Starting with ABC: working together to avoid brain injury in childbirth

By Gill Walton, Chief Executive of the RCM and Eddie Morris President at the RCOG on 05 July 2021 Maternity Services Safety

How many parents-to-be, when asked about the sex of their baby, answer “we don’t mind as long as it’s healthy”? That’s their hope and the expectation, and indeed, that’s the outcome for the vast majority of parents. Sadly for some, though, complications during labour and birth can result in newborn brain injury, leading to potentially life-limiting conditions or, in rare circumstances, neonatal death.

The impact of avoidable newborn brain injury is profound: on the newborn, on the family and on the midwives and obstetricians involved. It can affect our practice, maybe making us second guess ourselves or causing us to become overly defensive, both of which can also have adverse implications for safety. And, while no-one can put a price on human life, avoidable newboard brain injury has a significant impact on NHS finances. While around one in ten claims settled by NHS Resolution in 2018/19 were for maternity cases, they accounted for half of the compensation awarded.

All of us as healthcare professionals do what we can to avoid harm, to ensure that outcomes for mother and baby are as positive as possible. But it is naïve and wrong to think that accidents and mistakes do not happen. We also know that we need to move beyond describing the problem when mistakes happen, to investigating how best we can provide personalised support and care for women in labour. We need to learn from these events and to apply that learning to future care, and we need to do so openly.

Both the Royal College of Midwives and the Royal College of Obstetricians & Gynaecologists are committed to working together, openly, honestly and collaboratively, to do just that. We already do so on a number of initiatives, including Each Baby Counts Learning & Support and the forthcoming collaboration with birth charity Tommy’s to identify and support women with higher risk pregnancies. Today, we want to share with you a new initiative that will look specifically at avoiding newborn brain injury in childbirth.

First of all, we acknowledge that there’s already a dizzying array of initiatives in maternity care, and that there’s often a risk of ‘initiative-itis’. For our part, we want to ensure that each of these dovetails with the others to provide midwives and obstetricians the right training, guidance and support to improve outcomes. In the prevention of newborn brain injury, good communication between staff and with the family, alongside understanding when to escalate and when to act, are fundamental, just as they are in the prevention of other harm.

This project, which is being run jointly by the two Colleges and The Healthcare Improvement Studies (THIS) Institute and funded by the Department for Health & Social Care, aims to address the challenges around effective fetal monitoring. We’re not starting from a blank sheet of paper - we know that there is great work being done in units across the country. We want to capitalise on that, to learn from it and see whether and how it can be applied more widely, together with the new research we have too.

We also want to understand better what the women and families in our care need from us. We all know that labour and birth is a partnership between the professionals and the women in our care. Knowing what information women and families want, when they want it and how they want that information communicated could significantly improve that partnership.

In July, we will be inviting those working in maternity care to complete a brief survey around fetal monitoring to help us listen to everyone to build a consensus for best care. And we’ll be asking women and families, those who are currently working with our services and those who are previous users, including those who have experienced newborn brain injury, about their expectations, particularly in terms of communication.

We all share a common goal: to ensure that the women and families receive the best possible care and support through pregnancy, labour and birth and that they leave our care with a healthy baby. While the latter may not always be possible, we must do all we can to make sure that we have achieved the former. We strongly believe that this new programme will help us achieve that.