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Found 819 results
  1. Content Article
    In this article, Claire Brader summarises the recent findings on the performance of NHS maternity services in England, as well as recent government and NHS policies aimed at improving the quality of maternity care.
  2. Content Article
    This is the first edition of this guidance, published by the Royal College of Obstetricians and Gynaecologists. It highlights the challenges in maternity triage departments* and defines their role as emergency portals into maternity units. It has been produced in response to a UK Government and Parliament petition in 2021, which requested a national review of triage procedures used by NHS maternity wards, and proposed to mandate the implementation of a standardised risk assessment-based system for maternity triage; assessing every woman within 15 minutes and prioritising care based on urgency. The paper is aimed at stakeholders responsible for developing and improving maternity services. It presents the recommendations for the operational structure and pathways within maternity triage to improve safety and experience for both women and staff, by recommending implementation of the Birmingham Symptom-specific Obstetric Triage System (BSOTS), while recognising opportunities for future research and evaluation
  3. News Article
    The number of women dying during pregnancy or soon after childbirth has reached its highest level in almost 20 years, according to new data. Experts have described the figures as “very worrying”. Between 2020 and 2022, 293 women in the UK died during pregnancy or within 42 days of the end of their pregnancy. With 21 deaths classified as coincidental, 272 in 2,028,543 pregnancies resulted in a maternal death rate of 13.41 per 100,000. This is a steep rise from the 8.79 deaths per 100,000 pregnancies in 2017 to 2019, the most recent three-year period with complete data. The death rate has increased to levels not seen since 2003 to 2005. The data comes from MBRRACE-UK, which conducts surveillance and investigates the causes of maternal deaths, stillbirths and infant deaths as part of the national Maternal, Newborn and Infant Clinical Outcome Review Programme (MNI-CORP). Urgent action is needed to bolster the quality of maternal healthcare, ensure it is accessible to all, and repair the damage inflicted by the pandemic on women’s healthcare services more generally. Clea Harmer, the chief executive of bereavement charity Sands, said improving maternity safety also needs to be at the top of the UK’s agenda. The government said it was committed to ensuring all women received safe and compassionate care from maternity services, regardless of their ethnicity, location or economic status. Anneliese Dodds, the shadow women and equalities secretary, said Labour would seek to reverse the “deeply concerning” maternal mortality figures by training thousands more midwives and health visitors and incentivising continuity of care for women during pregnancy. Read full story Source: The Guardian, 11 January 2024
  4. News Article
    Women who experience depression during pregnancy or in the year after giving birth are at a higher risk of suicide and attempting suicide, researchers have warned. The British Medical Journal study warned that women who develop perinatal depression are twice as likely to die compared to those who don’t experience depression. Suicide was the leading cause of death for women in the UK in 2022 between six weeks and one year after birth, while deaths from psychiatric causes accounted for almost 40 per cent of maternal deaths overall, according to a Perinatal Mortality Surveillance report. Last year an analysis by Labour revealed 30,000 women who were pregnant were on waiting lists for specialist mental health support. The number of women waiting rose by 40 per cent between August 2022 and March 2023. The most recent NHS data shows in September 2023, 61,000 women accessed perinatal mental health services. For 2023-24, the health service must hit a target to have 66,000 women accessing care. In August 2023, the Royal College of Midwives published a research warning half of anxiety and depression cases among new and expectant mothers were being missed amid NHS staff shortages in maternity care. Read full story Source: The Independent, 11 January 2024
  5. Content Article
    This study published in the BMJ found that women with clinically diagnosed perinatal depression were associated with an increased risk of death, particularly during the first year after diagnosis and because of suicide. Women who are affected, their families, and health professionals should be aware of these severe health hazards after perinatal depression.
  6. Content Article
    MBRRACE have released their latest UK maternal mortality figures. The maternal death rate in 2020-22 was 13.41 per 100,000 maternities. This is significantly 53% higher than the rate of 8.79 deaths per 100,000 maternities in the previous three year period (2017-19).
  7. News Article
    The senior midwife tasked by the government and NHS to investigate serious maternity scandals has warned that new mothers are being driven to suicide and backed an MP’s review into birth trauma. Donna Ockenden said it was “appalling” that women who should be in the “happiest times of their lives” were taking their own lives, after it was found suicide was the leading direct cause of deaths up to 12 months after giving birth. Ockenden, who has exposed poor maternity care across the country, is preparing to give evidence to an inquiry launched by Theo Clarke, the Conservative MP for Stafford, on birth trauma. Clarke thought she was going to die after giving birth to her daughter Arabella last year, having suffered a third-degree tear. But it was the lack of help available that opened her eyes to the estimated 200,000 women a year who experience birth trauma. Ockenden told The Times she had “huge respect” for Clarke’s inquiry and said: “I think that this whole issue of maternal trauma, sometimes long-term psychological trauma for families as well post a difficult maternity experience, is not necessarily given enough air time.” Read full story (paywalled) Source: The Times, 8 January 2023
  8. News Article
    A former midwife has told the BBC she quit because she could not live with herself if she provided poor care. Hannah Williams says staff shortages meant she kept patients safe, but sometimes only "by the skin of her teeth". BBC Verify analysis shows that the number of full-time equivalent midwife posts in England has gone up by 7% in the last decade. In comparison, the overall NHS workforce has increased by 34%. The country has a shortage of about 2,500 midwives, and maternity units are struggling with safety concerns. BBC research has also found that some trusts have more than one in five midwife jobs unfilled. The Royal College of Midwives says staffing is the "most important issue" and the gap needs to close. Read full story Source: BBC News, 9 January 2024
  9. Content Article
    The maternal mortality rate (MMR) in the United States continues to increase despite medical advances and is exacerbated by stark racial disparities. Black women are disproportionately affected and are three times more likely to experience a pregnancy-related death (PRD) compared to Non-Hispanic White (NHW) women. Keisha E. Montalmant and Anna K. Ettinger carried out a literature review to examine the racial disparities in the United States' MMR, specifically among pregnant Black women. The review highlights that maternal health disparities for Black women are further impacted by both structural racism and racial implicit biases. Cultural competence and educational courses targeting racial disparities among maternal healthcare providers (MHCP) are essential for the reduction of PRDs and pregnancy-related complications among this target population. Additionally, quality and proper continuity of care require an increased awareness surrounding the risk of cardiovascular diseases for pregnant Black women.
  10. News Article
    At least 38 babies died in the space of nine years after serious incidents in the country’s maternity units, it has emerged. The total is based on research of both media reports of inquests and settled claims. Before Christmas, a review by the Irish Examiner revealed 21 hospital baby deaths followed one or more serious incidents, between 2013 and 2021. However, further study in the same nine-year period shows the toll to be higher. The worst year was 2018, when not only did at least 10 babies die, but three of them died at the same Dublin hospital over a five-month period. In at least 18 of the 38 deaths, issues around foetal heartbeat monitoring (CTG) were raised either at inquest or in the High Court. At least 18 of the inquests resulted in a verdict of medical misadventure. As well as issues around heart monitoring, the Irish Examiner review shows that in at least seven of the 38 cases, maternity staff missed signs that a woman was in labour, leading to repeated recommendations around training. In at least seven cases, mothers’ concerns were ignored. Read full story Source: Irish Examiner, 29 December 2023
  11. Content Article
    The Professional Standards Regulatory Body are holding a series of webinars in January 2024 designed for professionals working in or with maternity services where they will review the updated Digital Maternity Record Standard. Each session will focus on different aspects of maternity care.  Having access to the right information at the right time helps professionals make decisions for safer, more personalised care and supports people using services to manage their own information. Health and care professionals, organisations that support people during and after pregnancy, IT system suppliers and people who use maternity services are welcome at these sessions. Find out more about the sessions and how to sign up via the link below.
  12. Content Article
    If you’ve recently used maternity services, or if you’re pregnant at the moment, the Professional Records Standards Body (PRSB) would like to invite you to join one of their online workshops in January 2024. Each session will last no longer than 1 hour 30 minutes and you’ll receive a £25 shopping voucher to thank you for your time if you attend. The PRSB are working with the NHS to improve how information about your health is recorded and shared during your pregnancy and after your baby has been born. This could include information about treatment or advice you’ve received, tests and scans you’ve had or decisions you’ve made about your maternity care.   Find out more about the project, and how to book onto a workshop via the link below.
  13. Content Article
    The Maternal, Newborn and Infant Clinical Outcome Review Programme has published an MBRRACE-UK Perinatal confidential enquiry report on a comparison of the care of Black and White women who have experienced a stillbirth or neonatal death. It is based on deaths reviewed in England, Wales, Scotland and Northern Ireland, for the period between 1 July 2019 and 31 December 2019. The overall findings of this enquiry were based on the consensus opinion of panel members concerning the quality of care provided for the 36 Black and 35 White mothers and their babies. This enquiry was developed to try and identify any differences in the quality of care provided to women of Black ethnicity compared with their White counterparts, and forms the main focus of this report. As such, the recommendations are targeted at trying to ensure equity for the quality of care provision for both Black and White mothers and their babies.
  14. Content Article
    The Maternal, Newborn and Infant Clinical Outcome Review Programme has published an MBRRACE-UK Perinatal confidential enquiry report that compares the care of Asian and White women who have experienced a stillbirth or neonatal death. It is based on deaths reviewed in England, Wales, Scotland and Northern Ireland, for the period between 1 July 2019 and December 2019. The overall findings of this enquiry were based on the consensus opinion of panel members concerning the quality of care provided for 34 Asian and 35 White mothers and their babies. This enquiry was developed to try and identify any differences in the quality of care provided to women of Asian ethnicity compared with their White counterparts, and forms the main focus of this report. As such, the recommendations are targeted at trying to ensure equity for the quality of care provision for both Asian and White mothers and their babies.
  15. News Article
    Patients have been harmed as a result of doctors striking this year, and others needing time-critical treatment will be at risk during next month’s walkout in England, hospital bosses have said. Cancer patients and women having induced or caesarean section births will be in danger of damage to their health unless junior doctors in those areas of care abandon their plans to strike for six days in January, they said. People awaiting urgent eye surgery risk permanent sight loss unless the British Medical Association (BMA) lets junior doctors keep working in that area, according to NHS Employers, which represents health service trusts in England. Its intervention comes amid mounting concern in the NHS that it may prove impossible to maintain patient safety in high-risk, time-sensitive areas of treatment when tens of thousands of junior doctors stage what will be the longest strike in NHS history from 3 January, when hospitals are facing what is often the service’s busiest week of the year. Read full story Source: The Guardian, 21 December 2023
  16. Content Article
    Problems in intrapartum electronic fetal monitoring with cardiotocography (CTG) remain a major area of preventable harm. Poor understanding of the range of influences on safety may have hindered improvement. Taking an interdisciplinary perspective, authors of this study, published in BMJ Quality and Safety, sought to characterise the everyday practice of CTG monitoring and the work systems within which it takes place, with the goal of identifying potential sources of risk.
  17. Content Article
    This study compared two quality improvement (QI) interventions to improve antenatal magnesium sulphate (MgSO4) uptake in preterm births for the prevention of cerebral palsy. It found that PReCePT improved MgSO4 uptake in all maternity units. Enhanced support did not further improve uptake but may improve teamwork, and more accurately represented the time needed for implementation. Targeted enhanced support, sustainability of improvements and the possible indirect benefits of stronger teamwork associated with enhanced support should be explored further.
  18. Content Article
    Since the launch of the national Perinatal Mortality Tool (PMRT) in early 2018, over 23,000 reviews have been started. This fifth annual report presents the findings for reviews completed from March 2022 to February 2023 coinciding with the third year of the global health emergency due to the COVID-19 virus.
  19. News Article
    Women in labour at a London maternity unit deemed “inadequate” were left alone with unsupervised support workers who were not given any guidance, an NHS safety watchdog has found. In a scathing report of North Middlesex Hospital’s maternity services, the Care Quality Commission also found examples of delays to induction of birth for women, and one case of a woman with a still-born baby who was left waiting for the unit to call her in for an induction. Inspectors have downgraded the maternity unit from “good” to the lowest possible rating “inadequate” following an inspection earlier this year. Staff reportedly told inspectors they felt they were “criticised” or “bullied” when reporting safety incidents within the unit. “We heard that the criticism or bullying was worse if the incident reported was relative to other staff and their perceived behaviours,” the report said. There was also evidence the hospital was not recording the severity of safety incidents correctly for example two “never events”, which are among the highest category incidents, were categorised as “low harm”. Other findings included women and babies came to harm as the hospitals did not follow standards to language interpretation despite covering a higher than average minority ethnic population. Read full story Source: The Independent, 11 December 2023
  20. News Article
    The expert tasked by government and NHS England to investigate maternity scandals has criticised ministers for failing to provide the funding necessary to address the problems. Donna Ockenden said the funding provided so far was “nowhere near good enough” and progress made to improve services had been “extremely disappointing”. After her investigation into the deaths and harm of 295 babies and nine mothers at Shrewsbury and Telford Hospitals Trust, the Department of Health and Social Care endorsed recommendations to invest an additional £200m to £350m per year into maternity services. IMs Ockenden suggests the recent impact of inflation, pay awards, and other rising costs means the full £350m is required. According to NHSE an additional £165m per year has been invested since 2021, and the DHSC said this would rise to £187m from April. Ms Ockenden, a senior midwife, told HSJ: “What I would like to say loud and clear to the government is that we are broadly 50 per cent of the way there in receiving the money we know is needed for maternity services. That is nowhere near good enough. “There are workforce issues across [the whole team], whether that’s midwives, obstetricians or neonatologists, and it’s hardly surprising. “The government must now do more – whilst we were grateful for the endorsement [of her report], the lack of progress in providing what is known to be the required funding is extremely disappointing.” Read more (paywalled) Source: HSJ, 11 December 2023
  21. News Article
    NHS England has issued a national alert to all trusts providing maternity services after faults were discovered in IT software that could pose “potential serious risks to patient safety”. According to the alert, the Euroking electronic patient record provided by Magentus Software could be displaying incorrect patient information to clinicians. The Euroking EPR is used in the maternity departments of at least 15 trusts according to information held by HSJ. These organisations have been asked to “consider if Euroking meets their maternity service’s needs” and to “ensure their local configuration is safe”. Trusts with different maternity EPR providers have also been asked to reassess the clinical safety of their solutions. The potential “serious risks” relate to a fault in the Euroking EPR which allows new patient information to overwrite previously recorded information, which could lead to “incorrect management of the pregnancy and subsequent harm”. Read full story (paywalled) Source: HSJ, 8 December 2023
  22. Content Article
    Potential serious risks to patient safety have been identified with the use of Magentus Software Limited’s Euroking maternity information system. These concern specific data fields: certain new patient information, recorded during a patient contact, can overwrite ('back copy') information previously recorded in the patient’s pregnancy record. certain pregnancy-level data (information relevant only to a specific pregnancy event) can be saved at a patient level (where information relevant throughout a person's life is recorded), causing new information to overwrite (‘back copy’) previously recorded data across an entire patient record. certain recorded pregnancy-level data can pre-populate into new pregnancy records (‘forward copy’), which can mean clinicians will see incorrect patient information, and attempts to correct this can result in the issue described at (ii) above.
  23. News Article
    NHS figures obtained by Labour reveal 11,507 women sought care but did not get any last year. Almost 20,000 women a year living with mental health problems triggered by being pregnant or giving birth are being denied support by the NHS, the Guardian can reveal. Furthermore, those who do receive mental health help for their trauma are having to wait up to 19 months to start treatment in some parts of England because specialist services are so overstretched. The situation has been described as “an absolute scandal” and sparked warnings that “rationing” of such vital care could leave women who do not get it in a very vulnerable state and risk their children facing lifelong health problems and stop mothers bonding with their baby. Read full story Source: Guardian, 5 December 2023
  24. Content Article
    Large-scale improvement programmes are a frequent response to quality and safety problems in health systems globally, but have mixed impact. The extent to which they meet criteria for programme quality, particularly in relation to transparency of reporting and evaluation, is unclear. The aim of this study from Mary Dixon-Woods and colleagues was to identify large-scale improvement programmes focused on intrapartum care implemented in English National Health Service maternity services in the period 2010–2023, and to conduct a structured quality assessment. They found poor transparency of reporting and weak or absent evaluation undermine large-scale improvement programmes by limiting learning and accountability. This review indicates important targets for improving quality in large-scale programmes.
  25. News Article
    The management of fragile maternity services is being hamstrung by a lack of clear standards and direction from government and regulators, trust chairs and chief executives have told HSJ. Kathy Thomson, the retiring chief executive of Liverpool Women’s Foundation Trust, told HSJ that a major overhaul of regulation and oversight of maternity care was needed. She warned that trust leaders were confused about what was expected of their stewardship of maternity services. Much of the increased scrutiny of the sector was coming from people with little knowledge and experience of maternity care, and maternity was beset by too many initiatives which “somebody thinks are a nice thing to do”. Ms Thomson’s comments were echoed by a wide range of other NHS leaders (see ’damaging confidence’ below). Ms Thomson told HSJ: “How clear are we nationally about the real ask of maternity services? Are we going to say it’s the ten NHS Resolution (NHSR) safety standards, which are really tough to achieve and which we agonise over? Or is it the CQC standards, because they will often take a different view around very similar issues? “We’ve had that this year after we’ve been assessed as compliant by NHSR, but then had to re-provide evidence after we’ve been criticised by the CQC for something… and then NHSR have written back to say we’re still fully compliant. “So, should you put your time and energy into the NHSR standards, or do you spend the time on the more subjective drivers? Because we can’t keep doing all of it and having different parts of the NHS saying this is what you need to do or expecting something different.” Read full story (paywalled) Source: HSJ, 30 November 2023
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