Facts & Figures

Scale of the problem:

  • Numbers affected estimated at over 500 babies dying unnecessarily every year in labour or soon after (1)
  • Regular newspaper reports of babies harmed/dying in maternity wards
  • Value of litigation relating to obstetric mistakes : £3.1 billion over 10 years to March 2010.  Obstetrics is the highest area of litigation by cost (2)
  • The UK has very poor stillborn rates – 33rd out of 35 similar high income countries (3)
  • Having a baby through the night or at the weekend is associated with a 45% increased risk of neonatal death due to oxygen starvation during the birth.  This is thought to be due to poor staffing and junior doctors being left alone, even though 70% of babies are born through the night (4)

Issues:

  • Overstretched maternity wards having to turn women away  – An RCM report found more than half of NHS trusts had to close their door an average of seven times a year (5)
  • Lack of Consultant cover –Royal College of Obstetricians and Gynaecologists (RCOG) agree that 24/7 consultant cover is required urgently
  • Hospitals not consistently following national NICE (National Institute for Health and Care Excellence) guidelines – procedures and staffing levels
  • Midwife numbers not keeping pace with the rising birth rate (5)
  • Lack of quality control and monitoring both internally and externally and lack of Coroner involvement – Coroners are involved in all deaths that are sudden, unexpected or due to neglect, except for babies dying at birth – why?
  • Hospitals not disclosing their mistakes and therefore not learning

Changes needed:

  • Increased Consultant cover – ideally 24 hours a day to oversee labour wards
  • Midwife numbers – be sufficient to give good care and to keep pace with the rising birth rate.
  • For improvements in care to reduce stillbirths, for example, improved identification of growth restriction (customised growth charts and 3rd trimester scans)
  • Improved monitoring, measurement and Coroners involvement.  In other countries thorough and honest investigations when problems happen have meant problems are understood, improvements implemented and stillbirth rates reduced
  • Duty of candour – organisations and individuals

 

References

(1) Perinatal Mortality Report 2009, Centre for Maternal and Child Enquiries 2011, ITV Tonight programme, RCOG Each Baby Counts report published 2017

(2) NHS Litigation Authority Report: Ten Years of Maternity Claims An Analysis of NHS Litigation Authority Data, October 2012

(3)  V Flenady et al. Stillbirths: the way forward in high-income countries. The Lancet 2011, Vol. 377, Issue 9778, Pages 1703-1717

(4) 38 D Pasupathy, A Wood, J Pell, H Mechan, M Fleming, GCS Smith. Time of birth and risk of neonatal death at term: retrospective cohort study, BMJ 2010

(5) Royal College Midwives: State of Maternity Services Report, 2012