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Found 810 results
  1. News Article
    Leaders of two maternity services have been told to take urgent action, after inspectors found understaffing and declining levels of care, despite safety warnings from midwives. Maternity services at University Hospital North Durham and Darlington Memorial Hospital have been downgraded from “good” to “inadequate” in Care Quality Commission reports, published today. The CQC noted a “concerning deterioration” in the care the two services provided, despite midwives telling managers they felt the service was unsafe. Sue Jacques, chief executive of County Durham and Darlington Foundation Trust, which runs the hospitals, said the CQC’s findings would be taken “extremely seriously”. The reports also said staff reported “feeling ‘frozen out’ or that their concerns were ignored by leaders” and that staff felt “‘continuity of carer’ was the trust’s main focus, despite depleted safe staffing levels, skill mix, and staff being pulled in to cover acute areas on a frequent basis”. Last year, trusts were told not to pursue continuity of carer models – which were previously championed by NHS England – unless they had adequate staffing levels to do so safely. Read full story (paywalled) Source: HSJ, 15 September 2023
  2. Content Article
    The Maternal, Newborn and Infant Clinical Outcome Review Programme, which is delivered by MBRRACE-UK, has published a report on UK Perinatal Deaths for Births from January to December 2021. Overall, it found that perinatal mortality rates increased across the UK in 2021, with 3.54 stillbirths per 1,000 total births and 1.65 neonatal deaths per 1,000 live births (3.33 and 1.53 respectively in 2020). However, there was a wide variation in stillbirth and neonatal mortality rates across organisations, though these rates increased in almost all gestational age groups. It was also found that inequalities in mortality rates by deprivation and ethnicity remain, but the most common causes of stillbirth and neonatal death are unchanged (for example, congenital anomalies continue to contribute to a significant proportion of perinatal deaths).
  3. 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
  4. News Article
    A trust facing a police investigation into one of the NHS’s largest ever maternity scandals is no longer rated ‘inadequate’ by the Care Quality Commission in its well-led and maternity domains. Nottingham University Hospitals Trust was rated “inadequate” for its leadership and maternity services during inspections in 2021 and 2022, following serious care failings exposed by staff and patients during this period. The Nottinghamshire police confirmed last week they were opening an investigation. But the regulator noted improvements after its well-led and maternity inspections which took place in April and June. The well-led rating has gone up from “inadequate” to “requires improvement” and maternity services at both hospitals have also gone up to “requirements improvement”. Greg Rielly, CQC deputy director of operations in the Midlands, said: “During this inspection, we saw a team that consistently led with integrity who were open and honest in their approach.” However, he stressed that while the culture across the trust was improving, some staff still didn’t feel able to raise concerns without fear of retribution. “Leaders were aware of this and were working to create a workplace that is free from bullying, harassment, racism, and discrimination so we hope to see an improved picture soon,” he said. Read full story (paywalled) Source: HSJ, 13 September 2023
  5. Content Article
    In 2008, five ‘serious untoward incidents’ occurred on a small maternity unit in a hospital in the UK. The prevailing view, held by clinical staff, hospital managers, and executives, was that these events were unconnected and did not signal systemic failures in care. This view was maintained by the testimony of staff and governance procedures which prevented the incidents from being considered together. Drawing on the inquiry report of the Morecambe Bay Investigation (2015), Dawn Goodwin examines how the prevailing view was built and dismantled, eventually being replaced with a very different description of events. Overturning this view required affected parents to engage with governing bodies and legal processes, challenge clinical staff, lobby for inquests, and mobilise social media and the national press. Tracing how different descriptions of events weaken or gather force as they travel through different forums, processes, and are presented to different audiences, she explores the sociology of knowledge around establishing failures of care.
  6. News Article
    A police investigation is to be launched into failings that led to dozens of baby deaths and injuries at a hospital trust. The maternity units at Nottingham University Hospitals (NUH) NHS Trust are already being examined in a review by senior midwife Donna Ockenden. The review will become the largest ever carried out in the UK, with about 1,800 families affected. Nottinghamshire Police said its decision to investigate followed discussions with Ms Ockenden. Her team is looking into failings that led to babies dying or being injured at Nottingham City Hospital and the Queen's Medical Centre. Chief Constable Kate Meynell said: "On Wednesday I met with Donna Ockenden to discuss her independent review into maternity cases of potentially significant concern at Nottingham University Hospitals NHS Trust (NUH) and to build up a clearer picture of the work that is taking place. "We want to work alongside the review but also ensure that we do not hinder its progress. "However, I am in a position to say we are preparing to launch a police investigation. "I have appointed the Assistant Chief Constable, Rob Griffin, to oversee the preparations and the subsequent investigation." Read full story Source: BBC News, 7 September 2023
  7. 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
  8. News Article
    A woman who suffered chronic abdominal pain for 18 months after undergoing a caesarean section was found to have a surgical instrument the size of a dinner plate inside her abdomen. The Alexis retractor, or AWR, was left inside the New Zealand mother after her baby was delivered at Auckland City Hospital in 2020. Following initial investigations into the case, Te Whatu Ora Auckland, formerly Auckland District Health Board, claimed it had not failed to exercise reasonable skill and care towards the patient, who was in her 20s. But on Monday, New Zealand’s Health and Disability Commissioner, Morag McDowell, found Te Whatu Ora Auckland in breach of the code of patient rights. Read full story Source: Guardian, 4 September 2023
  9. News Article
    Campaigners have expressed alarm at new analysis showing a sharp increase in new or expectant mothers waiting for mental health care, with one woman found to have waited 319 days for a first appointment. More than 30,000 women who are pregnant or have newly given birth are on waiting lists for mental health support, according to NHS England data analysed by Labour, with the party saying many of them were being left to “suffer in silence”. Amid rising demand for what are known as perinatal mental health services, during the period from August 2022 to March 2023 the numbers of women waiting rose by 40%. Over that same period, the numbers who accessed support also rose, but only by 8%. Read full story Source: Guardian, 4 September 2023
  10. News Article
    Tonjanic Hill was overjoyed in 2017 when she learned she was 14 weeks pregnant. Despite a history of uterine fibroids, she never lost faith that she would someday have a child. But, just five weeks after confirming her pregnancy she seemed unable to stop urinating. She didn’t realize her amniotic fluid was leaking. Then came the excruciating pain. “I ended up going to the emergency room,” said Hill, now 35. “That’s where I had the most traumatic, horrible experience ever.” An ultrasound showed she had lost 90% of her amniotic fluid. Yet, over the angry protestations of her nurse, Hill said, the attending doctor insisted Hill be discharged and see her own OB-GYN the next day. The doctor brushed off her concerns, she said. The next morning, her OB-GYN’s office rushed her back to the hospital. But she lost her baby. Black women are less likely than women from other racial groups to carry a pregnancy to term — and in Harris County, where Houston is located, when they do, their infants are about twice as likely to die before their 1st birthday as those from other racial groups. Black fetal and infant deaths are part of a continuum of systemic failures that contribute to disproportionately high Black maternal mortality rates. “This is a public health crisis as it relates to Black moms and babies that is completely preventable,” said Barbie Robinson, who took over as executive director of Harris County Public Health in March 2021. “When you look at the breakdown demographically — who’s disproportionately impacted by the lack of access — we have a situation where we can expect these horrible outcomes.” Read full story Source: KFF Health News, 24 August 2023
  11. Content Article
    During pregnancy, and up to one year after birth, one in five women will experience mental health issues, ranging from anxiety and depression to more severe illness. For those women experiencing mental ill-health, barriers often exist preventing them from accessing care, including variation in availability of service, care, and treatment. These are often worsened by cultural stigma, previous trauma, deprivation, and discrimination. This document by the Royal College of Midwives outlines recommendations to ensure that women are offered, and can access, the right support at the right time during their perinatal journey.
  12. News Article
    The United States is in the middle of a maternal health crisis. Today, a woman in the US is twice as likely to die from pregnancy than her mother was a generation ago. Statistics from the World Health Organization show the United States has one of the highest rates of maternal death in the developed world. Women in the US are 10 or more times likely to die from pregnancy-related causes than mothers in Poland, Spain or Norway. Some of the worst statistics come out of the South - in places like Louisiana, where deep pockets of poverty, health care deserts and racial biases have long put mothers at risk. Dr Rebekah Gee: The state of maternal health in the United States is abysmal. And Louisiana is the highest maternal mortality in the US. So, in the developed world, Louisiana has the worst outcomes for women having babies." A third of Louisiana's parishes are maternal health deserts – meaning they don't have a single OB-GYN, leaving more than 51 thousand women in the state without easy access to care and three times more likely to die of pregnancy related causes. Read full story Source: CBS News, 20 August 2023
  13. Content Article
    .As healthcare organisations continually strive to improve, there is a growing recognition of the importance of establishing a culture of safety. This handbook was published by Healthcare Improvement Scotland to support NHS board maternity services to: understand the importance of safety culture. undertake a patient safety climate survey. understand what the survey results are telling them. develop an improvement plan to address areas that have been highlighted. It includes: the Maternity Services Patient Safety Survey. template letters for NHS boards to adapt for local use. an example improvement plan template.
  14. Content Article
    Georgia Stevenson discusses NHS England’s Long Term Workforce Plan, evaluating its potential to alleviate staffing shortages, enhance training routes, and ultimately improve care quality in maternity and neonatal services.
  15. News Article
    A teaching trust has had its maternity services downgraded to ‘inadequate’ after inspectors found stillbirths and massive haemorrhages were not being treated as ‘serious incidents’. Maternity services at St George’s University Hospitals Foundation Trust in south London were previously inspected in 2016, when they were assessed as “good”. The Care Quality Commission (CQC) said serious incident declaration meetings at St George’s were regularly classing serious incidents as “adverse incidents”, meaning executives were not informed and there were missed opportunities for learning and development. Inspectors also found incidents such as severe perineal tears, emergency hysterectomy, and birth injuries were rated as causing low or no harm when a higher level would have been appropriate, or and sometimes downgraded from a higher rating. Carolyn Jenkinson, CQC’s deputy director of secondary and specialist healthcare, said: “We saw areas where significant and urgent improvements are needed to ensure safe care is provided to women, people using this service, and their babies. “Both staff and people using the service were being let down by leaders who failed to respond quickly, resulting in care that was unsafe, and in the delivery suite, also chaotic.” Read full story (paywalled) Source: HSJ, 17 August 2023
  16. Content Article
    This briefing was commissioned by the Maternal Mental Health Alliance who are dedicated to ensuring all women, babies and their families across the UK have access to compassionate care and high-quality support for their mental health during pregnancy and after birth. One woman in five experiences a mental health problem during pregnancy or after they have given birth. Maternal mental health problems can have a devastating impact on the women affected and their families. NICE guidance states that perinatal mental health problems always require a speedy and effective response, including rapid access to psychological therapies when they are needed. Integrated care systems (ICSs) have a unique opportunity to ensure that all women who need support for their mental health during the perinatal period get the right level of help at the right time, close to home.
  17. News Article
    Women who struggle with their mental health have an almost 50% higher risk of preterm births, according to the biggest study of its kind. The research, published on Tuesday in the Lancet Psychiatry, examined data from more than 2m pregnancies in England and found about one in 10 women who had used mental health services had a preterm birth, compared with one in 15 who did not. The study also found a clear link between the severity of previous mental health difficulties and adverse outcomes at birth. Women who had been admitted to psychiatric hospital were almost twice as likely to have a preterm birth compared with women who had no previous contact with mental health services. And women with history of mental health difficulties faced a higher risk of giving birth to a baby that was small for its gestational age (75 per 1,000 births compared with 56 per 1,000 births). The study recommends that when pregnant women are first assessed by doctors and midwives they should be sensitively questioned in detail about their mental health. One of the reports authors, Louise Howard, professor emerita in women’s mental health at King’s College London, said such screening would help identify “clear red flags for a possible adverse outcome”. Read full story Source: Guardian, 14 August 2023
  18. Content Article
    The Maternity Survey 2022, run by Ipsos on behalf of the Care Quality Commission, looked at the experiences of women and other pregnant people who had a live birth in early 2022. In this article Anita Jefferson from Ipsos looks at the results of this and considers what they tell us about experiences of maternity services.
  19. Content Article
    This report provides a review of the Healthcare Safety Investigation Branch (HSIB) maternity investigation programme during 2022/23. During this period HSIB completed 702 reports and made more than 1,380 safety recommendations.
  20. Content Article
    This report by the Royal College of Midwives (RCM) highlights the impact of midwifery staffing shortages on women. It looks at historical failures to invest appropriately in maternity services and talks about a mounting maternity crisis, drawing attention to Care Quality Commission inspections of maternity services that are identifying concerns around safety directly linked to staffing shortages. According to the report’s findings, if the number of NHS midwives in England had risen at the same pace as the overall health service workforce since the last general election, there would be no midwife shortage; there would be 3,100 more midwives in the NHS, rather than having a shortfall of 2,500 full-time midwives. The RCM published the results of a survey last month which showed that midwives give 100,000 hours of free labour to the NHS per week to ensure safe care for women. It also showed that staffing levels were repeatedly cited as cause for concern around the safety of care, and that midwives and maternity support workers are exhausted and burnt out.
  21. News Article
    America is facing an intensified push to pass stalled federal legislation to address the US’s alarming maternal mortality rates and glaring racial disparities which have led to especially soaring death rates among Black women giving birth. Maternal mortality rates in the US far outpace rates in other industrialised nations, with rates more than double those of countries such as France, Canada, the UK, Australia, Germany. Moms in the US are dying at the highest rates in the developed world. Overall maternal mortality rates in the US spiked during the pandemic. Maternal deaths in the US rose 40% from 861 in 2020 to 1,205 in 2021, a rate of 32.9 deaths per 100,000 live births. For Black women, these maternal mortality rates were significantly higher, at 69.9 deaths per 100,000 live births in 2021. These racial disparities in maternal health outcomes have persisted and worsened for years as the number of women who die giving birth in the US has more than doubled in the last two decades. The CDC noted in a review of maternal mortalities in the US from 2017 to 2019, that 84% of the recorded maternal deaths were preventable. Read full story Source: The Guardian, 23 July 2023
  22. Content Article
    The aim of the study was to explore the factors that affect the safety attitude and teamwork climate of Cyprus maternity units and Cypriot midwives. The study found that the safety climate in the maternity settings was negative across all six safety climate domains examined. The higher mean total score on team work and safety climate in the more experienced group of midwives is a predominant finding for the maternity units of Cyprus. It could be suggested that younger midwives need more support and teamwork practice, in a friendly environment, to enhance the safety and teamwork climate through experience and self-confidence.
  23. News Article
    Women who lose babies during pregnancy will be able to get a certificate as an official recognition of their loss as well as better collection and storage of remains under new government plans. The government will make sure the certificate is available to anyone who requests one after experiencing any loss pre-24 weeks’ gestation. The NHS will develop and deliver a sensitive receptacle to collect baby loss remains when a person miscarries. A&Es will also have to ensure that cold storage facilities are available to receive and store remains or pregnancy tissue 24/7 so that women don’t have to resort to storing them in their home refrigerators. The new recommendations are part of the government’s response to the independent Pregnancy Loss Review. Read full story Source: The Independent, 23 July 2023
  24. Content Article
    A vision for improving the care and support available to families when baby loss occurs before 24 weeks' gestation.
  25. News Article
    The government has admitted that many ‘vulnerable’ hospitals ‘suffer with a lack of permanence of leadership’, but said that chiefs are only sacked by NHS England ‘in extreme and exceptional circumstances’. The comments were included in the government’s response to the independent investigation into major maternity care failures at East Kent Hospitals University Foundation Trust, which highlighted how the practice of repeatedly hiring and firing leaders had contributed to its problems. The investigation said successive chairs and CEOs at the FT were “wrong” to believe it provided adequate care, and urged that they be held accountable. But it said senior management churn had been “wholly counterproductive”, and that it had “found at chief executive, chair and other levels a pattern of hiring and firing, initiated by NHS England” which would “never have been an explicit policy, but [had] become institutionalised”. Read full story (paywalled) Source: HSJ, 21 July 2023
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