In a review of 78 babies who died during or shortly after childbirth in 2015, but were alive at the onset of labour, researchers found in nearly 80% of deaths, improvements in care may have made a difference to the outcome for the baby.
In total, 225 babies died in 2015 due to intrapartum (death occurring during the act of birth) stillbirth and intrapartum-related neonatal death.
A team of academics, clinicians and charity representatives, called MBRRACE-UK, said that while the number of intrapartum-related deaths has more than halved since 1993, there needs to be more improvements in care.
Professor Elizabeth Draper, professor of perinatal and paediatric epidemiology at University of Leicester explained: “The main issues identified were care before labour (including induction), monitoring during labour, delay in expediting birth, heavy workload of the units, a lack of joint obstetric and neonatal input into bereavement care and a lack of rigour in the local review of the deaths.”
In the report, MBRRACE-UK looked at the quality of care for intrapartum-related deaths, where the babies were alive at the onset of labour.
All babies were singletons (sole births) and were not affected by a major congenital anomalies.
In the sample of 78 babies, the care provided for these mothers and babies was reviewed against national care guidelines by a panel of clinicians, including midwives, obstetricians, neonatologists, neonatal nurses and pathologists.
Poor “service capacity” (volume that staff could handle while maintaining standards of quality) affected over a fifth of the deaths reviewed.
The report found “heavy workload” contributed to delays in induction in one third of cases being induced.
There was a significant delay in both the decision to expedite the birth (speed up the process) and in actually achieving birth in approximately a third of the deaths reviewed.
There was also a failure to recognise the transition to the active phase of labour and to begin appropriate monitoring in one-eighth of cases.
MBRRACE-UK found there were errors in the “method, interpretation, escalation and response” to foetal monitoring during labour: Two fifths of babies had “intermittent auscultation” (previous form of foetal monitoring), which was “not compliant with national guidance”.
The researchers found that “for most cases”, resuscitation was delivered effectively by clinical staff present at the delivery.
The team concluded: “overall the quality of bereavement care was variable, with a lack of joint obstetric and neonatal input”.
Although the majority (95%) of intrapartum-related deaths were reviewed, many of the reviews were found to be “lacking in quality”.
Professor Sara Kenyon, professor of evidence-based maternity care at the University of Birmingham and joint author of the report said that while it is good that the number of babies who die has fallen, there remain problems with the quality of care, which need to be addressed.
“The forthcoming introduction of a national standardised tool to support staff reviewing perinatal death in their Trusts is an important step forward,” she said.
“If we learn the lessons and implement the changes the report has highlighted, the numbers of babies like this that die should reduce.”
Responding to the report, Dr David Evans, consultant neonatologist and vice president for training and assessment at the Royal College of Paediatrics and Child Health (RCPCH) agreed that we should focus on what else needs to be done to prevent the deaths that do occur.
“Perhaps most concerning is the finding that service capacity affected over a fifth of deaths reviewed,” he said.
“Heavy workloads are cited as contributing to delays in induction in a third of women, which can have devastating effects for the unborn child.
“Neonatal units have a strict set of services standards in place in order to protect their vulnerable patients, but the RCPCH knows from its own surveys that many units fail to meet these standards due to workforce pressures.
“Standards will only be met, and the quality of care driven up, with investment in staff. Government must look at this with urgency. The lives of many babies could be saved as a result.”
Gill Walton, chief executive and general secretary at the Royal College of Midwives (RCM) added: “We must ensure we have enough midwives and obstetricians to provide safe care throughout the maternity pathway and adequate facilities in all birth settings.”