal Life Support programme.

In 80% of the stillbirths and neonatal deaths analysed, improvements in care were identified which may have made a difference to the outcome of the baby.  

Another finding was that overall the quality of bereavement care was variable, with a lack of joint midwifery, obstetric and neonatal input.

RCM CEO Gill Walton said: ‘The RCM welcomes this report and recognises the achievement in an overall reduction in stillbirths and neonatal deaths. There is, however, much to take away from its findings that will go towards not only helping midwives, but the entire maternity team, improve how they deliver the safest possible care for women and their babies.’

She said it was concerning that the report found that staffing levels and capacity contributed to some of the poor outcomes particularly around the time of labour and birth.

She added that the increasing complexity of women being cared for in maternity services exacerbates this issue. ‘We must ensure we have enough midwives and obstetricians to provide safe care throughout the maternity pathway and adequate facilities in all birth settings,’ Gill said.

She continued: ‘The RCM believes that there needs to be a supernumerary labour ward coordinator in place in every single maternity service to have a helicopter view of birth activity in all settings and we have already begun leading on work in partnership with NHS Improvement.

‘This report clearly shows that improvements to the quality of investigations are needed. It is only through thorough investigation and implementation of recommendations that lessons can be learned from these tragic events. We must do everything possible to prevent them, and improve care and safety.’

Read the full report here