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News ArticlePoorer mothers are three times more likely to have stillborn children than those from more affluent backgrounds, according to a new study. The wide-ranging research, conducted by pregnancy charity Tommy’s, also found that high levels of stress doubled the likelihood of stillbirth, irrespective of other social factors and pregnancy complications. Unemployed mothers were almost three times more at risk. The government has been urged to take immediate action to address the social determinants of health and halt the rise in pregnant women who face the stress of financial insecurity. Researchers said getting more antenatal care can stop women from having a stillbirth — with mothers who went to more appointments than national rules stipulate having a 72% lower risk. Ros Bragg, director of Maternity Action said, “If the government is serious about combatting stillbirths, it must address the social determinants of health as well as clinical care. Women need safe, secure employment during their pregnancy and the certainty of a decent income if they find themselves out of work. It is not right that increasing numbers of pregnant women are dealing with the stress of financial insecurity, putting them at increased risk of serious health problems, including stillbirth.” Read full story Source: The Independent, 29 October 2020
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News ArticleWhen Jess and Patrick discovered they were expecting their first baby in the new year, they looked forward to an early glimpse of their unborn child via an ultrasound scan. But the couple, who live in the north-west of England, were soon told that Patrick would not be able to attend any antenatal appointments, including routine scans at 12 and 20 weeks. When their baby begins its journey into the world, Patrick will be permitted to join Jess only when labour is fully established, and he must leave an hour after delivery. He will not be able to visit his new family in hospital again. “It’s taken the shine off the pregnancy,” said Jess, a junior doctor. “Patrick hasn’t been able to come to a single appointment. It’s making me very anxious and stressed – I’ve had actual nightmares about things going wrong and Patrick not being with me. He’s had to wait at home when I’ve gone for appointments, worrying and waiting for me to call to say everything’s OK.” The hospital where Jess will give birth is among 43% of NHS trusts that – despite official guidance – have not eased restrictions imposed during lockdown on partners attending antenatal appointments, being present throughout labour, and staying with new mothers and babies after the birth. And as Covid transmissions rise across the UK, almost a quarter of NHS trusts have said they expect to reimpose such restrictions. Read full story Source: The Guardian, 24 October 2020
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Pregnant women must have flu jab this winter, warn health bodies
Patient Safety Learning posted a news article in News
All pregnant women have been urged by doctors to get a free flu vaccination this winter to ensure they and their babies are protected. People can get infected with flu and coronavirus at the same time - with Public Health England finding if you get both simultaneously you may get more seriously ill. Researchers previously said those who have been infected with both viruses face a serious increase to their risk of death and warned the public “not to be complacent” in the wake of fears flu could circulate around the country alongside COVID-19. The Royal College of Obstetricians and Gynaecologists (RCOG) and Royal College of Midwives note while getting flu is not a big deal for most people, getting the virus while you are pregnant can be serious for a small proportion of women and their babies. Flu can occasionally lead to stillbirth, maternal death and raise the chances of having a miscarriage. Dr Edward Morris, president of RCOG, said: “We are keen to reassure pregnant women that flu vaccination is safe for women to have at any stage in pregnancy - from the first few weeks right up to their due date, and while breastfeeding." "Over the last 10 years, the flu vaccine has been routinely and safely offered to pregnant women in the UK. The vaccine can also pass some protection to babies, which lasts for the first months of their lives." Read full story Source: The Independent, 12 October 2020 -
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Community PostWe should all strive to keep antibiotics working for our NHS surgeons and future generations, by decreasing antibiotic use in medicine. It is mums themselves who could dramatically decrease antibiotic use, in the only medical specialty where this is possible - in obstetrics - by keeping skin intact; by being informed of the 10cm diameter that 'Aniball' and 'Epi-no Delphine Plus' birth facilitating devices, the mechanical version of Antenatal Perineal Massage, achieve by skin expansion (much like by 'earlobe skin expanders') prior to birth, for back of baby's head. This enables a normal birth for many more babies by shortening birth, with no cutting (episiotomies) or tearing, and much fewer Caesarean sections, as each Caesarean section requires antibiotics to be injected into mum, to kill any bacteria, which might have invaded a skin cell, from being implanted with that skin cell, deep into the wall of the uterus, by the surgeon's knife. There are around 750,000 births in the UK alone and three-quarters of mums are damaged during birth and at risk of developing infection; so a dramatic decrease in antibiotic use is possible. Empowering mums with knowledge; that both the skin and the coats of the pelvic floor muscles, which form the floor of the lower tummy, can be stretched painlessly, in preparation of birth, from the 26th week of pregnancy, so a gentler, kinder birth for both baby and mum becomes possible by decreasing risky obstetric interventions. Muscle can be stretched to 3 times its original length, if stretched painlessly over 6 or more occasions, and still retains its ability to recoil back, contracting to its original length. So there is no damage to mum. Baby's delicate head is not used to achieve this 'birth canal widening', because Antenatal Perineal Massage or Aniball or Epi-no Delphine Plus have already achieved this prior to the start of birth. In birth this stretching is rushed within the last 2 hours of birth, with risk of avulsion of pelvic floor muscle fibres from the pubic bone and risk of skin tearing or the need for episiotomy. The overlying skin will likewise stretch without tearing if done over 6 or more occasions. The maximal opening in the outlet or lower part of the pelvis is 10cm diameter, so 10cm diameter is the goal of the birth aiding devices and 'Antenatal Perineal Massage' or 'Birth Canal Widening' - opening doors for baby maximally. The mother reviews on 'Aniball' and 'Epi-no Delphine Plus' are impressive: Wanda Klaman, a first time mum, gives birth at nearly 42 weeks to a 4.4kg baby, with no need for episiotomy or forceps; Sophie of London, avoids episiotomy, when forceps are used to aid delivery for her baby who lays across her tummy - transverse lay, because the skin at this opening is so stretchy thanks to the birth facilitating devices. Cochrane Collaborate Report on Antenatal Massage https://pubmed.ncbi.nlm.nih.gov/23633325/ https://www.dailymail.co.uk/news/article-7450045/Fears-infections-pandemic-grow-NINETEEN-new-superbugs-discovered-UK.html https://www.mirror.co.uk/news/uk-news/mistakes-maternity-wards-setting-nhs-22702909
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News ArticleCovid has brought many hidden tragedies: elderly residents in care homes bereft of family visits, families in quarantine missing loved one’s funerals, and mums forced to go through labour alone. Much of this has been necessary, however painful, but Jeremy Hunt fears we’re getting the balance badly wrong in maternity care. That’s why he is backing The Mail on Sunday’s campaign to end lone births, which has been championed in Parliament by Alicia Kearns. Infection control in hospitals is critically important, but mothers’ mental health can’t be pushed down the priority list. Imagine the agony of a new mum sent for a scan on her own, only to be told that her much longed-for baby has no heartbeat. Or the woman labouring in agony for hours who is told she is not yet sufficiently dilated to merit her partner joining her for moral support. "I have heard some truly heartbreaking stories, which quite frankly should have no place in a modern, compassionate health service. One woman who gave birth to a stillborn baby alone at 41 weeks; another woman who was left alone after surgery due to a miscarriage at 12 weeks," says Jeremy. Perhaps most concerningly of all, there are reports of partners being asked to leave their new babies and often traumatised mothers almost immediately after birth. That means they miss out on vital bonding time and mums lose crucial support to help them recover mentally and physically, in some cases with partners not allowed back to meet their new child properly for several days. "This is a question of basic compassion and decency – the very values that the NHS embodies and the reason we’re all so proud of our universal health service – so we need every hospital to commit to urgent action without delay." Read full story Source: MailOnline, 19 September 2020
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Content ArticleDuring the debate there were contributions from a range of parliamentarians reflecting on the First Do No Harm report and the implementation of its recommendations in Scotland. Some points of interest from the debate included: Jeane Freeman MSP indicated the intention of the Scottish Government to implement the recommendations of the First Do No Harm report which fall within its remit and powers. Their discussion about the report's recommendation that specialist centres should be set up to provide comprehensive treatment, care and advice for those affected by implanted mesh. While Jeane Freeman noted that a National Mesh Removal Service had been established in Glasgow last year, Neil Findlay MSP expressed concerns that the levels of coproduction involved in the design and delivery of this service were inadequate. Alison Johnstone MSP highlighted the particular impact of these issues on women and noted nthat the findings reflected the ways in which women are disadvantaged in accessed health and social care services. In her closing remarks Clare Haughey MSP, Minister for Mental Health, noted the intention to begin a consultation on the Scottish Government's proposal to introduce a Patient Safety Commissioner. Follow the link below for the full transcript.
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News ArticleA new study shows a quarter of mothers say their choices were not respected during childbirth, with some left with life-changing injuries as a result, despite Britain’s highest judges establishing women should be the primary decision makers during labour five years ago. A poll of 1,145 women, carried out by leading pregnancy charity Birthrights and shared exclusively with The Independent, also found that a third said healthcare professionals did not even seek their own opinions on the childbirth process, while 14& said their choices were overruled. One woman told The Independent she had been forced to give up her career as a lawyer following what she described as a “violent delivery”, while her baby daughter also sustained serious injuries to her face which can still be seen now – 12 years after she gave birth. Birthrights, which campaigns for respectful pregnancy care for women, pointed to the fact half a decade has passed since Nadine Montgomery’s Supreme Court case proved mothers-to-be are the primary decision-makers in their own care yet this is still not the reality for the majority of women. Read full story Source: The Independent, 3 September 2020
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News ArticlePregnant women in hospital with COVID-19 are less likely to show symptoms than non-pregnant women of similar age but may have an increased risk of admission to intensive care, a study published in The BMJ has found. Researchers from the UK, the US, Spain, China, Switzerland, and the Netherlands found that pregnant women with COVID-19 were also more likely to have a preterm birth and that their newborns were more likely to be admitted to a neonatal unit. Other factors that increased the risk of severe COVID-19 in these women included being older, being overweight, and having pre-existing medical conditions such as hypertension or diabetes. The authors concluded that healthcare professionals needed to be aware that pregnant women with COVID-19 might need access to intensive care and specialist baby care facilities and suggested that mothers with pre-existing comorbidities should be considered to be a high risk group for COVID-19, along with those who were obese or older. Read full story Source: BMJ, 2 September 2020
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Content ArticleWhat this means for healthcare professionals Based on existing data, healthcare professionals should be aware that pregnant and recently pregnant women with COVID-19 might manifest fewer symptoms than the general population, with the overall pattern similar to that of the general population. Emerging comparative data indicate the potential for an increase in the rates of admission to intensive care units and invasive ventilation in pregnant women compared with non-pregnant women. Mothers with pre-existing comorbidities will need to be considered as a high risk group for COVID-19, along with those who are obese and of greater maternal age. Clinicians will need to balance the need for regular multidisciplinary antenatal care to manage women with pre-existing comorbidities against unnecessary exposure to the virus, through virtual clinic appointments when possible. Pregnant women with COVID-19 before term gestation might need to be managed in a unit with facilities to care for preterm neonates.
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News ArticleA majority of pregnant women who died from coronavirus during the peak of the pandemic were from an ethnic minority background, it has emerged. A new study of more than a dozen women who died between March and May this year also heavily criticised the reorganisation of NHS services which it said contributed to poor care and the deaths of some of the women. This included one woman who was twice denied an intensive care bed because there were none available, as well as women treated by inexperienced staff who had been redeployed by hospitals and who made mistakes in their treatment of the women. The report, by experts at the National Perinatal Epidemiology Unit, based at the University of Oxford, also criticised mental health services after four women died by suicide. The report said women were “bounced” between services which had stopped face-to-face assessments during the crisis. The report looked at 16 women’s deaths in total. Eight women died from COVID-19, seven of whom had an ethnic minority background. Two women with Covid-19 died from unrelated causes, four died by suicide and two were victims of homicide. In the report, published on Thursday, the authors concluded improvements in care could have been made in 13 of the deaths they examined. In six cases, improvements in care could have meant they survived. Read full story Source: The Independent, 21 August 2020
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Content ArticleTake-home points Patient-related factors, cognitive errors, and systems factors are common categories of diagnostic errors, all three of which played a role in the failure to recognize that the patient in this case was in her third trimester of pregnancy and in early labor Communication among members of work teams is critical for avoiding perpetuation of cognitive errors Appropriate supervision of physician trainees is necessary to ensure high-quality patient care Diagnostic errors in the use obstetrical ultrasound can result from inadequate training and experience, and the lack of a systematic approach to examinations and interpretations; patient factors such as obesity can limit diagnostic detection of important findings.
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NHS rolls out additional support for pregnant BAME women
Patient Safety Learning posted a news article in News
After new analysis showed pregnant black women were eight times more likely and Asian women four times as likely to be admitted to hospital with COVID-19, the NHS is rolling out additional support for pregnant women of a Black, Asian and Ethnic Minority (BAME) background. Given evidence of the heightened risk to BAME expectant mums, urgent action is being taken in England including increasing uptake of Vitamin D and undertaking outreach in neighbourhoods and communities in their area. Research carried out by Oxford University has shown 55% of pregnant women admitted to hospital with coronavirus are from a BAME background, even though they represent only a quarter of the births in England and Wales. In response, England’s most senior midwife, Jacqueline Dunkley-Bent, has written to all maternity units in the country calling on them to take four specific actions to minimise avoidable COVID-19 risk for BAME women and their babies. The steps include: Increasing support of at-risk pregnant women – e.g. making sure clinicians have a lower threshold to review, admit and consider multidisciplinary escalation in women from a BAME background. Reaching out and reassuring pregnant BAME women with tailored communications. Ensuring hospitals discuss vitamins, supplements and nutrition in pregnancy with all women. Women low in vitamin D may be more vulnerable to coronavirus so women with darker skin or those who always cover their skin when outside may be at particular risk of vitamin D insufficiency and should consider taking a daily supplement of vitamin D all year. Ensuring all providers record on maternity information systems the ethnicity of every woman, as well as other risk factors, such as living in a deprived area (postcode), co-morbidities, BMI and aged 35 years or over, to identify those most at risk of poor outcomes. Read full story Source: NHE, 29 June 2020 -
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The Obs Pod, by obstetrician Florence Wilcock
PatientSafetyLearning Team posted an article in Maternity
Episodes: Beginnings Apprentice Flying Solo Detour Balance Night Shift Motherhood Part 1 Motherhood Part 2 Continuity Homebirth Caesarean Flexible Mistakes Dads Guidelines Hands on Postnatal Handover MindNBody Lithotomy Teacher Language 1 Language 2 Names Ally Baby Loss Awareness Week Names Click on the link below to access the full series. -
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Coronavirus: Risk higher for pregnant BAME women
Patient Safety Learning posted a news article in News
The high proportion of pregnant women from black and ethnic minority (BAME) groups admitted to hospital with COVID-19 "needs urgent investigation", says a study in the British Medical Journal. Out of 427 pregnant women studied between March and April, more than half were from these backgrounds - nearly three times the expected number. Most were admitted late in pregnancy and did not become seriously ill. Although babies can be infected, the researchers said this was "uncommon". When other factors such as obesity and age were taken into account, there was still a much higher proportion from ethnic minority groups than expected, the authors said. But the explanation for why BAME pregnant women are disproportionately affected by coronavirus is not simple "or easily solved," says Professor Knight, lead author. "We have to talk to women themselves, as well as health professionals, to give us more of a clue." Gill Walton from the Royal College of Midwives says, "Even before the pandemic, women from black, Asian or ethnic minority backgrounds were more likely to die in and around their pregnancy," She said they were "still at unacceptable risk" and getting help and support to affected communities was crucial. Ms Walton added: "The system is failing them and that has got to change quickly, because they matter, their lives matter and they deserve the best and safest care." Read full story Source: BBC News, 8 June 2020- Posted
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The group B Strep i-learn module
PatientSafetyLearning Team posted an article in Maternity
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