More than half of baby deaths at a number of West Midlands hospitals could have been avoided if the mothers had been better assessed for risk factors, and one quarter of the deaths would ‘probably’ have been avoided, a study has found.
The research, carried out by the West Midlands Perinatal Institute, found community midwives working on the patch had 50% higher caseloads than the recommended level, even though they were working five extra hours each per week.
The review of 94 baby deaths across six maternity units in 2008-9 found that of 65 normally-formed babies, 19 possibly could have avoided death, and 16 probably would have avoided death if they had received better care.
The WMPI, which covers five primary care trust areas, found poor initial assessments at booking by midwives meant that risk factors were often not identified.
The report also identified “substandard care” in: antenatal surveillance; communication with the mother; postnatal follow-up and support; and development of management plans.
The Institute surveyed community midwives working across the maternity units at the time, and found their average caseload at the time was 146, compared to the Royal College of Midwives recommended number of 98.
The midwives said they worked five hours on top of their contracted hours each week, on average, they said the quality and quantity of their antenatal and postnatal visits were affected by their lack of time, and one third of midwives were so dissatisfied they said they were considering leaving.
The report’s findings linked the avoidable deaths to social deprivation among mothers, with complex social factors adding to the need for good initial assessments.
The report recommended more community midwives to reduce caseloads, more training around social need, improved hand-held maternity records, and community-based ultrasound services.
Perinatal Institutute director Jason Gardosi said some of these changes had already reduced baby deaths and improved care in the region.
Royal College of Midwives deputy general secretary Louise Silverton said: “If midwives do not have sufficient time to assess and support women things including identification of risk factors can get missed.”
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