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Content ArticleThis 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.
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News Article
Women with poor mental health ‘have 50% higher risk of preterm birth’
Patient-Safety-Learning posted a news article in News
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 -
Content ArticleThe 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.
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Content ArticleThis 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.
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Content ArticleThis 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.
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News Article
‘A critical emergency’: America’s Black maternal mortality crisis
Patient Safety Learning posted a news article in News
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 -
Content ArticleThe 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.
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News Article
Government pledges better support for women who lose babies during pregnancy
Patient Safety Learning posted a news article in News
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 -
Content Article
A vision for improving the care and support available to families when baby loss occurs before 24 weeks' gestation. -
News ArticleThe 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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Content Article
This policy paper from the Department of Health and Social Care sets out the Government’s response to the recommendations of the Independent Investigation into East Kent Maternity services. -
News ArticleThe trust at the centre of a maternity scandal insists it has been providing immediate anaesthetic cover for obstetric emergencies, contrary to an NHS England report suggesting it had not and had been potentially breaching safety standards. Health Education England – now part of NHSE – visited William Harvey Hospital in March and was told senior doctors in training who were covering obstetrics could also be covering the cath lab – which deals with patients who have had a heart attack, and could receive trauma, paediatric emergency and cardiac arrest calls. This suggested the trust was in conflict with Royal College guidelines which state an anaesthetist should always be “immediately available” for obstetrics. East Kent Hospitals University Foundation Trust, which runs the hospital, originally told HSJ its rota had very recently been changed and that an anaesthetist with primary responsibility for maternity could leave any other work to attend to a maternity emergency immediately. However, it has since said it has been the case for a long time that an anaesthetist is available to return to maternity in case of an emergency. Read full story (paywalled) Source: HSJ, 17 June 2023
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News ArticleSoon after her son Jaxson was born, Lauren Clarke spotted that his eyes were yellow and bloodshot. “We kept asking if he had jaundice, but each time we were told to keep feeding him and just put Jaxson in front of a window,” she says. It was only when Clarke was readmitted six days later with an infection that Jaxson’s jaundice was detected by a midwife. By this time, his levels were becoming dangerously high. “We spent a further five days in hospital for Jaxson to be treated with light therapy and antibiotics. If I hadn’t had to go back to hospital, he could have died or had serious long-term health conditions,” she says. This week, the NHS race and health observatory will announce new funding for research into the efficacy of jaundice screening in black, Asian and minority ethnic newborns on the back of a recent report showing that tests to assess newborn babies’ health are not effective for non-white children. The research cannot come too soon. Jaxson’s aunt, Gemma Poole, a midwife from Nottingham, created her company, the Essential Baby Company, to develop resources and training about the specific needs of women and babies with black and brown skins, after Jaxson’s jaundice was initially missed by clinicians. Poole believes the trauma her nephew, brother and sister-in-law had to go through could have been avoided if health professionals had known better ways to spot jaundice in non-white babies. “The colour of gums, the soles of the feet and hands, the whites of eyes, how many wet and dirty nappies and if the baby is waking for feeds and alert could be more reliable indicators if a black or brown baby has jaundice,” she says. Read full story Source: The Guardian, 16 July 2023
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News Article
Maternity unit breached safety standards
Patient Safety Learning posted a news article in News
A trust at the centre of a maternity scandal has been failing to meet Royal College standards in one of its maternity units, HSJ can reveal. The duty anaesthetist for the maternity unit at the William Harvey Hospital in Ashford has also had to cover the hospital’s primary percutaneous coronary intervention suite. This could mean no anaesthetist is available to carry out an emergency Caesarean if they are needed to treat a heart attack patient. This goes against Royal College of Anaesthetists’ guidelines, which say a duty anaesthetist must be “immediately available for the obstetric unit 24/7”. The guidelines add that where the duty anaesthetist has other responsibilities – because, for example, they work at a smaller maternity unit where the workload does not justify them being there exclusively – then “these should be of a nature that would allow the activity to be immediately delayed or interrupted should obstetric work arise”. The William Harvey unit is East Kent Hospitals University Foundation Trust’s major birth centre. The trust has around 6,500 births a year – the majority at the WHH – and was heavily criticised for poor maternity care in a report by Bill Kirkup last year. Read full story Source: HSJ. 17 July 2023 -
News Article
Black maternal health in crisis across hemisphere, not just in USA
Patient Safety Learning posted a news article in News
Black women in the Americas bear a heavier burden of maternal mortality than their peers, but according to a report released Wednesday by the United Nations, the gap between who lives and who dies is especially wide in the world’s richest nation — the United States. Of the region’s 35 countries, only four publish comparable maternal mortality data by race, according to the report, which analyzed the maternal health of women and girls of African descent in the Americas: Brazil, Colombia, Suriname and the United States. And while the United States had the lowest overall maternal mortality rate among those four nations, the report said Black women and girls were three times more likely than their U.S. peers to die while giving birth or in the six weeks afterward. “The risk factor is racism,” said Joia Crear-Perry, an OB/GYN and founder of the National Birth Equity Collaborative, a nonprofit group dedicated to eliminating racial inequities in birth outcomes and one of the report’s co-sponsors. “This report drives this home over and over. When your pain is ignored, when your blood pressure is ignored, you die, and that happens across the Americas.” Read full story (paywalled) Source: The Washington Post, 12 July 2023 -
Content ArticleTests that indicate the health of newborns, moments after birth, are limited and not fit-for-purpose for Black, Asian and ethnic minority babies, and need immediate revision according to the NHS Race and Health Observatory.
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News Article
Baby died of brain injury after midwives ‘neglected’ mum while breastfeeding
Patient Safety Learning posted a news article in News
Olly Vickers died of a brain injury in February last year just weeks after two midwives at Royal Bolton Hospital let his mother Emma Clark feed him while she was having gas and air – in breach of guidelines. Despite being well when he was born, Olly was found “pale and floppy” hours later due to his airways being obstructed. He developed a brain injury and died five months later. Coroner Peter Sigee ruled his death was a result of “neglect” and due to a “gross failure to provide basic medical care”. An inquest into his death heard a student midwife placed a pillow under his mother’s arm while she was feeding him, “contrary to accepted practice”. Another midwife then gave Ms Clark gas and air while she was feeding Olly as she was stitched up for a tear obtained during labour – which again went against guidance. No risk assessment was carried out and the coroner said Olly’s breastfeeding should have been stopped before the midwives began to suture Ms Clark. Read full story Source: The Independent, 8 July 2023 -
News Article
Nottingham maternity review set to become UK's largest
Patient Safety Learning posted a news article in News
A review into failings in maternity care in hospitals in Nottingham is set to become the largest in the UK, the BBC understands. Donna Ockenden, chair of the inquiry, is expected to announce that 1,700 families' cases will be examined. She was in charge of the probe into services in Shropshire, which found at least 201 babies and mothers might have survived had they received better care. The review comes after dozens of baby deaths and injuries in Nottingham and focuses on the maternity units at the Queen's Medical Centre and City Hospital. So far, 1,266 families have contacted the review team themselves directly and to date, 674 of these have given consent to join it. But Ms Ockenden has called for a "radical review" to ensure "women from all communities" were being contacted by the trust and "felt confident" to come forward. Read full story Source: BBC News, 10 July 2023 -
Content ArticleNHS Resolution has launched its first eLearning module that focuses on learning from the significant avoidable harm that can occur during antenatal and postnatal care and is seen in the cases notified to its Early Notification Scheme. This free resource is designed to support clinicians working in maternity services. The module uses three illustrative case stories to immerse learners into the antenatal, intrapartum and postnatal care provided to mothers and the neonatal care provided to their babies. It aims to deepen learners' understanding of NHS Resolution’s role within the healthcare system, develop their understanding of the law of negligence as applied to clinical claims and explore how clinical decisions and actions can lead to avoidable harm. The module takes approximately two-and-a-half hours to complete and can be used as evidence of CPD hours undertaken for revalidation.
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News ArticleNearly half of all NHS hospital maternity services covered so far by a national inspection programme have been rated as substandard, the Observer can reveal. The Care Quality Commission (CQC), which regulates health and care providers in England, began its maternity inspection programme last August after the Ockenden review into the Shropshire maternity scandal, which saw 300 babies left dead or brain damaged by inadequate NHS care. Of the services inspected under the programme, which focuses on safety and leadership, about two-thirds have been found to have insufficient staffing, including some services that were rated as good overall. Eleven services saw their rating fall from their previous inspection. Dr Suzanne Tyler of the Royal College of Midwives said: “Report after report has made a direct connection between staffing levels and safety, yet the midwife shortage is worsening. Midwives are desperately trying to plug the gaps – in England alone we estimate that midwives work around 100,000 extra unpaid hours a week to keep maternity services safe. This is clearly unsustainable and now is the time for the chancellor to put his hand in the Treasury pocket and give maternity services the funding that is so desperately needed.” Read full story Source: The Guardian, 9 July 2023
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News Article
US maternal deaths doubled in last 20 years, study finds
Patient Safety Learning posted a news article in News
Maternal mortality rates have doubled in the US over the last two decades - with deaths highest among black mothers, a new study suggests. American Indian and Alaska Native women saw the greatest increase, the study in Journal of the American Medical Association (JAMA) said. Southern states had the highest maternal death rates across all race and ethnicity groups, the study found. In 1999, there were an estimated 12.7 deaths per 100,000 live births and in 2019 that figure rose to 32.2 deaths per 100,000 live births in 2019, according to the research, which did not study data from the pandemic years. Unlike other studies, this one examined disparities within states instead of measuring rates at the national level, and it monitored five racial and ethnic groups. Dr Allison Bryant, one of the study's authors, said the findings were a call to action "to understand that some of it is about health care and access to health care, but a lot of it is about structural racism". She said some current policies and procedures "may keep people from being healthy". Read full story Source: BBC News, 4 July 2023 -
Content ArticleEvidence suggests that maternal mortality has been increasing in the US. Comprehensive estimates do not exist. Long-term trends in maternal mortality ratios (MMRs) for all states by racial and ethnic groups were estimated. The objective of this study was to quantify trends in MMRs (maternal deaths per 100 000 live births) by state for five mutually exclusive racial and ethnic groups using a bayesian extension of the generalised linear model network. The study found that while maternal mortality remains unacceptably high among all racial and ethnic groups in the US, American Indian and Alaska Native and Black individuals are at increased risk, particularly in several states where these inequities had not been previously highlighted. Median state MMRs for the American Indian and Alaska Native and Asian, Native Hawaiian, or Other Pacific Islander populations continue to increase, even after the adoption of a pregnancy checkbox on death certificates. Median state MMR for the Black population remains the highest in the US. Comprehensive mortality surveillance for all states via vital registration identifies states and racial and ethnic groups with the greatest potential to improve maternal mortality. Maternal mortality persists as a source of worsening disparities in many US states and prevention efforts during this study period appear to have had a limited impact in addressing this health crisis.
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Content ArticleSince retiring from his role in public health, Dr Bill Kirkup has focused on independent investigations into public service failures, including maternity services at Morecambe Bay and East Kent. In this podcast, Bill talks to Parliamentary and Health Service Ombudsman Rob Behrens about his career, what he's learnt during his investigations and how we can make more progress in improving patient safety.
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News Article
Ministers refuse to set target for ending maternal deaths disparity
Patient Safety Learning posted a news article in News
The government has rejected calls to set a target and strategy to end ‘appalling’ disparities in maternal deaths. In response to a Commons women and equalities committee report, published on Friday, ministers said a “concrete target does not necessarily focus resource and attention through the best mechanisms”. The response added: “We do not believe a target and strategy is the best approach towards progress.” The government said disparities will be monitored through local maternity and neonatal systems, which are partnerships comprising commissioners, providers and local authorities. A recommendation to increase the annual budget for maternity services to up to £350m per year, backed by the now chancellor Jeremy Hunt, and maternity investigator Donna Ockenden, was also rejected. Read full story Source: HSJ, 3 July 2023 -
News Article
Sight-saving drug to be offered to premature babies, announces NHS
Patient Safety Learning posted a news article in News
Premature babies across England will be offered a sight-saving drug, the NHS has announced. Retinopathy of prematurity (ROP) is an eye disease that can occur among babies who are born early or those born with a low birth weight. The NHS routinely screens these babies for the condition, which affects blood vessels in the retina, creating damaging scar tissue and causing blindness. Traditionally the condition is treated with laser eye surgery but some babies are too unwell or fragile to have the treatment. Now the NHS is offering new “life-changing” drug ranibizumab to babies with ROP across England who are unable to receive traditional treatment. NHS chief executive Amanda Pritchard said: “The impacts of vision loss can be absolutely devastating, particularly for children and young people, so it’s fantastic that this treatment will now give families across the country another life-changing option to help save their child’s precious sight." Read full story Source: The Independent, 4 July 2023
