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‘Much more to do’ on reducing stillbirth rates across UK

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The rate of stillbirths in the UK has fallen by almost 8% in recent years, but there is still “much more to do” to achieve further reductions and address ongoing variations in care quality, say midwives.

The latest report from MBRRACE-UK – a team of academics, clinicians and charity representatives who monitor and investigate stillbirths and neonatal deaths – shows the stillbirth rate dropped from 4.2 per 1,000 total births in 2013 to 3.87 per 1,000 total births in 2015.

“We need to identify the extent to which pre-term stillbirths are avoidable”

Elizabeth Draper

While the reduction has been welcomed by maternity experts, they said more work was needed to ensure the UK matched lower stillbirth rates in other European countries and to achieve a government goal of halving stillbirths and neonatal deaths in England by 2030.

The research shows worrying variation across the country in stillbirth rates for babies born at or after 24 weeks, which cannot be explained by factors that can influence death rates such as poverty, age of mothers, multiple births and ethnicity.

Most stillbirths – about two thirds – are pre-term, noted MBRRACE-UK co-lead Elizabeth Draper, professor of perinatal epidemiology at the University of Leicester.

“We need to identify the extent to which pre-term stillbirths are avoidable to enable the development of practices and policies to prevent these and reduce any variation in the quality of care across the UK,” she said.

The research shows the neonatal death rate has remained fairly static with a slight fall from 1.84 per 1,000 live births in 2013 to 1.74 per 1,000 live births in 2015.

“There is still much more to do if we are going to match the lower stillbirth rates of other European countries”

Mandy Forrester

While there are marked differences in neonatal death rates in different parts of the UK – from 1.15 to 3.21 per 1,000 live births – much of this variation can be accounted for by differences in the proportion of babies dying from a major congenital abnormality, said the research team.

Their report groups together similar NHS trusts and health boards and uses a traffic light rating system to highlight those where action needs to be taken.

“Those trusts and health boards with high rates of stillbirth or neonatal death rates should review the quality of care they provide,” said Brad Manktelow, associate professor at Leicester University, who led the statistical analysis.

He said work was underway to develop a standard tool to help trusts review perinatal deaths and improve the quality of such investigations.

Mandy Forrester, head of quality and standards at the Royal College of Midwives, said the report showed “things are moving in the right direction”.

“But there is still much more to do if we are going to match the lower stillbirth rates of other European countries,” she said.

“There is rightly a need to tackle neonatal death rates which have not fallen as much as the stillbirth rate,” she said. “However, there is clearly a need to put even greater efforts into reducing both.”

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Mandy Forrester

She said it was vital that health services shared good practice and successful strategies but also highlighted the importance of ensuring continuity of care, with women seeing the same midwife or small group of midwives throughout pregnancy and after birth.

“Fragmented care in pressurised and overstressed services means that things can be missed,” she said.

There was also a “pressing need” to increase support to help women and partners stop smoking – a major contributor to stillbirth, noted Ms Forrester.

Meanwhile, she urged health services and policy-makers to be aware of a potential “unintended consequence” of the drive to reduce stillbirths – namely increased interventions during birth.

“We are hearing reports of increases in intervention such as induction of labour,” she said. “In addition to monitoring perinatal mortality and morbidity in women, we would like the effects of interventions on the wellbeing and long-term outlook for the mother to have similar attention.”

The Royal College of Obstetricians and Gynaecologist has just published a report on key factors in preventing baby deaths and brain injuries during childbirth, as part of its Each Baby Counts initiative.

It highlighted the importance of correct foetal monitoring and efforts to address “human factors” that can lead to poor decision-making by clinicians in stressful situations.

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“The RCOG publishes maternity indicators, which describe patterns of care during labour and delivery, enabling trusts to examine their own practice in context and to ensure their services meet the needs of women and their families,” said president Professor Lesley Regan.

“We also work closely with hospitals which invite us to conduct external reviews of their maternity services to identify where improvements can be made,” she said.

Reponding to the MBRRACE-UK report, a group of baby charities have called in the health secretary to prioritise a Conservative election pledge to reduce infant mortality.

In a letter (see below), they called on the government to “drive forward” improvement programmes across England’s maternity and neonatal services, and also called on the devolved nations to support and prioritise similar programmes.

Letter to editor re-MBRRACE report launch

Dear Sir/ Madam,

As the UK’s leading baby charities we welcomed the Conservative Party’s manifesto pledge to reduce infant mortality.

Figures released today show how urgently action is needed to deliver this pledge. 15 babies die every day in the UK, and new reports have found that a significant number of deaths and cases of harm are avoidable. They also show large, unacceptable variations in death rates between regions.

Despite a welcome drop in term stillbirths since 2013 there is much further to go to reduce these deaths; meanwhile early stillbirths and the neonatal death rate remain almost static. Two thirds of stillbirths and neonatal deaths are linked to prematurity, where an urgent focus is needed to better understand the causes of preterm birth and how it can be prevented.

Without concentrated efforts to address challenges across maternity and neonatal services, including a lack of staff, poor access to training, and units that are stretched beyond capacity, the Government’s pledge to reduce infant deaths cannot be met. Their own National Ambition, set out in 2015, to halve rates of stillbirths and neonatal deaths by 2030 needs to be expanded to include a reduction in preterm birth to be as effective as possible.

We call on Jeremy Hunt MP, as returning health secretary, to prioritise delivery of this manifesto pledge and to drive forward improvement programmes across England’s maternity and neonatal services in order to do so. We also call on each of the devolved nations to support and prioritise similar programmes within their own health services.

Significant action must be taken now – 15 babies dying each day in the UK is simply unacceptable.

Yours sincerely,

  • Marcus Green, CEO, Action on Pre-Eclampsia
  • Caroline Lee-Davey, CEO, Bliss
  • Ann Chalmers, CEO, Child Bereavement UK
  • Munira Oza, Director, Ectopic Pregnancy Trust
  • Jane Plumb MBE, CEO, Group B Strep Support
  • Francine Bates, CEO, The Lullaby Trust
  • Clea Harmer, CEO, Sands
  • Jane Brewin, CEO, Tommy’s
  • Keith Reed, CEO, Twins and Multiple Births Association
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