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Found 93 results
  1. Content Article
    Improving maternity care is a key Government and National Institute for Health and Care Research (NIHR) priority. In March 2024, an NIHR Evidence webinar showcased research from their recent Collection, Maternity services: evidence to support improvement.  This summary includes videos of researchers’ presentations and captures some of the points raised in the webinar Q&A. It highlights seven features of safety in the maternity units, kind and compassionate care around the induction of labour, and the role of hospital boards in improving maternity care.
  2. Content Article
    Women of colour frequently report that their race has impacted the quality of care they receive. In this study, women of colour who experienced a traumatic birth described the racist and gendered stereotypes ascribed to them (uneducated, negligent, (in)tolerant to pain, and dramatic) and how those stereotypes impacted the obstetrical care they received. Ultimately these experiences caused long-term harm to their mental health, decreased trust in healthcare, and reduced the desire to have children in the future.
  3. News Article
    An inquiry into birth trauma has received more than 1,300 submissions from families. It is estimated that 30,000 women a year in the UK have suffered negative experiences during the delivery of their babies, while 1 in 20 develop post-traumatic stress disorder. The investigation is a cross-party initiative, led by MPs Theo Clarke and Rosie Duffield, in collaboration with the Birth Trauma Association. Ms Clarke the Conservative MP for Stafford, triggered the first ever parliamentary debate on the issue in October. In an emotional exchange in the House of Commons, she described her own experience following her daughter's birth at the Royal Stoke University Hospital in 2022. She bled heavily after suffering a tear and had to undergo two-hour surgery without general anaesthetic, due to an earlier epidural. The Birth Trauma Association, which is administering the inquiry, invited the public to submit written accounts of their own experiences. Dr Kim Thomas, from the association, said she had received an "overwhelming" number of personal accounts. Some cases date back as far as the 1960s. Read full story Source: BBC News, 25 February 2024
  4. Content Article
    In this Lancet article, Lioba Hirsch shares her experience of labour and birth as a Black woman. She describes dismissive behaviours and blaming comments from several healthcare professionals that left her feeling unable to ask questions and advocate for herself and her baby. She suggests that the lack of compassion and dignity she was shown are a risk to patient safety: "I am so glad that my child was safe that day, but many children and their birthing parents are not and the slope from disrespect and disregard to dismissal and its consequences is a slippery one."
  5. Content Article
    On 9 January 2024, the All-Party Parliamentary Group (APPG) on birth trauma in the UK Parliament will set up an inquiry to investigate the reasons for traumatic birth and to develop policy recommendations to reduce the rate of birth trauma. Research shows that about 4–5% of women develop post-traumatic stress disorder (PTSD) after giving birth – equivalent to approximately 25,000-30,000 women every year in the UK. Studies have also found that a much larger number of women – as many as one in three – find some aspects of their birth experience traumatic. Birth trauma affects 30,000 women across the country every year. 53% of women who experienced birth trauma are less likely to have children in the future and 84% of women who experienced tears during birth, did not receive enough information about birth injuries ahead of time.  
  6. News Article
    Lawyers and charities tell of mothers told to ‘labour at home as long as they can’, dangerously few midwives and ‘lies’ during natal care. As Rozelle Bosch approached her due date she had every reason to expect a healthy baby. Neither she, her husband nor the midwives knew that the child was in the breech position at 30 weeks. When her waters broke a fortnight early, Bosch and her husband, Eckhardt, both first-time parents, had been reassured by NHS Lanarkshire that all was well and that the mother was “low risk”. They were sent home from Wishaw hospital and told to monitor conditions until the pregnancy became “active”. Shortly before 11pm on 1 July 2021, her husband called an ambulance saying that Bosch was in labour and was giving birth. Bosch was in an upstairs bedroom on her knees and paramedics noted that “the baby was pink”. They soon asked the control room for a doctor or midwife to attend but none were available. By the time the ambulance took the family to hospital, the baby had turned blue. Within two days, baby Mirabelle had died. She had become trapped with only her feet and calves delivered while the couple were still at home. A post-mortem has found that Mirabelle suffered oxygen deprivation to the brain from “head entrapment” during delivery. Last month, her father explained to a fatal accident inquiry (FAI) at Glasgow sheriff court: “We were told Rozelle was healthy and Mirabelle was healthy. I think this was a lie and the consequences have me standing here today.” The way that the tragedy unfolded is striking, not just because of the devastating consequences, but because it is not an entirely isolated case. The same FAI is examining the deaths of two other newborns, Ellie McCormick and Leo Lamont, who also died in NHS Lanarkshire less than a month apart in 2019. Experts say it is rare for the Crown and Procurator Fiscal Service to group investigations in this way. Darren Deery, the McCormicks’ lawyer and a medical negligence specialist with Drummond Miller, said he had noticed a “considerable increase” in parents contacting the law firm in the past three years. Read full story (paywalled) Source: The Times, 11 February 2024
  7. News Article
    Doctors have warned of the risks of “freebirthing” – where a woman gives birth without the help of a medic or midwife. Unassisted births, or “freebirths”, are thought to have been on the increase since the start of the Covid pandemic, when people may have been worried about attending hospitals and home births were suspended in many areas. The practice is not illegal and women have the right to decline any care during their pregnancy and delivery. Some women hire a doula to support them during birth. The Royal College of Obstetricians and Gynaecologists (RCOG) said women should be supported to have the birth they choose, but “safety is paramount” and families need to be aware of the risks of going it alone. The Nursing and Midwifery Council (NMC) said it is in the early stages of collaboration with the Chief Midwifery Officer’s teams, the Royal College of Midwives (RCM) and the Department of Health to better understand professional concerns about freebirthing and what organisations may need to do. Its statement on unassisted births supports women’s choice, but notes that “midwives are understandably concerned about women giving birth at home without assistance, as it brings with it increased risks to both the mother and baby”. It also states that women need to be informed that a midwife may not be available to be sent out to their home during labour if they change their mind and wish to have help. Read full story Source: The Independent, 8 February 2024
  8. News Article
    Maternity departments are raising thousands of safety reports every year about delayed inductions of labour, HSJ can reveal. Induction of labour may be used when women are overdue, because their waters have broken, or for other medical reasons to speed up the birth, such as poor growth of the baby. Delaying induction therefore may increase risks for both mothers and babies and the National Institute for Health and Care Excellence says trusts should raise a “red flag event” if it is delayed for more than two hours after admission. Information collected by HSJ from 50 trusts show 4,945 red flags related to delays in induction of labour in 2022-23. HSJ also found 3,109 reports in 2021-22 and 1,807 in 2020-21 across 47 trusts. Meanwhile, there were 1,997 Datix reports mentioning induction of labour in 2022-23 across 59 trusts able to give HSJ figures, in response to Freedom of Information Act requests, compared with 1,690 in 2021-22 and 1,368 in 2020-21. The Care Quality Commission has also raised concerns in inspections that incidents which should have been treated as “red flags” have not always been reported as such. The watchdog has also raised concerns about a lack of board-level oversight of maternity safety incidents and a need for clearer guidance for staff on reporting processes. Read full story (paywalled) Source: HSJ, 2 April 2024
  9. News Article
    Women have faced delays in giving birth due to the ongoing strikes, a major trust’s chief executive has said. Matthew Hopkins, who joined Mid and South Essex Foundation Trust last month, told a board meeting on Thursday that industrial action was having a “significant and growing” impact on patients. He added that this extended beyond delays to outpatient appointments and elective operations, saying: “It is also delaying mums giving birth, because we are seeing delays now in being able to conduct our elective Caesarian sections.” Mr Hopkins said the impact was also “really significant” on staff, with those covering for colleagues “very, very tired”. “It is important we give a very clear message to the two sides of the argument – government and the [British Medical Association] – that we need a light at the end of the tunnel, and staff need a light at the end of the tunnel. “Going into winter, with this continuing disruption for our patients and our staff, is in my view unacceptable.” Read full story (paywalled) Source: HSJ, 28 September 2023
  10. News Article
    Thousands of women are having induction of labour delayed because of a shortage of staff, raising concerns about the safety of them and their babies, HSJ has found. The issue has been highlighted at seven hospitals in Care Quality Commission reports over the past six months, and HSJ has identified a further three trusts declaring they are concerned about it in their own board papers over the same period. At University Hospitals of Leicester Trust, more than 1,300 “red flags” were raised in a five-month period due to delays in the induction of labour, linked to staffing levels, the CQC said earlier this month. Most were dealys in continuing inductions, and a smaller number were delays between admission and beginning an induction. UHL indicated it had set its own “red flag” bar locally, so all the delays did not represent a national alert. Carolyn Jenkinson, CQC deputy director of secondary and specialist healthcare, told HSJ: “At some maternity services we’ve found women having to wait long periods of time to be induced or for transfer to a labour ward once the induction process has started, and in some cases a lack of effective monitoring during periods of delay. “Where we have found concerns about delayed treatment – including induction of labour – we have made clear to those trusts that effective oversight of the issue is vital and that all action possible should be taken to mitigate any risk and keep people using the service safe.” Read full story (paywalled) Source: HSJ, 27 September 2023
  11. News Article
    Hospitals are still promoting a “natural birth is best” philosophy – despite a succession of maternity scandals highlighting the dangers of the approach. A Telegraph investigation has found a number of trusts continuing to push women towards “normal” births – meaning that caesarean sections and other interventions are discouraged. On Saturday, the Health Secretary has expressed concern about the revelation, vowing to raise the matter with senior officials. Guidelines for the NHS make it categorically clear that a woman seeking a caesarean section should be supported in her choice, after “an informed discussion about the options”. Maternity services were last year warned by health chiefs to take care in the language they used, amid concern about “bias” towards natural births. The warning from maternity officials followed concern that women were being left in pain and fear, with their preferences routinely ignored. The findings come 18 months after Dame Donna Ockenden published a scathing report into maternity care at Shrewsbury and Telford NHS Trust, which warned that a focus on natural birth put women in danger. Read full story (paywalled) Source: The Telegraph, 23 September 2023
  12. News Article
    Women are being "failed at every stage" when it comes to maternity care, say campaigners, as they call for more support for those experiencing traumatic births. Mumsnet found 79% of the 1,000 women who answered their questionnaire had experienced some form of birth trauma, with 53% saying it had put them off from having more children. And according to the snapshot of UK mothers, 44% also said healthcare professionals had used language implying they were "a failure or to blame" for what happened. Conservative MP Theo Clarke is leading calls for more action after her own experience, where she thought she was "going to die" after suffering a third degree tear and needing emergency surgery. Now, she has set up an all party parliamentary group on birth trauma. She said: "[It is] clear that more compassion, education and better after-care for mothers who suffer birth trauma are desperately needed if we are to see an improvement in mums' physical wellbeing and mental health. "It is vitally important women receive the help and support they deserve." Chief executive of Mumsnet, Justine Roberts, said the trauma had "long-lasting effects", adding: "It's clear that women are being failed at every stage of the maternity care process - with too little information provided beforehand, a lack of compassion from staff during birth, and substandard postnatal care for mothers' physical and mental health." Read full story Source: Sky News, 15 September 2023
  13. News Article
    Staffing shortages are likely to restrict the use of a beneficial painkiller in birthing suites, even once its use has been recommended by national guidance. Research by HSJ suggests that just over half of trusts are already offering remifentanil to women in labour, although some are having to restrict its use due to lack of staffing. Responses to freedom of information requests from 108 trusts revealed 55 offered remifentanil during labour in 2022-23. Recent draft National Institute for Health and Care Excellence guidance on intrapartum care, published in April, suggested healthcare professionals “consider intravenous remifentanil patient-controlled analgesia” in obstetric units. This is partly because it reduces the likelihood of forceps or ventouse being required compared to intramuscular pethidine (an opioid commonly used in labour). However, the drug is not yet mentioned in official NICE guidelines and the opioid’s use in labour is currently off-label (its more common licenced use is alongside anaesthesia in surgery). A Royal College of Anaesthetists spokesperson said the use of drugs off-label “is extremely common in obstetrics given that drug trials do not often include pregnant women”. Read full story (paywalled) Source: HSJ, 1 September 2023
  14. News Article
    An 11-year-old boy suffered permanent brain damage after birth because of negligence by hospital midwives who then fabricated notes, a high court judge has ruled. Jayden Astley’s challenges in life include deafness, motor impairments, cognitive difficulties and behavioural difficulties, his lawyers said. After a five-day trial at the high court in Liverpool, Mr Justice Spencer ruled that staff at the Royal Preston hospital in Lancashire were negligent in their treatment of Jayden in 2012. The brain injury was caused by prolonged umbilical cord compression that resulted in acute profound hypoxia – lack of oxygen – sustained during the management of the birth, the court found. Midwives failed to accurately monitor Jayden’s heart rate when he was born and failed to identify his bradycardic, or slow, heart rate during delivery. The judge also found that some entries in notes were fabricated. In his judgment Spencer said it was agreed that all permanent damage to Jayden’s brain would have been avoided if he had been delivered three minutes earlier. Read full story Source: The Guardian, 2 August 2023
  15. News Article
    A simple intervention to detect and treat postpartum haemorrhage could dramatically cut maternal mortality and morbidity worldwide, a large trial led by the University of Birmingham has shown. Use of a special drape to measure blood loss during childbirth and rapid deployment of a “bundle” of existing treatments reduced severe bleeding, the need for laparotomy, or maternal death by 60% in a study done in 80 hospitals across Kenya, Nigeria, South Africa, and Tanzania. Reporting the results in the New England Journal of Medicine, the researchers said that postpartum haemorrhage was detected in 93.1% of patients in the intervention and in 51.1% of those receiving usual care. Read full story (paywalled) Source: BMJ, 10 May 2023
  16. News Article
    Maternity services at a trust in Staffordshire have been rated as 'requires significant improvement' by the Care Quality Commission (CQC). University Hospitals of North Midlands NHS Trust in Stoke-on-Trent must now make urgent changes by June 30th 2023, to ensure patients are cared for safely. It follows an inspection in March where inspectors said staff did not have enough effective systems in place to ensure patients were looked after to the standard they should be. Staff also failed to implement a prioritisation process to ensure delays in the induction of labour were monitored and effectively managed, according to the review of services. The CQC said midwives evaluating patients and handling triage processes did not effectively assess, document and respond to the ongoing risks associated with safety through triage. Read full story Source: ITV News, 28 April 2023
  17. News Article
    Women in labour should be offered an alternative to an epidural spinal block injection, say new draft guidelines for the NHS. The National Institute for Health and Care Excellence (NICE) is recommending remifentanil, which is a fast-acting morphine-like drug given into a vein. Women control the medication themselves, by pressing a button to get more of the drug for pain relief. A timer ensures the user cannot administer too much of it. Women who decide to try remifentanil and do not like it could still decide to have an epidural instead if there is no medical reason why they should not. They can use gas and air, also called Entonox, which is a mix of oxygen and nitrous oxide, at the same time. NICE says having remifentanil as a treatment option has advantages - it might enable women to be more mobile than with an epidural, which makes the legs numb and weak, for example. Evidence suggests fewer epidurals might mean fewer births using instruments like forceps and ventouse vacuum suction, says NICE. Read full story Source: BBC News, 25 April 2023
  18. News Article
    Some hospitals are suspending supplies of gas and air, after it was found to pose health risks to midwives. What can be done to ensure pregnant women still get the help they need? When Leigh Milner was expecting her first baby, she knew exactly how she wanted her labour to go. Her birth plan included an epidural for the pain and she was hoping, she says ruefully, for “all the drugs”. But that is not how things worked out. Milner, 33, a BBC presenter, ended up giving birth to Theo at Princess Alexandra hospital in Harlow last month with nothing but paracetamol for pain relief, in what she calls a positively “Victorian” experience. “I kept begging over and over again – ‘I need something for pain relief’ – and the only thing they could give me was paracetamol because they didn’t have gas and air. I was quite frightened, I didn’t know what else to do,” says Milner. "Birth is painful, but it shouldn’t be traumatic.” Read full story Source: The Guardian, 16 March 2023
  19. News Article
    A couple whose baby died after he was starved of oxygen during a home birth are campaigning for risky breech deliveries to be spotted earlier. Arthur Trott was an undiagnosed breech baby, born after a planned home birth in Burgess Hill on 24 May 2021. A breech delivery is when a baby's bottom or feet will emerge first. An inquest into his death found a delay in transfer to hospital "materially contributed" to his brain injury. The South East Coast Ambulance Service Trust said it welcomed "any changes to national breech birth guidance". Arthur's parents believe a breakdown in communication between the paramedics who attended and their control room meant Mrs Trott was kept at home too long. Arthur's father, Matt Trott, said: "You could hear the panic and confusion in everyone's voices. One minute they were told to go to hospital, the next minute to stay." As a result of Arthur's death, all planned home births in Sussex are being offered a presentation scan at 38 weeks. Read full story Source: BBC News, 14 March 2023
  20. Content Article
    Risk assessment during the maternity pathway relies on healthcare professionals recognising a change in a pregnant woman/person’s circumstances that may increase the level of risk. Risk assessments are undertaken during the numerous contacts pregnant women/people have with a team of healthcare professionals throughout the maternity pathway. This thematic review draws on findings from the Healthcare Safety Investigation Branch's (HSIB's) maternity investigation programme to identify key issues associated with assessing risk during pregnancy, labour and birth (known as the ‘maternity pathway’). It examined all reports undertaken by the HSIB maternity investigation programme from April 2019 to January 2022, with the aim of identifying key learnings about risk assessment. A total of 208 reports that had made findings and recommendations to NHS trusts about risk assessment during the maternity pathway were included. The review identified an overarching theme around the need to facilitate and support individualised risk assessments for pregnant women/people to improve maternity safety. Within this, seven specific ‘risk assessment themes’ within the maternity care pathway were identified as commonly appearing in HSIB reports. These seven themes require a focus from the healthcare system to help mitigate risks and enable NHS trusts and clinicians to deliver safe and effective maternity care to pregnant women/people.
  21. News Article
    When Amy Fantis gave birth to her first child two years ago, the labour was rapid, lasting only about four hours, and she was reliant on gas and air. Her second baby is due in just a few days — but the hospital has, like others around Britain, imposed a ban on the popular form of pain relief. Fantis, 36, from Broxbourne, Hertfordshire, is one of many women affected by the decision of several NHS trusts to suspend the use of the gas because of fears that midwives and doctors have been exposed to unsafe levels for prolonged periods. In some hospitals, levels of the nitrous oxide and oxygen mix are more than 50 times higher than the safe workplace exposure limits. In a survey of more than 16,600 women who gave birth last year, the Care Quality Commission found that 76% of respondents used gas and air at some point during labour. Although short-term use of the gas in childbirth is harmless to women and their babies, long-term exposure for midwives and doctors can affect the body’s ability to absorb vitamin B12, damaging nerves and red blood cells and causing anaemia. It is not believed that any NHS staff have become ill as a result of long-term exposure to gas and air. NHS England and the Health and Safety Executive recently warned other hospitals that they need to check the ventilation on maternity wards and ensure staff are kept safe. NHS England is planning to send out new guidance to trusts on the issue after a series of hospitals had to stop using the gas. Read full story (paywalled) Source: The Times, 25 February 2023
  22. Content Article
    The OptiBreech project is a research study exploring the feasibility of evaluating a new care pathway for women with a breech pregnancy. About 1 in 25 babies are born bottom-down (breech) after 37 weeks of pregnancy. Women who wish to plan a vaginal breech birth have asked for more reliable support from an experienced professional. This aligns with national policy to enable maternal choice. In this video, Dr Shawn Walker explains why the combination of meconium and tachycardia, particularly in the first stage of labour, indicates increased risk in breech births.
  23. News Article
    Rana Abdelkarim died at Gloucestershire Royal Hospital in March 2021 after suffering a bleed post-birth. The Healthcare Safety Investigation Branch (HSIB) found there were delays in calling for specialist help. Her husband, Modar Mohammednour, said that in March 2021 his wife attended the maternity unit at 39 weeks into her pregnancy for what she thought was a routine check-up. Mr Mohammednour said due to language barriers his wife thought she was going "for a scan and to check on her health" and then "come back home", but in fact she was being sent to be induced. "Immediately" after the labour, Ms Abdelkarim suffered heavy bleeding and her condition deteriorated - something Mr Mohammednour said he was "unaware of", until he was eventually called into the hospital to speak to a doctor. According to the investigation by the HSIB, the obstetric team of senior doctors were not told about the drastic change in her condition for almost 30 minutes. An investigation into her death by the HSIB found that once Ms Abdelkarim had been given a drip to speed up labour, regular support from midwives and assessments could not be given to her because the maternity ward was so busy. It also found there was a 53-minute delay from the point of bleeding to administering the first blood transfusion. HSIB also found Ms Abdelkarim was "uninformed" about the reason for her admission, "consent to induce labour was not given" and because she was thin and small, staff underestimated how much relative blood volume she was losing. Read full story Source: BBC News, 7 February 2023
  24. Content Article
    Globally, the under-five mortality rate (U5MR) fell to 38 deaths per 1,000 live births in 2021, while under-five deaths dropped to 5.0 million. Although this demonstrates a decrease, this immense, intolerable and mostly preventable loss of life was carried unequally around the world , and children continue to face widely differing chances of survival based on where they are born. In contrast to the global rate, children born in sub-Saharan Africa are subject to the highest risk of childhood death in the world with a 2021 U5MR of 74 deaths per 1,000 live births – 15 times higher than the risk for children in Europe and Northern America and 19 times higher than in the region of Australia and New Zealand This report outlines and analyses figures from The United Nations Inter-Agency Group for Child Mortality Estimation (UN IGME) to examine levels and trends in child mortality around the world during 2022.
  25. Content Article
    On the 19 July 2021, an investigation commenced into the death of Quinn Lias Parker, born on the 14 July 2021, who died on 16 July 2021. The investigation continues and the case will come to Inquest in 2022. Quinn was born in a very poor condition, and it was sadly clear within 1- 2 hours of his birth, that he remained extremely unwell, and there was a high probability that he would not survive. There were concerns raised by his parents at this early point, regarding the care provided by The Trust, in relation to the management of Emmie, his mother, in late pregnancy, and regarding the timing of Quinn’s delivery. In the event of Quinn’s death, it would therefore require referral to the coroner, and thought needed to be given to the preservation of the placenta, to ensure that it was available for examination as part of the Paediatric post mortem. In this case, the placenta was cut into/dissected after Quinn’s death without discussion with the Coroner. This has affected the ability of the Paediatric Pathologist instructed by the Coroner, to determine the likely cause of Emmie’s antepartum haemorrhage. Whilst the medical cause of Quinn’s death will be explored in full at the Inquest, it is likely that the antepartum haemorrhage, and the underlying pathology causing it, is directly related to Quinn’s death. It is not clear how the placenta was cut into after Quinn’s death without discussion with the Coroner - this will be fully explored at the Inquest, but what is clear is that the outcome is highly detrimental to the independent investigation by the Coroner and other agencies investigating the circumstances of this case. This death follows a number of similar early neonatal deaths in Nottingham, where the placenta has not been retained, and therefore key information regarding placental pathology has been lost
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