Measures to counter “human factors”, such as stress and fatigue among maternity staff, are key to reducing baby deaths and brain injuries during childbirth, according to a detailed new analysis.
Its authors emphasised the potential impact of “human factors” on care, and the fact that “decision-making is more difficult when staff feel stressed and/or tired”.
“Decision-making is more difficult when staff feel stressed or tired”
Their report, published today by Royal College of Obstetricians and Gynaecologists, also highlighted the vital importance of good teamwork and communication.
In addition, failure to monitor babies’ wellbeing during labour accurately and staff misinterpreting results were among the common issues to emerge from the college’s Each Baby Counts initiative.
Experts examined local reviews of the care received by 1,136 babies in the UK in 2015 – of which 126 were stillborn, 156 died within a week of birth and 854 were born with a severe brain injury.
In three out of four cases, where there was enough information, they concluded the outcome for babies might have been different if they had received different care.
“Problems with accurate assessment of foetal wellbeing during labour and consistent issues with staff understanding and processing of complex situations, including interpreting foetal heartrate patterns, have been cited as factors in many of the cases we have investigated,” said co-principal investigator Professor Zarko Alfirevic, from the University of Liverpool.
“Clinical staff should be empowered to seek out advice from a colleague”
The new Each Baby Counts 2015 Summary Report made a number of recommendations aimed at preventing incidents in the future, including stressing the importance of correct foetal monitoring.
It said all women who were apparently low risk should have a formal foetal risk assessment to work out the most appropriate method of foetal monitoring – irrespective of the type of setting where they were giving birth.
Regular risk assessment should be carried out during labour and midwives and others should follow official guidance from the National Institute for Health and Care Excellence on when to switch from intermittent auscultation to continuous cardiotogography (CTG) monitoring.
Meanwhile, all staff tasked with interpreting CTG results should undergo documented annual training.
The report stressed that key decisions should not be made based on CTG results alone.
Reducing midwife stress ‘key’ to improving birth safety
“Healthcare professionals must take into account the full picture, including the mother’s history, stage and progress in labour, any antenatal risk factors and any other signs the baby may not be coping with labour,” said the report.
As well as refreshing clinical skills, midwives and others should be offered multi-disciplinary training and have opportunities to develop non-clinical skills, such as “situational awareness” – understanding everything that is happening around you and anticipating potential consequences.
A senior member of staff should have oversight of activity on the delivery suite “especially when others are engaged in complex technical tasks”, noted the report.
“Ensuring someone takes this ‘helicopter view’ will prevent important details or new information from being overlooked and allow problems to be anticipated earlier,” it stated.
Meanwhile, midwives and other clinicians should feel able to seek “a different perspective” when dealing with complex situations, which “improves the chances of making a safe decision”.
“Clinical staff should be empowered to seek out advice from a colleague not involved in the situation who can give an unbiased perspective – either in person or over the phone,” highlighted the report, which also recommended “safety huddles” for complex or unusual situations.
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Regarding neonatal care, the report stressed the need to ensure neonatal teams were fully briefed on any issues or risks relating to a baby “in a timely and consistent manner”.
The investigation revealed huge variation “in the time and effort” NHS trusts put into investigating incidents and learning from mistakes, said the RCOG.
Investigators were only able to draw conclusions from 727 of the cases they looked at, as a quarter of the local investigations studied were not thorough enough.
“The fact that a quarter of reports are still of such poor quality that we are unable to draw conclusions about the quality of care provided is unacceptable and must be improved as a matter of urgency,” said RCOG president Professor Lesley Regan.
“This report shows that there is a need for additional support for our maternity staff and units”
Judy Ledger, founder and chief executive of the charity Baby LifeLine, said the RCOG report highlighted the support needed by maternity wards and hospitals to ensure they had the “vital tools” required during pregnancy and birth to deliver safer maternity care.
“This report shows that there is a need for additional support for our maternity staff and units so that every mother and every family has the healthiest possible outcome from pregnancy and birth,” said Ms Ledger, who is a former nurse.