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

(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