Three Key Steps To Reduce Death During Childbirth

Improvements in care may have made a difference in reducing intrapartum death to the outcome for almost 80% of cases.

Still birth, more than halved since 1993 representing a reduction of around 220 intrapartum deaths per year.

In their latest report a team of academics, clinicians and charity representatives, called MBRRACE-UK*, has looked at the quality of care for stillbirths and neonatal deaths of babies born at term who were alive at the onset of labour, singletons (sole births) and who were not affected by a major congenital anomaly.

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‘The recommendations for improvement in service provision, local review of the death, the development of new national guidance and of training for staff provide an opportunity to reduce stillbirth.’

This type of death occurred in 225 pregnancies in 2015 in the UK. It is important to study the deaths of these babies as any normally formed baby who is alive at the onset of labour at term would be expected to be alive and healthy at birth.

A random representative sample of 78 of these babies who were born in 2015 was selected. The care provided for these mothers and babies was reviewed in detail against national care guidelines by a panel of clinicians, including midwives, obstetricians, neonatologists, neonatal nurses and pathologists who considered every aspect of the care.

Professor Elizabeth Draper, Professor of Perinatal and Paediatric Epidemiology at University of Leicester said: "The premise of the enquiry was that these babies would be born alive and healthy. Findings from the panels indicated that improvements in care may have made a difference to the outcome for almost 80% of cases.

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"The main issues identified were care before labour was established including induction, monitoring during labour, delay in expediting birth, heavy workload of the units, a lack of joint obstetric and neonatal input into bereavement care and a lack of rigour in the local review of the deaths."

Professor Sara Kenyon, Professor of Evidence Based Maternity Care at the University of Birmingham and joint author of the report said, "While fewer babies at term die after care in labour starts than previously, this report has identified that there remain problems with the quality of care. The recommendations for improvement in service provision and local review of the death, the development of new national guidance and of training for staff provide an opportunity to reduce this further. The forthcoming introduction of a national standardised tool to support staff reviewing perinatal death in their Trusts is an important step forward. If we learn the lessons and implement the changes the report has highlighted, the numbers of babies like this that die should reduce."