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Content ArticleThe goal of this US-based study, published in Psychiatric Services, was to characterise racial-ethnic differences in mental health care utilisation associated with postpartum depression in a multi-ethnic cohort of Medicaid recipients. Medicaid in the United States is a federal and state program that helps with medical costs for some people with limited income and resources. Findings of the study presents evidence of low rates of postpartum depression treatment initiation and continuation, indicating barriers to care among low-income mothers; racial-ethnic disparities imply additional challenges for black women and Latinas. The presence of such disparities points to the need for clinical and institutional policies and programs to address the particular barriers to mental health care faced by black women and Latinas in the months after delivery.
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Content ArticleThis paper, from THIS Institute, aims to describe exactly what needs to happen for maternity care to be safe by examining how interventions and context work together to nurture and sustain safe practice.
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Content ArticleMore women are choosing to birth at home in well-resourced countries. Concerns persist that out-of-hospital birth contributes to higher perinatal and neonatal mortality. This systematic review, published by The Lancet, and meta-analyses determines if risk of fetal or neonatal loss differs among low-risk women who begin labour intending to give birth at home compared to low-risk women intending to give birth in hospital.
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Content ArticleThe government-commissioned review, First Do No Harm, into why mesh implants and other treatments were allowed to harm hundreds of women said the failings were “caused and compounded by failings in the health system itself”. HSJ's Health Check podcast considers why it is being buried by government.
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Content ArticleOn Wednesday 8 July 2020 the Independent Medicines and Medical Devices Safety Review published its report First Do No Harm, examining how the healthcare system in England responds to reports about the harmful side effects from medicines and medical devices. Chaired by Baroness Julia Cumberlege, the review focused on looking at what happened in relation to three medical interventions: hormone pregnancy tests, sodium valproate and pelvic mesh implants. In this blog Patient Safety Learning consider the reports findings in more detail, highlighting the key patient safety themes running through this, which are also found in many other patient safety scandals in the last twenty years. It also looks at what needs to change to prevent these issues recurring and asks whether NHS leaders stick with the current ways of working, make a few improvements, or take this opportunity for transformational change.
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The group B Strep i-learn module
PatientSafetyLearning Team posted an article in Maternity
Group B Strep can be a complex topic, with some confusion about what exactly is the latest guidelines on testing, risk factors, recommended antibiotics, and the impact (if any) of GBS on homebirths, waterbirths, breastfeeding, and much more.This is why Group B Strep Support and the Royal College of Midwives (RCM) have produced an evidence-based group B Strep i-learn module.The group B Strep i-learn module focuses on the current UK guidelines for preventing group B Strep infection in newborn babies and on signs of these infections in babies. It will refresh clinician knowledge of the national guidelines, and help you tackle the FAQs you get from expectant and new parents.Follow the link below to find out how to sign up. -
Content ArticleGroup B streptococcus (GBS) is a naturally occurring bacterium, often found in the mother’s vagina, which can be dangerous for babies during labour and immediately after birth. The mothers carry this bacterium in the birth canal without any problem to themselves. Giving antibiotics to the mother during labour reduces the incidence of GBS infection passing on to the baby (National Institute for Health and Care Excellence, 2012).
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Content ArticleCOVID-19 has created unprecedented pressures for the NHS as a whole including maternity services. How can maternity leaders run a safe and rights respecting maternity service during a pandemic? This guide, produced by Brithrights, sets out a process to support maternity service leaders to reach decisions that help them to achieve this. All those affected by decisions need to be involved in making them. NHS England guidance states that Maternity Voices Partnership Chairs should be involved in decisions about temporary changes to maternity services, in addition to staff and partner organisations.
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Content ArticleThis Review was announced in the House of Commons on 21 February 2018 by Jeremy Hunt, the then Secretary of State for Health and Social Care. Its purpose is to examine how the healthcare system in England responds to reports about harmful side effects from medicines and medical devices and to consider how to respond to them more quickly and effectively in the future. The Review was asked to investigate what had happened in respect of two medications and one medical device: hormone pregnancy tests (HPTs) – tests, such as Primodos, which were withdrawn from the market in the late 1970s and which are thought to be associated with birth defects and miscarriages; sodium valproate – an effective anti-epileptic drug which causes physical malformations, autism and developmental delay in many children when it is taken by their mothers during pregnancy; and pelvic mesh implants – used in the surgical repair of pelvic organ prolapse and to manage stress urinary incontinence. Its use has been linked to crippling, life- changing, complications; and to make recommendations for the future. The Review was prompted by patient-led campaigns that have run for years and, in the cases of valproate and Primodos over decades, drawing active support from their respective All-Party Parliamentary Groups and the media.
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Risks of CTG monitoring
PatientSafetyLearning Team posted an article in Maternity
This is a series of three articles written by Kirsten Small, a specialist obstetrician and gynaecologist in Australia, exploring the risks that flow from the use of intrapartum monitoring. Part 1 Examines evidence of short and long-term physical harms to birthing women relating to higher rates of surgical birth when intrapartum Cardiotocography (CTG) monitoring is used. Part 2 Focuses on possible psychological harms which have been reported relating to CTG use. Part 3 Looks at the possibility that CTG use might cause harm to the baby, while the two previous posts have examined the risk to birthing women. -
Content ArticleIn this candid blog, 'The Secret Midwife', gives her account of the pressure and lack of resource and support that makes it so difficult to provide safe care.
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Letter from America: Kick off to a new year of hope
lzipperer posted an article in Letter from America
Football is a popular American pastime. Its focus on collaboration, individual skill reliance and teamwork serves as a touchpoint for the January 2020 Letter from America. Letter from America is a Patient Safety Learning blog series highlighting fresh accomplishments in patient safety from the United States. -
Content ArticleThis article, published by Medium, looks at the story of a woman who had a stroke while pregnant. Both survived. The authors highlight a growing concern that the US is in the midst of a maternal morbidity and mortality crisis.
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Content Article
Consent: Maternity
Claire Cox posted an article in Consent issues
This area of the Royal College of Obstetricians and Gynaecologists website provides guidance for healthcare professionals on obtaining consent from women within obstetrics and gynaecology services. It provides easy access to all procedure-specific consent documentation and gives advice on how best to support women’s decision-making about their care.- Posted
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Each baby counts: Aims and objectives
Claire Cox posted an article in Maternity
In the UK, each year over 1000 babies die or are left with severe brain injury, not because they are born too soon or too small, or have a congenital abnormality, but because something goes wrong during labour. The Royal College of Obstetricians and Gynaecologists does not accept that all of these are unavoidable tragedies, and with the Each baby counts project, they are aiming to reduce this unnecessary suffering and loss of life by 50% by 2020. -
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RCOG: Video briefing on human factors and situational awareness
Claire Cox posted an article in Maternity
Each baby counts is the Royal College of Obstetricians and Gynaecologist's national quality improvement programme to reduce the number of babies who die or are left severely disabled as a result of incidents occurring during term labour. Watch the Each baby counts human factors video for information on how to address issues within your unit. -
Content Article
Safety, experience, or both?
Claire Cox posted an article in Maternity
Is safety and a good experience two separate issues? This blog by Florence Wilcock, consultant obstetrician, discusses this issue. -
Content ArticleOne of many legal, ethical, and patient safety issues raised by the COVID-19 pandemic across the NHS is that expectant mothers are considering freebirthing more after home births are cancelled. The charity AIMS (Association for Improvements in the Maternity Services) states that while there is no specific definition of freebirthing, “…broadly speaking, a woman freebirths when she intentionally gives birth to her baby without a midwife or doctor present. Some women prefer to use the term ‘unassisted childbirth’ or UC to describe this.” This may carry major health risks. For example, if complications occur during a freebirth, professional clinical help will not be at hand to help. John Tingle explores this further in his blog for the Bill of Health. John Tingle is a regular contributor to the Bill of Health blog and is a Lecturer in Law at Birmingham Law School in the UK and a Visiting Professor of Law, Loyola University Chicago, School of Law.
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Content ArticleMore than 1 in 10 women will experience postnatal depression within the first year after giving birth. With a recent study showing that postnatal depression is 13% higher among black and ethnic minority women than it is among white women, it raises significant questions around whether these women are receiving the right treatment and support.
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Content ArticleSome of the serious findings of external reviews of NHS services from recent years, previously unpublished, have been released to HSJ. An HSJ investigation has found the NHS has kept secret dozens of external reviews into care failings in local services including: A hospital where surgery may have “shortened life expectancy”. An alleged “cartel” of private patients said to be put on NHS lists. “Very high risk” consultant on-call arrangements. Problems with fetal heart monitoring in a maternity service. Potentially unnecessary operations being carried out. Rows among doctors putting patients at risk. Read their full report below.
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Content ArticleThis is the response form the Parliamentary Under-Secretary of State for Health and Social Care, Nadine Dorries MP, to an urgent question from Sir Roger Gale MP on maternity care failings at the East Kent Hospitals University NHS Foundation Trust. It was followed by questions from MPs in the chamber and Ms Dorries’ responses.
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Content ArticleA significant fall in maternal death due to Venousthromboembolisation (VTE) followed the publication of the Royal College of Obstetricians and Gynaecologists guideline ‘Thromboprophylaxis’ in 2004. It is likely that the fall in deaths is the result of better recognition of at-risk women and widespread thromboprophylaxis. All women should undergo a documented assessment of risk factors for VTE in early pregnancy or before pregnancy. All pregnant women should have a documented VTE risk assessment at the booking appointment whilst the comprehensive history is being taken.
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RCOG: Each Baby Counts 2019 progress report
Patient Safety Learning posted an article in Maternity
Each Baby Counts is a national quality improvement programme led by the Royal College of Obstetricians and Gynaecologists (RCOG) to reduce the number of babies who die, or are left severely disabled, as a result of incidents occurring during term labour. The Each Baby Counts programme brings together the results of local investigations into stillbirths, neonatal deaths and brain injuries occurring during term labour to understand the bigger picture, share the lessons learned and prevent babies from dying or suffering brain injuries in the future. This report presents key findings and recommendations based on the analysis of data relating to the care given to mothers and babies throughout the UK, to ensure each baby receives the safest possible care during labour. -
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Improving birthing pool design
Claire Cox posted an article in Maternity
Chartered Institute for Ergonomics and Human Factors has come together with industry and maternity units to redesign birthing pools to ensure they are safe and ergonomical for users. Read the attached case study. -
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Home births, fears and patient safety amid COVID-19
PatientSafetyLearning Team posted an article in Blogs
The COVID-19 outbreak has had an impact on all areas of health and social care. While understandably the focus of the healthcare system currently rests on the pandemic, it is important that we also consider the impact on non COVID-19 treatment and care. This has been recently highlighted by the UK Chief Medical Officer Professor Chris Whitty, who has warned about the impact that the pandemic will have on other areas as the health system is “reorientated towards COVID”.[1] Patient Safety Learning believe that in this context the need to pay attention to patient safety is now more important than ever. Pregnant women represent a unique patient group, facing very specific challenges. Although early evidence indicates that babies and children are less severely affected by the virus, many are concerned for the safety of their baby within the unfamiliar backdrop of COVID-19. It is understandable that fears persist when there are reports of pregnant women, children and midwives who have tragically lost their lives. This is the first blog where we will look at the impact of the pandemic on maternity services. Here we will focus on the safety implications of both low and high-risk women choosing to birth at home due to fears of contracting the virus in hospital. We also raise questions as to whether a blanket suspension of home birth services is putting some women and babies at greater risk.
