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News ArticleMylissa Farmer’s pregnancy was doomed. But no one would help her end it. Over the course of a few days in August 2022, Farmer visited two hospitals in Missouri and Kansas, where doctors agreed that because the 41-year-old’s water had broken just 18 weeks into her pregnancy, there was no chance that she would give birth to a healthy baby. Continuing the pregnancy could risk Farmer’s health and life – yet the doctors could not act. Weeks earlier, the US supreme court had overturned Roe v Wade and abolished the national right to abortion. It was, legal counsel at one hospital determined, “too risky in this heated political environment to intervene”, according to legal filings. In immense pain and anguish, Farmer ultimately traveled several hours to Illinois, where abortion is legal. There, doctors were able to end her pregnancy. Farmer’s account is detailed in a legal complaint she filed against the hospitals, arguing that they broke a federal law that requires hospitals to treat patients in medical emergencies. In a first-of-its-kind investigation, the US government sided with Farmer and declared that the two hospitals had broken the law. The future of the government’s ability to invoke that law to protect women seeking emergency abortions is now in question. The law, the Emergency Medical Treatment and Labor Act (Emtala), is at the heart of the US supreme court’s latest blockbuster abortion case, which comes out of Idaho. Read full story Source: The Guardian, 9 January 2024
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Content ArticleThe maternal mortality rate (MMR) in the United States continues to increase despite medical advances and is exacerbated by stark racial disparities. Black women are disproportionately affected and are three times more likely to experience a pregnancy-related death (PRD) compared to Non-Hispanic White (NHW) women. Keisha E. Montalmant and Anna K. Ettinger carried out a literature review to examine the racial disparities in the United States' MMR, specifically among pregnant Black women. The review highlights that maternal health disparities for Black women are further impacted by both structural racism and racial implicit biases. Cultural competence and educational courses targeting racial disparities among maternal healthcare providers (MHCP) are essential for the reduction of PRDs and pregnancy-related complications among this target population. Additionally, quality and proper continuity of care require an increased awareness surrounding the risk of cardiovascular diseases for pregnant Black women.
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Content ArticleThe Professional Standards Regulatory Body are holding a series of webinars in January 2024 designed for professionals working in or with maternity services where they will review the updated Digital Maternity Record Standard. Each session will focus on different aspects of maternity care. Having access to the right information at the right time helps professionals make decisions for safer, more personalised care and supports people using services to manage their own information. Health and care professionals, organisations that support people during and after pregnancy, IT system suppliers and people who use maternity services are welcome at these sessions. Find out more about the sessions and how to sign up via the link below.
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Content Article
If you’ve recently used maternity services, or if you’re pregnant at the moment, the Professional Records Standards Body (PRSB) would like to invite you to join one of their online workshops in January 2024. Each session will last no longer than 1 hour 30 minutes and you’ll receive a £25 shopping voucher to thank you for your time if you attend. The PRSB are working with the NHS to improve how information about your health is recorded and shared during your pregnancy and after your baby has been born. This could include information about treatment or advice you’ve received, tests and scans you’ve had or decisions you’ve made about your maternity care. Find out more about the project, and how to book onto a workshop via the link below. -
Content ArticleProblems in intrapartum electronic fetal monitoring with cardiotocography (CTG) remain a major area of preventable harm. Poor understanding of the range of influences on safety may have hindered improvement. Taking an interdisciplinary perspective, authors of this study, published in BMJ Quality and Safety, sought to characterise the everyday practice of CTG monitoring and the work systems within which it takes place, with the goal of identifying potential sources of risk.
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News Article
GPs to offer more mental health support for mothers in England after giving birth
Patient Safety Learning posted a news article in News
Mothers in England will be asked in detail if pregnancy or giving birth has affected their mental health as a result of new NHS guidance to GPs. The move is part of a drive by NHS England to improve support for women suffering postnatal depression or other mental health problems linked to their pregnancy or childbirth. Under the new guidance GPs will ask women more questions than before about how they are feeling when they attend their postnatal health check six to eight weeks after giving birth. Family doctors will look for any sign that the woman may have a condition such as postnatal PTSD as a result of experiencing a traumatic birth or psychosis induced by bearing a child. Anyone who the GP feels needs help with their mental wellbeing will be referred to specialist maternal mental health services, which have been expanded in recent years. Read full story Source: The Guardian, 18 December 2023 -
Content ArticleSince the launch of the national Perinatal Mortality Tool (PMRT) in early 2018, over 23,000 reviews have been started. This fifth annual report presents the findings for reviews completed from March 2022 to February 2023 coinciding with the third year of the global health emergency due to the COVID-19 virus.
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News Article
NHSE warns widely used EPR could pose ‘serious risks to patient safety’
Patient Safety Learning posted a news article in News
NHS England has issued a national alert to all trusts providing maternity services after faults were discovered in IT software that could pose “potential serious risks to patient safety”. According to the alert, the Euroking electronic patient record provided by Magentus Software could be displaying incorrect patient information to clinicians. The Euroking EPR is used in the maternity departments of at least 15 trusts according to information held by HSJ. These organisations have been asked to “consider if Euroking meets their maternity service’s needs” and to “ensure their local configuration is safe”. Trusts with different maternity EPR providers have also been asked to reassess the clinical safety of their solutions. The potential “serious risks” relate to a fault in the Euroking EPR which allows new patient information to overwrite previously recorded information, which could lead to “incorrect management of the pregnancy and subsequent harm”. Read full story (paywalled) Source: HSJ, 8 December 2023 -
Content ArticlePotential serious risks to patient safety have been identified with the use of Magentus Software Limited’s Euroking maternity information system. These concern specific data fields: certain new patient information, recorded during a patient contact, can overwrite ('back copy') information previously recorded in the patient’s pregnancy record. certain pregnancy-level data (information relevant only to a specific pregnancy event) can be saved at a patient level (where information relevant throughout a person's life is recorded), causing new information to overwrite (‘back copy’) previously recorded data across an entire patient record. certain recorded pregnancy-level data can pre-populate into new pregnancy records (‘forward copy’), which can mean clinicians will see incorrect patient information, and attempts to correct this can result in the issue described at (ii) above.
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News ArticlePregnant women have been urged to get vaccinated following a spike in suspected whooping cough cases in England and Wales. Official figures show doctors reported some 716 suspected cases between July and November - up from 217 in the previous period last year. Whooping cough, or pertussis, is a bacterial infection of the lungs and breathing tubes that spreads easily and infected tens of thousands of people before vaccines were introduced. It is easily preventable, experts say, but can sometimes cause serious problems for babies and children. Dr Gayatri Amirthalingam, consultant epidemiologist at the UKHSA, said the rise in suspected cases of whooping cough was “expected” due to low immunity as a result of the Covid pandemic. Despite vaccinations being available in the UK the infection hasn’t gone away “completely” but immunisation can provide “life-long protection”. “Social distancing and lockdown measures imposed across the UK during the COVID-19 pandemic had a significant impact on the spread of infections, including whooping cough,” Dr Amirthalingam added. “As expected, we are now seeing cases of whooping cough increase again so it’s vital pregnant women ensure they get vaccinated to protect their baby.” Read full story Source: The Independent, 7 December 2023
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News Article
Huge delays to access maternal mental health care in England called a scandal
Patient_Safety_Learning posted a news article in News
NHS figures obtained by Labour reveal 11,507 women sought care but did not get any last year. Almost 20,000 women a year living with mental health problems triggered by being pregnant or giving birth are being denied support by the NHS, the Guardian can reveal. Furthermore, those who do receive mental health help for their trauma are having to wait up to 19 months to start treatment in some parts of England because specialist services are so overstretched. The situation has been described as “an absolute scandal” and sparked warnings that “rationing” of such vital care could leave women who do not get it in a very vulnerable state and risk their children facing lifelong health problems and stop mothers bonding with their baby. Read full story Source: Guardian, 5 December 2023 -
News ArticleNewborn babies could be at a higher risk of a deadly bacterial infection carried by their mothers than previously thought. Group B Strep or GBS is a common bacteria found in the vagina and rectum which is usually harmless. However, it can be passed on from mothers to their newborn babies leading to complications such as meningitis and sepsis. NHS England says that GBS rarely causes problems and 1 in 1,750 babies fall ill after contracting the infection. However, researchers at the University of Cambridge have found that the likelihood of newborn babies falling ill could be far greater. They claim one in 200 newborns are admitted to neonatal units with sepsis caused by GBS. Pregnant women are not routinely screened for GBS in the UK and only usually discover they are carriers if they have other complications or risk factors. Jane Plumb, co-founded charity Group B Strep Support with her husband Robert after losing their middle child to the infection in 1996. She said: “This important study highlights the extent of the devastating impact group B Strep has on newborn babies, and how important it is to measure accurately the number of these infections. “Inadequate data collected on group B Strep is why we recently urged the Government to make group B Strep a notifiable disease, ensuring cases would have to be reported. “Without understanding the true number of infections, we may not implement appropriate prevention strategies and are unable to measure their true effectiveness.” Read full story Source: The Independent, 29 November 2023 Further reading on the hub: Leading for safety: A conversation with Jane Plumb, Founder of Group B Strep Support
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Content ArticleThe MHRA is asking organisations to put a plan in place to implement new regulatory measures for sodium valproate, valproic acid and valproate semisodium (valproate). This follows a comprehensive review of safety data, advice from the Commission on Human Medicines and an expert group, and liaison with clinicians and organisations. This alert is for action by: Integrated Care Boards (in England), Health Boards (in Scotland), Health Boards (in Wales), and Health and Social Care Trusts (in Northern Ireland).
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News Article“Gut-wrenching,” says Lisa McManus. She is looking for words to describe how she and other thalidomide survivors feel ahead of a historic apology by Anthony Albanese for government failings in the tragedy. She is grateful for recognition of the medical disaster and relieved that a decade of advocacy has come to fruition. Around 80 of the 146 recognised survivors will witness the apology in Canberra on Wednesday in what McManus hopes will be “a step in the healing process”. But she is also frustrated that too many others have not lived to see the day. Thalidomide caused birth defects including “shortened or absent limbs, blindness, deafness or malformed internal organs”, according to the Department of Health. The drug was not tested on pregnant women before approval, and the birth defect crisis led to greater medical oversight worldwide, including the creation of Australia’s Therapeutic Goods Administration. Survivors and independent reports have criticised the government of the day for not acting sooner to remove thalidomide from shelves when problems became apparent. McManus leads Thalidomide Group Australia, having lobbied governments for a decade for an apology and better support. She’s “extremely grateful” for the apology, and says many survivors are anxious, excited and nervous – but that the apology itself can’t be the end. “I’m relieved it’s happening, I just can’t say ‘thank you’,” McManus says. “I’m very happy to think it’s here, but it won’t fix things, and I don’t want the government thinking they will deliver this and it’ll all be fine.” Read full story Source: The Guardian, 28 November 2023
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Content ArticleThe latest Care Quality Commission (CQC) report on the state of care in England is far from an encouraging read.1 Although the healthcare system is under serious strain, maternity services are among the areas identified as especially challenged. The problems identified in maternity care, while shocking, come as no surprise. The sector is seeing repeated high profile organisational failures and soaring clinical negligence claims, together with grim evidence of ongoing variation in outcomes, culture, and workforce challenges and inequities linked to socioeconomic status and ethnicity. In this BMJ Editorial, Mary Dixon-Woods and colleagues discuss why it's time for a fresh approach to regulation and improvement.
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News Article
Black babies in England three times more likely to die than white babies
Patient Safety Learning posted a news article in News
Black babies in England are almost three times more likely to die than white babies after death rates surged in the last year, according to figures that have led to warnings that racism, poverty and pressure on the NHS must be tackled to prevent future fatalities. The death rate for white infants has stayed steady at about three per 1,000 live births since 2020, but for black and black British babies it has risen from just under six to almost nine per 1,000, according to figures from the National Child Mortality Database, which gathers standardised data on the circumstances of children’s deaths. Infant death rates in the poorest neighbourhood rose to double those in the richest areas, where death rates fell. The mortality for Asian and Asian British babies also rose, by 17%. The annual data shows overall child mortality increased again between 2022 and 2023, with widening inequalities between rich and poor areas and white and black communities. Most deaths of infants under one year of age were due to premature births. Karen Luyt, the programme lead for the database and a professor of neonatal medicine at Bristol University, said many black and minority ethnic women were not registering their pregnancies early enough and the “system needs to reach them in a better way”. “There’s an element of racism and there’s a language barrier,” Luyt said. “Minority women often do not feel welcome. There’s cultural incompetence and our clinical teams do not have the skills to understand different cultures.” Read full story Source: The Guardian, 9 November 2023 -
Content ArticleTrust boards’ regular oversight of the quality and safety of maternity and neonatal services has been the subject of successive inquiries and reviews. In this report, the Sands and Tommy’s Joint Policy Unit review publicly available board papers and minutes for seven NHS Trusts in England. They analyse whether the information presented to boards, the process for review, and actions taken enabled boards to deliver effective oversight over the safety and quality of maternity and neonatal services.
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Content ArticleReducing inequalities in maternal health care in England is an important policy aim. One part of achieving that is to ensure that women from Black, Asian and minority ethnic communities, as well as women from the most deprived areas, see the same midwife or midwifery team throughout their pregnancy and postnatal period. Emma Dodsworth takes a closer look at the data to reveal what progress is being made on this.
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News Article
Woman stored baby’s remains in fridge after London hospital refused them
Patient Safety Learning posted a news article in News
A London hospital has launched an investigation after a woman whose baby died in the womb had to deliver her son at home due to lack of beds and keep his remains in her fridge when A&E staff said they could not store them safely. Laura Brody and her partner, Lawrence, said they were “tipped into hell” after being sent home by university hospital Lewisham to await a bed when told their baby no longer had a heartbeat but no beds were immediately available to give birth, the BBC reported. Two days later, after waking up in severe pain, Brody, who was four months into her pregnancy, gave birth in agony on the toilet in their bathroom. “And it was then,” she told the broadcaster, “I saw it was a boy”. The couple, who wanted investigative tests to be carried out at a later time, dialled 999 but were told it was not an emergency. They wrapped their baby’s remains in a wet cloth, placed him in a Tupperware box, and went to A&E where they were told to wait in the general waiting room, they said. She was eventually taken into a bay and told she would require surgery to remove the placenta. But, with the waiting room hot and stuffy and staff refusing to store the remains or even look inside the Tupperware box, they decided as it got to midnight they had no option but for her partner to take their baby’s remains home. Brody said the whole experience “felt so grotesque”. “When things go wrong with pregnancy there are not the systems in place to help you, even with all the staff and their experts – and they are working really hard – the process is so flawed that it just felt like we had been tipped into hell,” she told Radio 4’s Today programme. The case is said to have raised wider concerns among campaigners who argue that miscarriage care needs to be properly prioritised within hospitals including A&E. Read full story Source: The Guardian, 30 May 2022 -
News Article
'I was repeatedly ignored' - report finds maternity racism
Patient Safety Learning posted a news article in News
Black and Asian women are being harmed by racial discrimination in maternity care, according to an inquiry. The year-long investigation into "racial injustice" was conducted by the charity Birthrights. Women reported feeling unsafe, being denied pain relief, facing racial stereotyping about their pain tolerance, and microaggressions. The government has set up a taskforce to tackle racial disparities in maternity care. Hiral Varsani says she was traumatised by her treatment during the birth of her first child. The 31-year-old from north London developed sepsis - a potentially life-threatening reaction to an infection - after her labour was induced, which she says was only spotted after a long delay. "I was shivering, my whole body was aching, my heart was beating really fast and I felt terrible. But everyone kept saying everything was normal," she says. "It was almost 24 hours later before a doctor took my bloods for the first time and realised I was seriously ill." She believes her race played a role in her care: "I experienced microaggressions and was stereotyped because of the colour of my skin. "I was repeatedly ignored, they just thought I was a weak little Indian girl, who was unable to take pain." While death in pregnancy or childbirth is very rare in the UK, there are stark racial disparities in maternal mortality rates. Black women are more than four times more likely to die in pregnancy or childbirth than white women in the UK, while women from Asian backgrounds face almost twice the risk. Read full story Source: BBC News, 23 May 2022 -
News Article
Blackpool death: Abortion sepsis risk training inadequate
Patient Safety Learning posted a news article in News
Doctors are receiving "inadequate" training about the risk of sepsis after a mother-of-five died following an abortion, a coroner has warned. Sarah Dunn, 31, died of "natural causes contributed to by neglect" in hospital on 11 April 2020, an inquest found. Assistant coroner for Blackpool and Fylde, Louise Rae, said Ms Dunn had been treated as a Covid patient even though the "signs of sepsis were apparent". Her cause of death was recorded as "streptococcus sepsis following medical termination of pregnancy". In her record of inquest, the coroner noted Ms Dunn was admitted to Blackpool Victoria Hospital in Lancashire on 10 April 2020. She was suffering from a streptococcus infection caused by an early medical abortion on 23 March, which had produced sepsis and toxic shock by the time she was admitted to hospital. The coroner said "signs of sepsis were apparent" before and at the time of Ms Dunn's hospital admission but she was instead treated as a Covid-19 patient. "Sepsis was not recognised or treated by the GP surgery, emergency department or acute medical unit and upon Sarah's arrival at hospital, the sepsis pathway was not followed," she added. Read full story Source: BBC News, 19 May 2022 -
News ArticleWomen and babies in the UK are “dying needlessly” because of a lack of suitable medicines to use in pregnancy, according to a report that calls for a radical overhaul of maternal health. A “profound” shortage of research and the widespread exclusion of pregnant and breastfeeding women from clinical trials means hardly any new drugs are approved for common medical problems in pregnancy or soon after childbirth, the report finds. Meanwhile, scarce or contradictory information about the safety of existing medicines women may be taking for continuing conditions can make it impossible to reach a confident decision on whether or not to continue them in pregnancy, the experts add. “While pregnancy in the UK is generally considered safe, women and babies are still dying needlessly as a direct result of preventable pregnancy complications,” the authors say. Each year, 5,000 babies in the UK are either stillborn or die shortly after birth, while about 70 women die of complications in pregnancy. The Healthy Mum, Healthy Baby, Healthy Future report draws on evidence from patient groups, clinicians, researchers, lawyers, insurance specialists and the pharmaceutical industry, it proposes “urgent” changes to transform women’s access to modern medicine. The report highlights the “profound lack of research activity” and up-to-date information that leaves pregnant women and their physicians in the dark about whether to continue with certain medicines in pregnancy. Some epilepsy drugs, for example, can increase the risk of birth defects, but coming off them can put the woman at risk of severe seizures, which can also harm the baby. Lady Manningham-Buller said the situation “urgently needs to change”, with the report setting out eight recommendations to prevent needless deaths. Read full story Source: The Guardian, 12 May 2022
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News Article
Senegal midwives convicted over mother's death
Patient Safety Learning posted a news article in News
Three Senegalese midwives involved in the death of a woman in labour have been found guilty of not assisting someone in danger. They received six-month suspended sentences, after Astou Sokhna died while reportedly begging for a Caesarean. Her unborn child also died. Three other midwives who were also on trial were not found guilty The case caused a national outcry with President Macky Sall ordering an investigation. Mrs Sokhna was in her 30s when she passed away at a hospital in the northern town of Louga. During her reported 20-hour labour ordeal, her pleas to doctors to carry out a Caesarean were ignored because it had not been planned in advance, local media reported. The hospital even threatened to send her away if she kept insisting on the procedure, according to the press reports. Her husband, Modou Mboup, who was in court, told the AFP news agency that bringing the case to light was necessary. "We highlighted something that all Senegalese deplore about their hospitals," "If we stand idly by, there could be other Astou Sokhnas. We have to stand up so that something like this doesn't happen again." Read full story Source: BBC News, 11 May 2022 -
News Article
Covid vaccines are ‘safe for pregnant women and cut stillbirth risk’, study says
Patient Safety Learning posted a news article in News
Covid-19 vaccines are safe for pregnant women to take and can even reduce the risk of stillbirths, according to a new study. Researchers at St George’s University of London and the Royal College of Obstetricians and Gynaecologists collated data from studies and trials involving over 115,000 vaccinated pregnant women. They found that pregnant women – who are more likely to become serious ill if they catch Covid-19 – are 15% less at risk of stillbirth if vaccinated. “We wanted to see if vaccination was safe or not for pregnant women,” said Asma Khalil, professor of obstetrics and maternal fetal medicine at London’s St George’s Hospital in London to The Guardian. “It is safe, but what’s surprising, and it’s a positive finding, is that there was a reduction in stillbirths.” “So far, most of the data on vaccines in pregnancy have been about protecting the pregnant woman herself from Covid. Now we have evidence that the vaccines protect the baby too,” she added. Read full story Source: The Independent, 10 May 2022 -
News Article
Baby death mother 'was not seen by obstetrician'
Patient Safety Learning posted a news article in News
A woman whose baby died after sustaining severe brain damage during labour was not seen by an obstetrician during her pregnancy, an inquest heard. It meant his mother Eileen McCarthy was unable to discuss her birthing options. Walter German was starved of oxygen during a long labour at the Royal Sussex County Hospital in Brighton. Lawyers at Fieldfisher are pursuing a civil negligence case, claiming a C-section should have been offered due to a previous third-degree tear. Walter was born in December 2020. His life-support was turned off after nine days, as his injuries were unrecoverable. Recording a narrative verdict, coroner Sarah Clarke said Walter died as a result of his brain being starved of oxygen, likely due in part to an umbilical cord obstruction. She said: "Walter's mother was not seen by an obstetrician during her pregnancy and this led to her being unable to discuss birth options regarding delivery given her previous third degree tear. "Walter's mother was in the advanced stages of labour for a prolonged period of time with an indication for an earlier obstetric review being apparent." Read full story Source: BBC News, 4 May 2022
