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Found 818 results
  1. Content Article
    On the 18 April 2023 the Women and Equalities Select Committee published a report on Black maternal health. This analysed Government and NHS activities to date in this area and made a number of recommendations for further action needed to end disparities in maternal deaths. This paper sets out the UK Government’s response to the recommendations in this report.
  2. Content Article
    Postpartum hypertensive disorders pose a serious health risk to new mothers; nearly 75 percent of maternal deaths associated with hypertensive disorders occur in the postpartum period. For the past decade, the obstetrics department at the Hospital of the University of Pennsylvania (HUP) has tried to lower these risks by checking patients’ blood pressure after they are released from the hospital. Their initial efforts to have patients return to the office for an in-person blood pressure check shortly after discharge yielded disappointing results, so the team revamped their approach and ultimately developed an extremely successful program called Heart Safe Motherhood. The programme started when the team at HUP gave a small group of women a blood pressure cuff each. They told them they would receive text messages after discharge instructing them to take their blood pressure at 8am, and that they would need to send in the reading. At 1pm, they would get another text requesting that they send their blood pressure again. This article describes how Heart Safe Motherhood evolved to improve the likelihood of mothers submitting their readings, and how the programme was scaled up to five hospitals in the group. It looks at how the approach has helped tackled health inequalities and improved the safety of postpartum mothers.
  3. Content Article
    This study in BMJ Open Quality aimed to assess the patient safety status in selected hospitals in Ghana. The authors concluded that the current patient safety status in the hospitals in the study was generally good, with the highest score in the knowledge and learning in the patient safety domain. Patient safety surveillance was identified as the weakest action area.
  4. Content Article
    In 2022, an illustration of a Black foetus in the womb by Nigerian medical illustrator and medical student Chidiebere Ibe, went viral. The image sparked an important conversation around representation in medical imagery and the impact this has on health outcomes for patients who are Black, Indigenous and people of colour (BIPOC). Research showed that only 5% of medical images show dark skin and only 8% of medical illustrators identified as BIPOC. A collaboration between Chidiebere Ibe, Deloitte and Johnson & Johnson, Illustrate Change aims to build the world's largest library of BIPOC medical illustrations for use in medical education and training. So far, the library contains images relevant to the following specialties: Dermatology Eye disease General health Haematology Maternal health Oncology Orthopaedics
  5. Content Article
    Race and ethnicity have been associated with poor pregnancy outcomes in many countries. In the UK, the rates of baby death and stillbirth among Black and Asian mothers are double those for White women. Most studies examine trends for individual countries. This large database study explored how race and ethnicity is linked to pregnancy outcomes in wealthy countries. Key findings Black women consistently had worse outcomes than White women across the globe.  Hispanic women were three times more likely to experience baby death compared with White women.  South Asian women had an increased risk of early birth and having a baby with an unexpectedly low weight (small for the length of pregnancy) compared with White women.  Racial disparities in some outcomes were found in all regions. The researchers call for a global, joined-up approach to tackling disparities. Breaking down barriers to care for ethnic minorities, particularly Black women, could help. More research is needed to understand why outcomes are for worse for ethnic minorities. The researchers recommend routine collection of data on race and ethnicity. The link below takes you to the Plain English summary of the research, you can also view the full research study.
  6. Content Article
    An NHS consultant who was sacked after whistleblowing says it was because he raised concerns that “normal birth” ideology was putting the lives of women and babies at risk. Martyn Pitman, a respected obstetrician and gynaecologist, became a whistleblower to prevent “avoidable disasters” in NHS maternity care, but it cost him his career. Pitman lost his job last month after more than 20 years as a consultant at Royal Hampshire County Hospital in Winchester. His bosses cited an “irretrievable breakdown in his relationship with management”. His dismissal caused outrage from hundreds of former patients and doctors’ leaders, who say it highlights an NHS culture of “punishing those who dare to speak out”.
  7. Content Article
    The National Institute for Health and Care Research (NIHR) Evidence Collections draw together evidence from important NIHR-funded and wider research. They aim to help people in policy and practice understand recent important research in a topic area. The most recent Collection is Maternity services: evidence for improvement. In this blog, one of the Collection's authors, Candace Imison, describes how it was framed by the findings from a recent investigation into failings in East Kent Hospitals’ maternity services. She focuses on some key messages from evidence on how to identify poor performance and provide effective board governance and oversight.
  8. Content Article
    In March 2019, NHS England published Saving Babies Lives version 2, which included information for providers and commissioners of maternity care on how to reduce perinatal mortality across England. One element of this recommends the appointment of a fetal monitoring lead with the responsibility of improving the standard of fetal monitoring. The aim of the fetal monitoring lead is to support staff working on the labour ward to provide high quality intrapartum risk assessments and accurate CTG interpretation and should contribute to building and sustaining a safety culture on the labour ward with all staff committed to continuous improvement. The importance of fetal monitoring was highlighted again in the Ockenden Report, published December 2020. The report recommended, as an essential action, that all maternity services must appoint a dedicated lead midwife and lead obstetrician, both with demonstrated expertise, to focus on and champion best practice in fetal monitoring. Monitoring May is a month long learning event based around fetal monitoring, human factors, maternity safety and shared learning. The East Midlands Academic Health Sciences Network has shared the recording of Monitoring May’s discussions and presentations.
  9. Content Article
    In this blog Paul Whiteing, Chief Executive of AvMA, reflects on the recent report by the House of Commons Women and Equalities Committee on Black maternal health. Paul questions why these racial health disparities, that have long been reported on, have been allowed to continue over many decades and highlights the need for more challenging conversations as to wider root causes.   
  10. Content Article
    Recently, there has been a concerning increase in the number of deaths of pregnant women, especially from Black, Asian and deprived backgrounds. In addition, there have been several investigations into safety issues in maternity services, such as the Ockenden, East Kent, and Shrewsbury and Telford report. This National Institute for Health and Care Research (NIHR) Collection highlights evidence in priority areas, identified in the East Kent report, to support high-quality care and avoid safety issues in maternity services.
  11. Content Article
    Healthcare systems rely on self-advocacy from service users to maintain the safety and quality of care. Systemic bias, service pressures and workforce issues often deny agency to patients at times when they need to have most control over representation of their story. This drives diagnostic error, treatment delay or failure to treat important conditions. In maternal care, perinatal mental health and thrombosis are significant challenges. With funding from SBRI Health care, Ulster University and Southern Health and Social Care Trust are developing an NLP powered platform that will empower mothers to be more active agents in their perinatal care. Download the poster below.
  12. Content Article
    In 2022 the charities Sands and Tommy’s came together to form a Joint Policy Unit. Together they are focussed on achieving policy change that will save more babies’ lives during pregnancy and the neonatal period and on tackling inequalities in loss, so that everyone can benefit from the best possible outcomes. This first report from the Unit brings together a range of evidence to identify the key changes needed to save more babies’ lives and reduce inequalities in pregnancy and baby loss. None of the individual data it contains is new, but it gives decision makers a clear view of where we are now, and where action is required to make progress.
  13. News Article
    Health officials have “paid lip service” to racism in the NHS for years, leading black, Asian and minority ethnic doctors have warned as they called for “concrete” action to tackle inequalities exposed by a landmark review. The damning study – the largest of its kind – had found “vast” and “widespread” inequity in every aspect of healthcare it reviewed, and warned that this was harming the health of minority ethnic patients in England. In response, an NHS spokesperson said the health service was “already taking action” to improve the experiences of patients and access to services and was working “to drive forward” the recommendations made in the report. However, Dr JS Bamrah, a consultant psychiatrist in Greater Manchester and national chairman of the British Association of Physicians of Indian Origin, said he was unsatisfied with the response. “This 166-page review … is a terrible indictment of the current state of the NHS,” he told the Guardian. “As many of us have often said and reported, we don’t need any further reports. It’s action we need, as there are scores of patients who are not getting optimal treatment, and many are being neglected. “It really isn’t good enough for NHS bosses to say that action is being taken and it’s even more disappointing to then not see any concrete proposals on dealing with glaring disparities despite all that we have learnt during the pandemic.” Dr Rajesh Mohan, presidential lead for race and equality at the Royal College of Psychiatrists, said it was “time for warm words to end” as he urged NHS leaders to “do everything they can to ensure patients from ethnic minority backgrounds get the care they need”. Read full story Source: The Guardian, 15 February 2022
  14. News Article
    Current models of maternity care in the UK are failing to reach pregnant women living in adverse social circumstances, research commissioned by the Royal College of Obstetricians and Gynaecologists has found. Georgina Jones, one of the report’s authors and professor of health psychology at Leeds Beckett University, told The BMJ, “Women are often living in a tangled web of complex inequalities that is beyond their control, and this impacts on the care they receive and the outcomes of that care . . .We’ve really been letting down these women in the way that our maternity and reproductive health services are currently delivered, and strategies and care pathways need to be identified and put in place to remedy this.” A number of recommendations have been made in the paper including: Understanding it is the vulnerable, minoritised and disadvantaged women in society that have an increased risk of maternal death. These women are often living in an entangled web of complex inequalities that is beyond their control, which impacts on the care they receive and the outcomes of that care. Strategies and care pathways need to be identified and put in place to improve their situation. These women have been let down in the way that our maternity and reproductive health services are currently delivered. We need to find a better way of recording social determinant data. The current way of doing this is inadequate and not fit for purpose, and it doesn’t provide us with enough information to really understand how the complex circumstances of the woman impacts on her maternal outcomes. The research shows current models of care are still failing pregnant women who have lived in adverse social circumstances prior to, during and after pregnancy. Maternal outcomes are particularly poor for socially disadvantaged women affected by pre-existing physical or mental health problems; those who misuse substances; those who have a lower level of education; those who are overweight, undernourished or poorly sheltered; and those who are at increased risk due to the threat of abusive and unsupportive partners, families and peers. Read full story (paywalled) Source: BMJ, 10 February 2022
  15. News Article
    About 1 in 10 fathers will experience a depressive episode within the first year after a baby is born but no Scottish health board has any specific measures to monitor their mental health, BBC Scotland has learned. Peter Divers, 39, says he hid his feelings of depression for months after his second child was born in November 2016. "It was the darkest time of my life," he says. "I woke up every morning with a knot in my stomach. I felt like there was a big dark cloud following me about." Peter didn't tell anyone what he was experiencing, including his wife, for five months. He did not feel comfortable going to see his GP. His feelings came to a head one day when he arrived to pick his older daughter up from his mother's house, and started crying on her couch. Dr Selena Gleadow-Ware, a consultant psychiatrist who chairs the perinatal faculty at the Royal College of Psychiatrists in Scotland, said research showed about 8-10% of men experience depression in the postnatal period. "Men may be much less likely to talk about or feel comfortable sharing how they're feeling, so it often goes as an under-recognised or hidden problem," she says. Read full story Source: BBC News, 10 February 2022
  16. News Article
    Research shows black women are at a 40% higher risk of pregnancy loss than white women. It is an urgent problem, which the Royal College of Obstetricians and Gynaecologists says needs greater attention, with many complex reasons driving this higher risk. These include a lack of quality research involving all ethnicities - but RCOG head Dr Edward Morris says implicit racial bias is also affecting some women's experience of care. Isabel Gomes Obasi and her husband, Paulson, from Coventry, are expecting a baby boy in March. They are extremely anxious as almost a year ago their baby boy Andre died four months into Isabel's pregnancy. Giving birth to Andre was extremely traumatic, Isabel says, but how she was treated when in severe pain and bleeding, in the days before her loss, made the experience worse. "We knew something was wrong, so we went into hospital and waited five hours to be seen by a doctor," she says. "I remember being laughed at by one of the nurses, who said, 'Just go home. Why do you keep coming in?'" Isabel was checked over and told the baby was fine but says her intuition and pain were belittled and ignored. Within 48 hours of going home, Isabel began bleeding heavily. There is little doctors can do at this relatively early stage of pregnancy to save a baby's life. But the feeling of not being listened to has stayed with Isabel ever since. "I just shut down," she says. "The experience made me anxious and depressive, if not suicidal." Asked why she was not listened to, she said: "The colour of my skin," the attitude of some staff was: "'You have black skin - you are not from here - you can wait.'" Dr Morris says it is "unacceptable" women belonging to ethnic minorities face worse outcomes than white women - especially in maternity care. "Implicit racial bias from medical staff can hinder consultations and negatively influence treatment options," he says. This can stop some women engaging with healthcare. Read full story Source: BBC News, 8 February 2022
  17. News Article
    Unable to move and with her newborn baby crying out of reach, Neya Joshi was left alone for hours on an understaffed maternity ward and had to beg for a glass of water. “It was awful, I was so helpless and so desperate, and no one was interested in helping me. I have never felt fear like it,” she said. The medical copywriter, 30, was diagnosed with post-traumatic stress disorder months after giving birth to her son Arjun at Croydon University Hospital in May 2020 and had therapy for a year to recover from the trauma. She is one of thousands of mothers across the country experiencing poorer care because maternity units lack enough staff. Data from 122 NHS trusts in England shows maternity units were forced to shut their doors to women in labour more than 323 times in 2020-21, with units shut for a total of 16,294 hours, the equivalent of 679 days. When this happens women are forced to go to an alternative hospital to give birth. Staffing shortages were given as a reason in more than two-fifths of the closures. Joshi saw first hand the impact of a lack of midwives when she was admitted to hospital to be induced after her waters broke at the height of the pandemic. Visiting restrictions meant she was alone on a ward for 24 hours and, despite being told she was a high priority, there were no free beds. “After they had started the induction I was told someone would come and check me within six hours but no one came and I was just left on my own for hours,” she said. Eventually, after concerns over her baby’s heart rate, she had an emergency caesarean section but her husband was then made to leave an hour later. “I was taken to the postnatal ward and that’s where it all really went downhill,” she said. “It was awful. I was just lying there. I couldn’t move because I had the epidural and my baby was crying." Read full story (paywalled) Source: The Times, 6 February 2022
  18. News Article
    An NHS England letter has warned of “significant variation” in the uptake of the COVID-19 vaccine amongst pregnant women, and called on systems to enable more “spontaneous” antenatal vaccination. In the letter, sent to integrated care system vaccination programme leads, ICS maternity leads and other NHS clinical directors, NHS England said that while the rates of women who had received at least two doses of the vaccine before giving birth was on the rise, there was “significant variation in uptake between regions and systems and in every system, between women of different ethnicities, decile of deprivation in their local area, and age groups”. The letter asks that covid vaccines are made available within antenatal clinics “to maximise uptake” and that partially vaccinated women “are offered vaccine confidence conversations and advised antenatally on the nearest available walk-in vaccinations”. Vaccination programme and maternity service leads have also been told to make use of resources and funding available to drive uptake in at-risk groups. It said: “Vaccination and maternity leads should discuss how this resource could be used to provide in-reach clinics within every maternity service, without creating additional burden on midwifery staff.” Read full story (paywalled) Source: HSJ, 26 January 2022
  19. News Article
    More than £100 million has been paid out in damages by one hospital trust over 10 years after its maternity units were accused of being responsible for dozens of deaths and stillbirths, Channel 4 News has revealed. From April 2010 to March 2021, £103,097,198 was paid out by the Mid & South Essex NHS Foundation Trust involving 176 obstetrics claims, according to NHS Resolution figures obtained by a freedom of information request. Of those claims made against the trust, 36 related to mothers and children dying, 27 referred to stillbirths and 55 concerned babies born with brain damage or cerebral palsy. Gabriela Pintilie died in Basildon University Hospital, which is run by the trust, in 2019 after losing six litres of blood giving birth, and a coroner said there were “serious failings” in her care. Basildon University Hospital’s maternity unit was twice rated inadequate in 2020, following two separate inspections, with a report saying the service “did not always have enough staff to keep women safe”. The report also criticised “longstanding poor staff culture” which had “created an ineffective team”. In August 2020, the Care Quality Commission (CQC) issued a warning notice to the hospital as inspectors found six serious incidents occurred between March and April that year in which babies were born in a poor condition starved of oxygen and at risk of brain damage. Read full story Source: Channel 4 News, 14 January 2022
  20. News Article
    A trust has warned it could be forced to restrict maternity services due to a high midwife vacancy rate, and large numbers unvaccinated among the current staff. The government has mandated that all patient-facing NHS staff must have had two covid vaccination doses from 1 April — meaning they will need to have received their first dose by 3 February. If not, they can be redeployed to non patient-facing roles, or face dismissal. Barking, Havering and Redbridge University Hospitals Trust’s board heard on Tuesday that the current numbers pose a “significant operational problem” amid efforts to encourage more staff to get both covid jabs before the government’s deadline. The board meeting was told that, of the trust’s 7,550 staff, approximately 1,300 workers – or 17.4% – do not have a vaccination recorded against them, with the areas of greatest concern being women’s and children’s health, geriatric services, the emergency departments and some clinical support services. At the board meeting, BHRUHT chief executive Matthew Trainer said: “The vacancy rate, plus the unvaccinated rate, would put us in quite a serious position. “At the minute, for example, the Queen’s Birth Centre [at Queen’s Hospital in Romford, east London], I don’t think, has been open since I got here. I couldn’t see any circumstances in which it would reopen if we lost another chunk of midwives, for the foreseeable future certainly, in terms of vaccination. “I think it would leave us in a position where we’d have to look at constraining services and focusing in on core [services], establishment being focused on the labour ward, looking at complex births and making sure we’re doing everything we possibly can to manage it as safely as possible.” Read full story (paywalled) Source: HSJ, 12 January 2022
  21. News Article
    Entire hospital units could be forced to shut because of staff quitting in protest at the government’s order that they must all be vaccinated against COVID-19, a senior NHS leader has warned. Chris Hopson, the chief executive of NHS Providers, said that at one hospital trust in England, 40 midwives were refusing to get jabbed, raising fears that the maternity unit may have to close. “Trust leaders are acutely aware that, from April onwards, when Covid vaccinations will become mandatory, decisions by staff to remain unvaccinated could – in extreme circumstances – lead to patient services being put at risk,” said Hopson. “If sufficient numbers of unvaccinated staff in a particular service in a particular location choose not to get vaccinated, the viability and/or safety of that service could be at risk.” Hopson did not name the trust. But he cautioned that its maternity unit is “one representative example” of potential closures on grounds of patient safety that the government’s decision to compel NHS staff in England to be vaccinated or risk losing their job could lead to. Hopson said: “I was talking to a [trust] chief executive who said that 40 of the midwives on their midwifery service … were saying they were not prepared to be vaccinated. Those staff, given their skills and their expertise, are not easily redeployed but they’re also extremely difficult to replace." Read full story Source: The Guardian, 20 December 2021
  22. News Article
    Mothers and babies are being put at risk as vital health checks and support services remain shut months after lockdown was lifted, health professionals and charities have warned. Face-to-face services for new families stopped when lockdown began in March last year and have not come back in many parts of the country. Now experts fear the spread of the Omicron variant and the reintroduction of some restrictions means the reopening will be delayed further. Missing services include drop-in baby-weighing clinics, tongue-tie clinics, face-to-face breastfeeding support and council-run baby classes and playgroups. Experts have accused the government of failing to prioritise the needs of a generation of babies and their parents, with cost-cutting and a shortage of midwives and health visitors blamed for the closures. Health visitor drop-in clinics are “no longer running” in nearly a third of areas, and around 28% of newborn checks are being carried out via phone or video call, according to the No One Wants to See My Baby report by charities the Parent-Infant Foundation, Home-Start UK and Best Beginnings. The Institute of Health Visiting said different interpretations of government guidance meant some areas had brought back full services while others had not, creating a “postcode lottery of support for families”. It questioned official advice that routine checks could continue to be done via video and telephone calls, warning there was no evidence these were “safe or effective”. Executive director Alison Morton said: “Alongside the concerns of parents, there is a growing body of evidence that childhood conditions and disabilities are being missed, and vulnerable babies and young children are being harmed, as they are invisible to services when these assessments are not completed face to face.” Read full story Source: The Guardian, 12 December 2021
  23. News Article
    A hospital trust has been told to "immediately improve" its maternity and surgical services. The Care Quality Commission (CQC) made unannounced inspections in September and October at four of the hospitals run by University Hospitals Sussex NHS Foundation Trust. Inspectors raised concerns about staff shortages, skills training and risk management. At the trust's four maternity services, inspectors found departments "did not have enough staff to keep women and babies safe" and staff were "not up to date" with training. Infection prevention measures in surgical services at the Royal Sussex County Hospital were "not consistently applied" and managers were not running services well, inspectors noted. The report also said morale was low and often staff "did not have time to report incidents". The trust said it has taken "urgent action" to make improvements. Read full story Source: BBC News, 10 December 2021
  24. News Article
    A couple whose child died in the womb after mistakes by maternity staff have received a £2.8m settlement. Sarah Hawkins was in labour for six days before Harriet was stillborn at Nottingham City Hospital in April 2016. Hospital bosses initially found "no obvious fault", but an external inquiry identified 13 failings in care. Solicitors representing Mrs Hawkins and husband Jack said it was believed to be the largest payout for a stillbirth clinical negligence case. Mrs Hawkins was nearly 41 weeks' pregnant when Harriet was delivered, almost nine hours after dying. The couple were first told their child had died of an infection but refused to accept this and launched their own investigation. A Root Cause Analysis Investigation Report published in 2018 concluded the death was "almost certainly preventable". The report said errors included a delay in applying appropriate foetal monitoring, the important omission of information on an antenatal advice sheet and a failure to follow the Risk Management Policy for maternity. It also found failures to record or pass on information correctly, failure to follow correct guidelines and delays in administering the correct treatment. Following the report's publication, the hospital trust apologised and said major changes would be made. Read full story Source: BBC News, 6 December 2021
  25. News Article
    Changes must be made across services at one of England's biggest NHS trusts following its first wide-ranging inspection, a health watchdog said. Mid and South Essex NHS Foundation Trust - which runs Basildon, Southend and Broomfield hospitals - has been rated as "requires improvement". The Care Quality Commission (CQC) turned up unannounced after concerns over standards were raised. Philippa Styles, the CQC's head of hospital inspection, said they "found a mixed picture" of positive improvements and areas of concern. "Following the trust's formation in 2020, leaders should now be able to work together effectively to ensure care is consistent across all services," she said. "I recognise the enormous pressure NHS services are under... and that usual expectations cannot always be maintained, especially in the urgent and emergency department, but it is important they do all they can to mitigate risks to patient safety." The report said: Patients had not always been protected from harm. Staff had not all received mandatory training. There had been nine "never-should-happen" medical events. Records were sometimes inaccurate and not kept securely. Nursing and medical staffing was a "challenge across the trust", with shifts regularly below planned staffing numbers. There had been a high number of whistle-blowers raising concerns. Read full story Source: BBC News, 1 December 2021
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