Saving Babies' Lives - a care bundle for reducing stillbirth

On 21 March 2016 NHS England published 'Saving Babies' Lives – a care bundle for reducing stillbirth' to provide support and guidance to reduce stillbirths. It has been developed with input from organisations including the Royal College of Obstetricians and Gynaecologists (RCOG), the Royal College of Midwives, the British Maternal and Fetal Medicine Society, and SANDS, the stillbirth and neonatal death charity.

Currently, more than 3,000 babies are born stillborn in the UK, one of the highest rates in the developed world. The aim is for the NHS to halve the rates of stillbirths by 2030, with a 20% reduction by 2020. It follows the recent publication of the MBRRACE-UK (Mothers and Babies: Reducing Risk through Audits and Confidential Enquiries across the UK) enquiry which highlighted 4 key areas to prevent stillbirth as follows:

• screening for gestational diabetes
• monitoring fetal growth
• managing reduced fetal movements
• improving learning from high quality review of deaths

The Saving Babies' Lives care bundle aims to build on this, and focuses on the 4 following factors to reduce stillbirth and early neonatal death. The features are:

• Reducing smoking in pregnancy
   
  • by carrying out carbon monoxide testing at antenatal booking appointments to identify smokers or those exposed to tobacco smoke and making a referral to a stop smoking service/specialist
     
• Risk assessment and surveillance for fetal growth restriction
   
  • to use an algorithm and risk assessment tool to assist decision making on classification of risk – low risk, increased risk, high risk
     
• Raising awareness of reduced fetal movement
   
  • encouraging women to be aware of and report reduced fetal movement
     
• Effective fetal monitoring during labour
   
  • all staff who care for women in labour will be required to have annual training and assessment on cardiotocograph (CTG) interpretation and the use of intermittent auscultation. There is also discussion of a 'buddy' system for review of interpretation where there are concerns regarding the CTG, and protocols for escalation.

It is the last of these which, in my opinion, is the most important, not least because of the devastating consequences that can arise if appropriate monitoring is not put in place. Stillbirth is one tragic outcome, but if a baby survives following a difficult labour, other injuries can occur, including brain damage in the form of hypoxic ischaemic encephalopathy (HIE), leading to severe cognitive and physical disabilities, and which require ongoing, lifelong support.

I am currently acting for a number of families who have been affected by both stillbirth and brain damage as a result of poor care. Some of these are being investigated by Coroners who have decided to hold inquests to identify the circumstances of the death. Almost all of my cases involve aspects identified in both of the reports referred to above, including a failure to identify and act on risk factors such as gestational diabetes, failing to take account of mum's concerns regarding reduced fetal movements, and delays in responding to a suspicious CTG trace, resulting in a poor outcome. I hope that the recommendations in the most recent publication are implemented and acted on as soon as possible to improve standards.

References

https://www.england.nhs.uk/ourwork/futurenhs/mat-review/saving-babies/
https://www.npeu.ox.ac.uk/mbrrace-uk/reports
https://www.sands.org.uk/