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Variations in perinatal mortality risk 'must be tackled'

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Hard-pressed midwives say they need more time to do essential work with vulnerable women, in the light of a major new report that suggests the quality of maternity care in the UK remains a postcode lottery.

While the review of perinatal mortality in 2013 found an overall improvement in rates of stillbirths and neonatal deaths, it also revealed wide variations in death rates across the UK.

Carried out by a team of academics, clinicians and charity representatives, the review uncovered glaring inequalities, with families from poor and minority ethnic backgrounds around 50% more likely to suffer the devastation of losing a baby at, or around, the time of birth.

“We need to ensure midwives have the time to do a thorough risk initial assessment of a woman”

Louise Silverton

But even when known risk factors such as poverty, a mother’s age and ethnicity are taken into account, the statistics show large regional differences in the numbers and rates of babies who die as well as variations between trusts and health boards.

Among organisations responsible for commissioning care, extended perinatal death rates – encompassing stillbirths and neonatal deaths – varied from 5.4 to 7.1 per 1,000 live births.

Altogether there were 4,722 extended perinatal deaths – 3,286 stillbirths and 1,436 neonatal deaths – among babies born at 24 weeks plus in 2013. This is the equivalent of six deaths per 1,000 births.

The statistics show just two areas in the UK – Barnet and Dorset – had mortality rates that were significantly better than the UK average.

Meanwhile, the report called on those with the worst rates to urgently review the figures in their areas and identify possible reasons.

Areas flagged “red”, where mortality rates are more than 10% higher than average, and areas flagged “amber”, with rates up to 10% higher than average, should probe their data and care provision, it concluded.

“Hard-pressed maternity staff can only do so much”

Louise Silverton

The report by MBRRACE-UK – Mothers and Babies: Reducing Risk through Audits and Confidential Enquiries across the UK – was welcomed by professional bodies include the Royal College of Midwives and Royal College of Obstetricians and Gynaecologists.

The RCM’s director for midwifery Louise Silverton said it was vital variations in outcomes for women were addressed, which could include the creation of more targeted services for disadvantaged groups.

However, she stressed a key factor in providing good all-round care was ensuring midwives had the time they needed to carry out thorough assessments and build up trusting relationships with the women they cared for.

“There are lessons here for midwives and other health professionals working in maternity services,” she said.

“We need to ensure midwives have the time to do a thorough risk initial assessment of a woman, and moving forward ensure women have ongoing risk assessments,” she said. “This is where continuity of care and carer can play a crucial part.”

Tackling risk factors like smoking and weight problems was easier if midwives were able to provide consistent, ongoing care as well as ensuring women have key information about topics like fetal movement, she added.

“It is important a wide range of organisations think about the messages in this report because hard-pressed maternity staff can only do so much,” she concluded.

“Lessons weren’t learned and mothers were put at risk”

Janet Scott

The report also revealed big gaps in the data, making it harder to get a clear picture, and called for more consistent data collection by trusts and health boards.

The MBRRACE-UK team said they wanted to see national health bodies in all four nations work with health professionals and other experts to set national goals for reducing perinatal deaths.

Other recommendations included that all families who experienced a stillbirth or neonatal death should be offered a post-mortem examination.

Stillbirth and neonatal death charity Sands has been pushing for a standardised review process for all deaths.

“Not all clinicians properly review the care families receive to understand whether a death might have been prevented,” said Sands research and prevention manager Janet Scott.

“The recent Morecambe Bay report illustrated this all too painfully. Lessons weren’t learned and mothers were put at risk,” she said.

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