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News Article
Covid: Stillbirth and prematurity risks may be higher
Patient Safety Learning posted a news article in News
A large UK study suggests having coronavirus around the time of birth may increase the chance of stillbirths and premature births - although the overall risks remain low. Scientists say while most pregnancies are not affected, their findings should encourage pregnant women to have jabs as soon as they are eligible. The majority are offered vaccines when they are rolled out to their age group. The study appears in the American Journal of Obstetrics and Gynecology. The research, led by the National Maternity and Perinatal Audit, looked at data involving more than 340,000 women who gave birth in England between the end of May 2020 and January 2021. Researchers say a higher risk of stillbirth and prematurity, as well as a greater chance of having a Caesarean section, remained even once factors such as the mother's age, ethnicity, socio-economic background and common health conditions were taken into account. Babies born to women who tested positive were more likely to need special neonatal intensive care because they were born early and needed more support - rather than being infected with coronavirus itself. Professor Asma Khalil, co-author of the paper, said it was important for women and healthcare workers to be aware of the potential risks. Read full story Source: BBC News, 21 May 2021 -
News Article
Baby death raises questions over maternity care
Patient Safety Learning posted a news article in News
Beth and Dan Wankiewicz want answers about why their baby son Clay died last year, shortly after his birth at Doncaster Royal Infirmary. Despite a low-risk pregnancy, the family say Clay died from multiple skull fractures. Doncaster and Bassetlaw NHS Foundation Trust said "the provision and delivery of high-quality" care is a priority. The BBC has found a 2016 review flagging concerns about the hospital's maternity care was never published. The report - one of scores of unpublished reports discovered by a Freedom of Information request by BBC's Panorama programme - highlighted significant patient safety concerns. Beth Wankiewicz was admitted to hospital last July, but after a day of labour her baby had still not been born. With no consultant doctor on site, a junior doctor made two attempts to deliver the baby with forceps, after getting advice on the phone. Father, Dan, remembers the second attempt with forceps being much more vigorous "which was a bit of a shock". The family say there was a further delay before they had a Caesarean section. Their baby had to be pushed back up the birth canal into the womb for the C-section to be performed. "I think after about 10 minutes, we both looked at the clock, and we said it's not looking good," said Dan. Around 20 minutes after their son was born, despite attempts to resuscitate him, they were told he had died. The following day they say a midwife told them she was being pressurised by other staff to say Clay had been stillborn, but she was sure he had been born alive, and she had heard a heartbeat. The family now believe this was to avoid scrutiny and the need for a coroner's inquest, which doesn't happen with still births. Read full story Source: BBC News, 19 May 2021 -
EventuntilThis free to attend webinar is being delivered by BAPM in partnership with the Healthcare Safety Investigation Branch (HSIB) to support the launch of the revised framework for practice on newborn infants who suffer a sudden and unexpected postnatal collapse (SUPC). Speakers will provide an overview of the new framework, cover ways to support good practice and reduce the risk of SUPC. This webinar is aimed at perinatal professionals who care for babies in hospital in the first week after birth as well as parents. Programme: The Parent Story Introduction to the new framework The SUPC Risk Reduction Pathway Investigating and Managing the Baby after a SUPC Questions Chair: Louise Page, Deputy Clinical Director of Maternity Investigation Programme, HSIB Speakers: Sarah Land, Charity Manager, PEEPS HIE Charity Julie-Clare Becher, Consultant Neonatologist, Simpson Centre for Reproductive Health, Edinburgh Esther Tylee, Infant Feeding Lead Midwife, Bedford Hospital NHS Trust Francesca Entwistle, Deputy Programme Director (Advocacy), UNICEF UK Baby Friendly Initiative Rachel Walsh, National Neonatal Clinical Fellow, NHS Resolution Register
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EventuntilThis event will mark the 2021 World Health Organisation’s World Patient Safety Day and aims to showcase the patient safety work happening in the NHS and with partners, to improve the safety of maternal and neonatal care. Speakers: Introduction from Aidan Fowler, National Director of Patient Safety (chair) Presentations from the National Maternity Champions, Matthew Jolly, National Clinical Director for Maternity and Women's Health and Professor Jacqueline Dunkley-Bent OBE, Chief Midwifery Officer Hear from AQUA (the Advancing Quality Alliance) about its safety culture programme for maternity and neonatal board safety champions Dr Nicola Mackintosh, Associate Professor in Social Science Applied to Health, SAPPHIRE Deputy, University of Leicester will present on ‘What a good maternity safety culture looks like’, providing an overview of a considered analysis of maternity and neonatal safety culture surveys Tony Kelly, National Clinical Lead for the Maternity and Neonatal Safety Improvement Programme will provide an introduction to the national Maternity Early Warning Score (MEWS) tool and Newborn Early Warning Trigger and Track (NEWTT) Expected Audience: NHS provider and commissioning staff, particularly those working in maternity and neonatal care and in patient safety roles. Register
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Event
The NHS maternity scandal: Inside a crisis
Patient Safety Learning posted an event in Community Calendar
At a time when the NHS is struggling unprecedently, having been battling a pandemic for 18 months, one of the most concerning areas is the state of maternity services at trusts around the country. It has been uncovered following recent investigations by the Independent newspaper's health correspondent Shaun Lintern that the scale of the problem is putting the lives of both mothers and babies at risk on a daily basis. To explore the apparent crisis existing within our hospitals Shaun will be hosting a live panel discussion with maternity experts who have experience of the situation from within the NHS as well as elsewhere. The speakers will help explain what has gone so wrong, what impact it has had and what lasting effects there might be, as well as what the future holds and if the scandal has at least ensured improvements are now in place and our maternity services are becoming safer for all who use them. The panel will include Donna Ockenden, the chair of Shrewsbury inquiry and Senior Midwifery Adviser, Gynaecologists president Edward Morris and James Titcombe, OBE and ambassador for charity Baby Lifeline; Associate Editor, Journal of Patient Safety and Risk Management and campaigner who helped expose poor care at University Hospitals Morecambe Bay Trust following the death of his son Joshua. Register -
Content ArticleThe maternity services at the Royal Devon and Exeter NHS Foundation Trust share their infographic which informs their staff of the 15 Immediate and Essential Actions from the Ockenden report and the action plan needed to implement these.
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Content Article
Breastfeeding Friend tool from Start for Life
Patient Safety Learning posted an article in Maternity
The Breastfeeding Friend, a digital tool from Start for Life, has lots of useful information and advice on breastfeeding. And because it's a digital tool, it's available whenever you need it 24 / 7. All the information provided is NHS-approved and based on questions asked by thousands of new mums. Whether you're experiencing breastfeeding difficulties, you've got sore nipples, or you want to know about vitamins and what you should include in your diet – if it's a breastfeeding related question, the Breastfeeding Friend is ready to help you. -
Content ArticleWhen critically ill premature infants require transfer by ambulance to another hospital, they frequently require mechanical ventilation. This observational study investigated acceleration during emergency transfers and looked at whether they result from changes in ambulance speed and direction, or from vibration due to road conditions. It aimed to assess how these forces impact on performance of neonatal ventilators and on patient-ventilator interactions. The authors found that infants are exposed to significant acceleration and vibration during emergency transport. Although these forces do not interfere with overall maintenance of ventilator parameters, they make the pressure-volume loops more irregular.
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Content ArticleDerek Richford shares Harry's Story from last year's HSJ Patient Safety Congress. Derek is grandfather of Harry Richford who died seven days after an emergency delivery at East Kent Hospitals Trust. Derek is joined by Donna Ockenden, Chair of the Independent review of maternity services at Shrewsbury & Telford Hospital, and Sarah-Jane Marsh, Chair of NHS England's Maternity transformation programme, in the 'Actioning recommendations from the Ockenden report' session at the Congress.
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Content ArticleDespite an increased focus in maternity services on ethnic and racial inequalities resulting in poorer outcomes, the experience of migrant women is often hidden from these data, research and improvement programmes. To understand these inequalities and their impact further, Doctors of the World UK (DOTW UK) analysed data collected through provision of health support to 257 pregnant women accessing their service between 2017 and 2021
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Content ArticleThe Medical Certificate of Stillbirth (MCS) records data about a baby’s death after 24 weeks of gestation but before birth. Major errors that could alter interpretation of the MCS were widespread in two UK-based regional studies. A multicentre evaluation was conducted, examining MCS issued 1 January 2018 to 31 December 2018 in 76 UK obstetric units. A systematic case-note review of stillbirths was conducted by Obstetric and Gynaecology trainees, generating individual ‘ideal MCSs’ and comparing these to the actual MCS issued. Anonymized central data analysis described rates and types of error, agreement and factors associated with major errors. The study demonstrates widespread major errors in MCS completion across the UK. MCS should only be completed following structured case-note review, with particular attention on the fetal growth trajectory. Correct stillbirth cause classification is crucial for families and society; when ‘unexplained’, conditions’ true perinatal mortality contributions are uncounted and preventative strategies cannot be appropriately targeted.
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Content ArticleMidwives and other healthcare professionals are an integral part of many bereaved parents’ birth story and can play an important role in caring for parents when their baby dies. In this blog, Clare Worgan, Head of Training and Education at the charity Sands, talks about the importance of bereavement care to parents, and how training helps healthcare professionals to better provide this care. She outlines five principles of bereavement care and talks about why Sands is calling for bereavement care training to be provided to all staff who come into contact with bereaved parents.
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Content ArticleThe delivery of safe and effective healthcare to paediatric and neonatal patients presents unique challenges to the medication-use system. The diversity of patients within this population and the consequences of ontogeny on pharmacokinetics and pharmacodynamics directly impact the safe use of medications in children and increase the risk of adverse drug events. This review from Elkeshawi et al. will explore the medication-use system for hospitalised children and neonates, discuss vulnerabilities within this system, and provide examples of advancements made to improve the paediatric medication-use system.
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Content Article
Family Integrated Care (FICare) is an approach to neonatal care which aims to involve parents as equal partners in the care of their babies while in the Neonatal Intensive Care Unit (NICU). FICare aims to minimise separation, support parent-child bonding and promote parental decision-making. In this blog, Katie Cullum, Lead Nurse for Innovation and Quality Improvement at East of England Neonatal Operational Delivery Network, talks about the proven benefits of Family Integrated Care and why all NICUs should be implementing the model to improve outcomes. -
Content ArticleThis is an Early Day Motion tabled in the House of Commons on 18 May 2022, which calls on the Government to implement the recommendations of the Independent Medicines and Medical Devices Safety Review in full, including paying compensation to people disabled by sodium valproate.
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Content ArticleSir David Sloman, Chief Operating Officer NHS England and NHS Improvement, has sent a letter to the families involved in the Nottingham Maternity Inquiry announcing that Donna Ockenden will taking over the Inquiry. A copy of the letter is below and attached.
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Content ArticleSystemic racism in maternity care is an urgent human rights issue. For too long, evidence and narratives about why racial inequities in maternal outcomes persist have focussed on Black and Brown bodies being the problem – ‘defective’, ‘other’, a risk to be managed. Birthrights’ year-long inquiry into racial injustice has heard testimony from women, birthing people, healthcare professionals and lawyers outlining how systemic racism within maternity care – from individual interactions and workforce culture through to curriculums and policies – can have a deep and devastating impact on basic rights in childbirth. This jeopardises Black and Brown women and birthing people’s safety, dignity, choice, autonomy, and equality. The inquiry’s report, Systemic Racism, Not Broken Bodies, uncovers the stories behind the statistics and demonstrates that it is racism, not broken bodies, that is at the root of many inequities in maternity outcomes and experiences.
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Content ArticleExtreme preterm birth, defined as birth before 28 weeks’ gestational age affects about two to five in every 1000 pregnancies, and varies slightly by country and by definitions used. Severe maternal morbidity, including sepsis and peripartum haemorrhage, affects around a quarter of mothers delivering at these gestations. For the babies, survival and morbidity rates vary, particularly by gestational age at delivery but also according to other risk factors (birth weight and sex, for example) and by country. In this BMJ clinical update, Morgan et al. focuses on high income countries and provide a broad overview of extreme preterm birth epidemiology, recent changes, and best practices in obstetric and neonatal management, including new treatments such as antenatal magnesium sulphate or changes in delivery management such as delayed cord clamping and placental transfusion. The authors cover short and long term medical, psychological, and experiential consequences for individuals born extremely preterm, their mothers and families, as well as preventive measures that may reduce the incidence of extreme preterm birth.
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Content ArticleThe Queen’s Speech was debated on Tuesday 17 May 2022. Copied below is Baroness Julia Cumberlege's excerpts on fulfilling the recommendations of the Cumberlege Report for a redress scheme.
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Content ArticleAn open letter to Brandon Lewis, the justice secretary, and the Sentencing Council for England and Wales warns that pregnant women in jail suffer severe stress and highlights evidence suggesting they are more likely to have a stillbirth. The signatories include the Royal College of Midwives and Liberty.
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Content ArticleUnsafe maternity care has cost the National Health Service in England (NHS) £8.2bn in 15 years. How many more surveys of women’s experiences, reports of poor quality care and failings of senior management at NHS maternity units do we need to know that there is still a massive problem with maternity services in England? Judy Shakespeare, Elizabeth Duff and Debra Bick discuss why a joined-up policy and investment in maternity services is urgently needed.
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Content ArticleThis document outlines the terms of reference for the independent review into maternity services at Nottingham University Hospitals NHS Trust (NUH), commissioned by NHS England and led by Donna Ockenden. The review has been established in light of significant concerns raised about the quality and safety of maternity services at NUH, and concerns voiced by local families. It replaces a previous regionally-led review after some families expressed concerns and made representations to the Secretary of State for Health and Social Care. The review began on 1 September 2022 following early engagement with families and NUH from June 2022. It is expected to last 18 months, although this timeframe is subject to review. Learning and recommendations will be shared with NUH as they become apparent, to allow rapid action to improve the safety of maternity care. The only and final report is expected to be published and presented to NUH and NHS England around March 2024.
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Content Article
The State of the World's Midwifery 2021
Patient Safety Learning posted an article in Maternity
The State of the World’s Midwifery (SoWMy) 2021 builds on previous reports in the SoWMy series and represents an unprecedented effort to document the whole world’s Sexual, Reproductive, Maternal, Newborn and Adolescent Health (SRMNAH) workforce, with a particular focus on midwives. It calls for urgent investment in midwives to enable them to fulfil their potential to contribute towards UHC and the SDG agenda. -
Content ArticleThe purpose of this investigation by the Healthcare Safety Investigation Branch (HSIB) was to consider the management and care of preterm labour and birth of twins. Preterm birth—defined as babies born alive before the completion of 37 weeks of pregnancy—is one of the main causes of death, long-term conditions and disability in under-fives worldwide, and 60% of twin pregnancies result in premature birth. The reference event for this investigation was the case of Sarah, who was pregnant with twins and was overseen by an obstetrician during her pregnancy. Sarah was assessed as having a higher-risk pregnancy as she had had previous medical intervention on her cervix and was pregnant with twins. Shortly after having been discharged from a hospital with a specialist neonatal unit following suspected early labour, she went to her local maternity unit at 29+2 weeks with further episodes of abdominal tightening. Her labour did not progress as expected and a caesarean section was required to deliver the babies at 29+6 weeks. The twin girls were born well, but 23 days after their birth a scan revealed brain injury in both babies. The investigation identified several findings to explain the experience of the mother in the reference event, including the lack of scientific evidence or specific guidelines and the uncertainty associated with the clinical decision making in this scenario. This highlighted the need for further research into preterm labour as a recognised risk factor for twin pregnancies. As part of the investigation, HSIB identified that since 2019 a large volume of national work and research in the area of twin pregnancy and preterm birth has been undertaken. The investigation report sets out the work currently in progress and seeks to understand if it will address gaps in knowledge.
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Content ArticleThis article and video tell the story of Rihan Neupane, a baby born prematurely in Dhapasi, Nepal, who was left in a vegetative state following a series of medical errors including a missed diagnosis of meningitis. His parents had chosen a private international hospital for their maternity care, but were let down by a series of medical errors including Rihan being mistakenly given a massive paracetamol overdose. Although external hospital safety inspectors found the hospital negligent on many counts, the hospital continued to deny any wrongdoing or responsibility for Rihan's condition. Rihan's father Sanjeev Neupane talks about his family's experience in the embedded video.
