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EventuntilDespite the NHS’s global reputation for safe childbirth, efforts to uphold exceptional maternity care standards persist. With a substantial increase in the annual maternity budget by ￡165 million since 2021, the focus remains on strengthening the maternity workforce and advancing neonatal care. This webinar hosted by GovConnect looks at disparities in maternal healthcare. Key Objectives: Understanding the significance of equity and equality in maternity and neonatal care. Acknowledging the influence of cultural norms on pregnancy and childbirth. Tackling disparities in accessing prenatal care and maternal health services among different communities. Fostering inclusivity and cultural competency within healthcare settings to better serve diverse patient groups. Collaborating with community partners to enhance support for expectant mothers and newborns from underserved backgrounds. Implementing strategies for delivering equitable neonatal care and ensuring healthy infant development across diverse populations. Register for the webinar
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Content ArticleThis is the tenth MBRRACE-UK Perinatal Mortality Surveillance Report. The report is divided into five sections: perinatal mortality rates in the UK; mortality rates for Trusts and Health Boards; mortality rates by gestational age; mortality rates by ethnicity and socio-economic deprivation; and a description of the causes of perinatal death. This report focuses on births from 24 completed weeks’ gestational age, with the exception of the section on mortality rates by gestational age, which also includes information on births at 22 to 23 completed weeks’ gestational age. This avoids the influence of the wide disparity in the classification of babies born before 24 completed weeks’ gestational age as a neonatal death or a late fetal loss. Terminations of pregnancy have been excluded from the mortality rates reported. Additional supporting materials to accompany this report include: a set of reference tables a data viewer with interactive mapping, which presents mortality rates for individual organisations, including Trusts and Health Boards a technical manual containing full details of the MBRRACE-UK methodology, including definitions, case ascertainment and statistical methods.
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Content ArticleThis film demonstrates how using SEIPS can help illuminate contributory factors within a work system, such as unconscious bias, stereotyping, workload, incivility, societal pressures and environmental factors under the six entity headings. Staff watch an animated explanation of SEIPS and then a short fictional maternity scenario looking out for relevant contributory factors. After viewing the film staff take part in a facilitated discussion to reflect. It is hoped that those using this film will be able to build on this experience, and then reflect on their own clinical service through the SEIPS lens, as taking a systems-based approach will strengthen a Just Culture, reduce blame and supports the PSIRF process.
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Content Article
Top picks: 6 resources about Group B Strep
Patient Safety Learning posted an article in Maternity
Knowing about Group B Strep when you’re pregnant or in the early weeks after birth can make a massive difference – most Group B Strep infections in newborn babies can be prevented, and early treatment can and does save lives. Group B Strep Awareness Month focuses on empowering new and expectant parents with the knowledge they need to make informed decisions about their baby and engaging with healthcare professionals to improve education and awareness. In this blog, Patient Safety Learning has pulled together six useful resources about Group Strep B shared on the hub. -
News Article
Biggest ever fall in maternal smoking after NHS prevention scheme expanded
Patient Safety Learning posted a news article in News
Last year saw the biggest ever fall in the proportion of mothers smoking during pregnancy, which campaigners have attributed to expansion of a “stop smoking” programme in maternity services. Newly published figures for this key public health indicator show the figure dropped by more than a percentage point from 2022-23 to 2023-24, for the first time since 2007-8. The absolute fall in mothers recorded as smoking at the time of delivery was about 6,300. Anti-smoking charities said it ”follows sustained investment to provide better quit support” and “shows what can be done with proper investment in evidence-based support”. Much of the new intervention work is done by midwives, and Royal College of Midwives professional policy advisor Clare Livingstone said the drop was “a testament to the dedication and hard work of our maternity services” which had “integrat[ed] smoking cessation support into routine care”. NHS England’s director for prevention and long-term conditions Matthew Fagg said the reduction was “fantastic” and added: ”With almost all NHS maternity services now offering support to help expectant mums quit smoking… this will protect the health of mums and babies and will help reduce inequalities in outcomes.” Read full story (paywalled) Source: HSJ, 4 July 2024 -
News Article
Maternity staff faced racism from colleagues
Patient Safety Learning posted a news article in News
Maternity staff at an NHS trust faced racism from their own colleagues, a Care Quality Commission (CQC) report said. The problem was identified at both the Luton and Dunstable (L&D) and Bedford hospitals during an inspection. Some ethnic minority overseas staff told the CQC discrimination had become "normalised". The regulator was alerted to concerns around the safety, culture, and management of the service by whistleblowers. On the first day of the inspection, last November, the Luton and Dunstable Hospital's maternity unit was at full capacity and the trust had to divert new arrivals. Low staffing levels also meant women and babies were not always kept safe. The trust was issued with a warning to improve and maternity services at both hospitals have now both been rated as 'inadequate'. At the L&D some staff told the inspectors they did not feel able to report instances of racism. Management acknowledged some parts of the unit had a "challenging culture". There were concerns racist incidents being reported to the trust would not be investigated in line with the trust’s values. Read full story Source: BBC News, 5 July 2024 -
Content ArticleThe Joint British Diabetes Societies (JBDS) for Inpatient Care group was created in 2008. It aims to improve inpatient diabetes care by developing and promoting high quality evidence-based guidelines and creating better inpatient care pathways. The JBDS–IP group was created and supported by Diabetes UK, ABCD and the Diabetes Inpatient Specialist Nurse (DISN) UK group, and works with NHS England, TREND-UK and with other professional organisations. This webpage contains guidance on a wide range of subjects relating to inpatient care for people with diabetes, including: The hospital management of hypoglycaemia in adults with diabetes mellitus The management of diabetic ketoacidosis in adults Management of adults with diabetes undergoing surgery and elective procedures: improving standards Self-Management of diabetes in hospital Glycaemic management during enteral feeding for people with diabetes in hospital The management of the hyperosmolar hyperglycaemic state (HHS) in adults with diabetes Admissions avoidance and diabetes: guidance for clinical commissioning groups and clinical teams Management of hyperglycaemia and steroid (glucocorticoid) therapy The use of variable rate intravenous insulin infusion (VRIII) in medical inpatients Discharge planning for adult inpatients with diabetes Management of adults with diabetes on dialysis Managing diabetes and hyperglycaemia during labour and birth with diabetes The management of diabetes in adults and children with psychiatric disorders in inpatient settings A good inpatient diabetes service Inpatient care of the frail older adult with diabetes Diabetes at the front door The management of glycaemic control in people with cancer COncise adVice on Inpatient Diabetes (COVID:Diabetes) - hyperglycaemia Optimal staffing for a good inpatient diabetes service Using technology to support diabetes care in hospital
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Content ArticleA fire at the University Hospital of Leicester in 2023 led to the recommendation of a full evacuation of the tertiary neonatal unit. The incident was ultimately stood down—however, it highlighted the lack of inter-agency understanding regarding the difficulty and complexity of moving critically unwell and premature babies in the event of a major incident. In response, the Leicester Royal Infirmary and other agencies staged a simulation exercise to enable teams to prepare for possible future incidents. This HSJ article describes the simulation exercise and the lessons it revealed about managing neonatal unit evacuations during major incidents. It highlights key learnings around the two themes of communication and estates.
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News Article
Midwives call women in labour ‘Asian princesses’ amid ‘hostile’ environment fears
Patient Safety Learning posted a news article in News
The NHS Race and Health Observatory has raised fundamental concerns about racism towards maternity patients after several cases have come to light in recent months, including midwives branding patients as “Asian princesses”. The watchdog’s intervention follows regulators identifying patterns of racist and discriminatory behaviour at the maternity departments of two large hospital trusts and a smaller general hospital in the last six months. The observatory’s CEO Habib Naqvi told HSJ he was “deeply concerned” by the seriousness of the issues raised. He added that “discriminatory behaviours and ways of working… [can] lead to hostile and unsupportive learning environments… impact patient care and safety, and also seriously undermine the NHS’s goal of attracting and retaining its workforce”. Examples given included the term “Asian princess” being used by midwives in reference to brown-skinned women requesting pain relief during labour. The students also described a “disregard” from some midwives towards black and brown-skinned women, particularly where English was not their first language. It was also reported when Asian women verbalised their pain during labour, some midwives responded with “Oh, they are all like this”, while additional derogatory comments were made towards asylum seekers, that “they are playing the system”, the NHSE team’s report said. Read full story (paywalled) Source: HSJ, 28 June 2024 -
Content ArticleSuicide is a leading cause of maternal death during the perinatal period, which includes pregnancy and the year after birth. While maternal suicide is a relatively rare event with a prevalence of 3.84 per 100,000 live births in the UK, the impact of maternal suicide is profound and long-lasting. Many more women will attempt suicide during the perinatal period, with a worldwide estimated prevalence of 680 per 100,000 in pregnancy and 210 per 100,000 in the year after birth. This qualitative study aimed to explore the experiences of women and birthing people who had a perinatal suicide attempt and to understand the context and contributing factors surrounding their perinatal suicide attempt. The researchers spoke to women with lived experience of perinatal mental illness. Their results highlighted three key themes: Trauma and Adversities which captures the traumatic events and life adversities with which participants started their pregnancy journeys. Disillusionment with Motherhood which brings together a range of sub-themes highlighting various challenges related to pregnancy, birth and motherhood resulting in a decline in women’s mental health. Entrapment and Despair which presents a range of factors that lead to a significant deterioration of women’s mental health, marked by feelings of failure, hopelessness and losing control. The authors called for further research into these factors which could lead to earlier detection of suicide risk, improving care and potentially prevent future maternal suicides.
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Content ArticleHow are community groups bridging some of the gaps between Black mothers and health and care services? What can the health and care system learn in response? Siva Anandaciva speaks to Amanda Smith, founder and Chief Executive of Maternity Engagement Action CIC, Benash Nazmeen, Professor of Midwifery and co-founder and co-director of the Association of South Asian Midwives CIC, and Chrissy Brown, founder and Chief Executive of the Motivational Mums Club CIC, to find out.
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Content ArticleImplementing levels of maternal care is one strategy proposed to reduce maternal morbidity and mortality. The levels of maternal care framework outline individual medical and obstetrical comorbidities, along with hospital resources required for individuals with these different comorbidities to deliver safely. The overall goal is to match individuals to hospitals so that all birthing people get appropriate resources and personnel during delivery to reduce maternal morbidity. This study examined the association between delivery in a hospital with an inappropriate level of maternal care and the risk of experiencing severe maternal morbidity.
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News Article
Maternity services ‘overwhelmed with reporting requirements’, warns DHSC group
Patient Safety Learning posted a news article in News
Government has been warned by its own advisory group that maternity services are being “overwhelmed with reporting requirements” which are hindering safety improvement work, according to documents seen by HSJ. The Department of Health and Social Care (DHSC) set up the “independent working group” on neonatal and maternal care to oversee its response to Donna Ockenden’s spring 2022 inquiry report into Shropshire maternity services; and was then asked to do the same for key recommendations from Bill Kirkup’s report later that year on failings in East Kent. The group is led by the Royal College of Midwives and the Royal College of Obstetricians and Gynaecologists and made up of representatives of maternity staff. It was asked particularly to look into advising on two Kirkup recommendations: first, on improving standards of professional behaviour and “embedding compassionate care”, including asking royal colleges and others how this can be done. Second, charging the royal colleges and others “with reporting on how teamworking in maternity and neonatal care can be improved, with particular reference to establishing common purpose, objectives, and training from the outset”. However, a recent report from the working group, to the DHSC, released under the Freedom of Information Act, suggests the staff groups are arguing there is little scope to introduce more change. Read full story (paywalled) Source: HSJ, 18 June 2024 -
News ArticleA scandal-hit hospital trust has come under fire yet again after advertising for a maternity doctor with "a desire to promote normal birth". Hampshire Hospitals NHS Foundation Trust said it was seeking an obstetrics and gynaecology consultant in its high risk baby unit who would support "active" labour. Yet safe birth campaigners have reacted with fury online, claiming 'normal' has become a codeword for 'natural' birth — a fixation which has led to many midwives frowning on medical intervention and caesareans, even when needed. This 'obsession', they add, has been linked to failures at a number of maternity units in recent years where hundreds of babies died, major inquiries have found. The trust was embroiled in a similar controversy last year after Winchester's Royal Hampshire County Hospital faced a claim of unfair dismissal by a former consultant obstetrician and gynaecologist. Martyn Pitman, who had worked at the hospital for 20 years, was sacked last March after raising concerns about midwifery care and patient safety at the hospital. In a post on X, Catherine Roy linked to the advert, adding: "Where Martyn Pitman used to work. The takeover by normal birth is now complete I think. What a scandal." In response, consultant paediatrician Dr Ravi Jayaram, whose evidence helped catch convicted serial baby-killer Lucy Letby at Countess of Chester Hospital, said: "Anyone who applies for this should be immediately excluded from consideration for the post." He added: "[It] should read 'desire to support and promote safe birth' — if it needed to be said at all." Read full story Source: The MailOnline, 13 June 2024
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News Article
C2-Ai launches Maternal and Neonatal Observatory
Clive Flashman posted a news article in News
C2.AI has formally launched its Maternity and Neonatal Observatory at the NHS ConfedExpo in Manchester (Government and Public Sector Journal). The observatory is intended to give hospitals and clinicians a detailed picture of the performance of maternity units and the health trajectories of individual women, so areas of concern can be identified and acted on. The system works by calculating and comparing observed outcomes for women and babies with expected outcomes for these individuals. To do this, it uses AI and machine learning to assess clinical factors, case-mix, and the social determinants of health. Early adopters within the NHS, where maternity services are under intense scrutiny, are expected soon. -
Content ArticleThe United States continues to have the highest rate of maternal deaths of any high-income nation, despite a decline since the Covid-19 pandemic. And within the U.S., the rate is by far the highest for Black women. Most of these deaths — over 80% — are likely preventable. With policies and systems in place to support women during the perinatal period, several high-income countries report virtually no maternal deaths. As policymakers and health care delivery system leaders in the U.S. seek ways to end the nation’s maternal mortality crisis, these countries may offer viable solutions. This brief updates an earlier Commonwealth Fund study of differences in maternal mortality, maternal care workforce composition, and access to postpartum care and social protections between the U.S. and other high-income countries: Australia, Canada, France, Germany, the Netherlands, New Zealand, Norway, Sweden, Switzerland, and the United Kingdom. In this edition, we have also included data on Chile, Japan, and Korea — all high-income countries with universal healthcare systems.
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News Article
New support for families critical of pregnancy care
Patient Safety Learning posted a news article in News
A new service in Somerset is being set up to support women who have had adverse outcomes during pregnancy. Maternity and neonatal independent senior advocates (MNISA) say they will act on behalf of women if they feel their experience when being cared for during pregnancy led to something going wrong. This can include death, babies being diagnosed with brain injuries or mothers needing critical care. MNISAs can attend meetings or support users through investigations and complaints. The service will be piloted until next year and while the role is independent from the maternity and neonatal trust provider (Somerset NHS Foundation Trust), it sits within NHS Somerset. Jane Innes, a qualified lawyer who has worked across the NHS for 30 years, will take up the new role in Somerset. She said: "There is an acknowledgement that people's voices need to be heard and listened to so systems can act and respond appropriately." Read full story Source: BBC News, 11 June 2024 -
Content ArticleHand hygiene is crucial in healthcare settings, especially in maternity units. This poster developed by the World Health Organization (WHO) shows the five key moments for hand hygiene care in a maternity unit.
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Content Article
Maternity: Broken Trust (itvX documentary)
Patient Safety Learning posted an article in Maternity
Exposure documentary exploring the failures in maternity care at the Nottingham University Hospitals Trust (NUH), and the toll it has taken on those fighting for justice. -
News Article
Parents hope documentary will help maternity inquiry bid
Patient Safety Learning posted a news article in News
A couple whose child died before birth due to failings in her care hope a new documentary can support their calls for a public inquiry into England's maternity services. Jack and Sarah Hawkins' daughter Harriet was stillborn at Nottingham City Hospital in April 2016. They hope an ITV programme - Maternity: Broken Trust - shown on Sunday evening can help their bid for a wider probe. An independent review into failings in maternity services in Nottingham is now the biggest maternity investigation in NHS history, but a report is not expected to be returned until 2025. Dr and Ms Hawkins - who received a £2.8m settlement over failings in their daughter's care - said a wider investigation was needed to highlight national issues. "I think maternity services across England are absolutely terrible," Ms Hawkins said. "We're in contact with people with dead babies from Leeds to Plymouth, and I think what really needs to happen is for there to be a public inquiry into England's maternity services. "It's not just Nottingham, it's everywhere, and hopefully this platform will give people the strength to come forward and speak up." Read full story Source: BBC News, 10 June 2024 -
Content ArticleMaternal morbidity and mortality is rising in the United States. Previous studies focus on patient attributes, and most of the national data are based on research performed at urban tertiary care centers. Although it is well understood that nurses affect patient outcomes, there is scant evidence to understand the nurse work system, and no studies have specifically studied rural nurses. The authors of this paper, published in The Joint Commission Journal on Quality and Patient Safety, sought to understand the systems-level factors affecting rural obstetric nurses when their patients experience clinical deterioration.
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Content ArticleThe maternity disadvantage assessment tool (MatDAT) is a standardised tool for assessing social complexity during maternity care based on women and birthing people’s broad social needs. Developed by the Royal College of Midwives (RCM), it provides a guide for midwives to identify the woman’s care level (Level 1–4) and develop a personalised care and support plan (PCSP), as well as facilitating smooth communication with the multidisciplinary team. The tool and the MatDAT Planning Guide also support maternity services to plan and allocate resources to level of care pathways.
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Content Article
Tommy’s National Centre for Maternity Improvement
Patient Safety Learning posted an article in Maternity
In partnership with the Royal College of Obstetricians and Gynaecologists and the Royal College of Midwives, The Tommy’s National Centre for Maternity Improvement is working to prevent stillbirths and premature births across the UK. Our current method of assessing risk during pregnancy has remained unchanged since the 1970s, with midwives or doctors using a checklist to classify a woman as either ‘high’ risk or ‘low’ risk. The current system does not measure how high or low this risk is, and so does not allow for more personalised care. As a result, Tommy's National Centre for Maternity Improvement are creating The Tommy’s Pathway – an online medical tool that will help healthcare providers work out which pregnant women are most at risk of giving birth prematurely or of developing pregnancy complications that can lead to stillbirth. The Pathway will use information routinely gathered by midwives and doctors to provide a personalised risk score and treatment recommendations for every pregnant woman, ensuring that every woman receives the best support possible throughout pregnancy. The Pathway will also empower pregnant women to become more engaged in their own care. -
News Article
Parents call for inquiry into maternity services
Patient Safety Learning posted a news article in News
The families of nine babies who died at a scandal-hit NHS trust over a three-year period have called for a public inquiry into the standard of its maternity care. A collective letter has been sent to each of the families' MPs after they lost babies at hospitals run by the University Hospitals Sussex NHS Foundation Trust. Of the nine bereaved mothers, four said they too almost died as a result of "poor standards of care" from maternity teams between 2021 and 2023 The trust said it had recruited more midwives and "changed" how it supported families, with outcomes now better "than most other trusts in the country". But the Sussex-based families said they had called for a public inquiry into its maternity services to ensure accountability for "systemic failures", and so the trust learns from past mistakes. In the letter to the MPs, the parents said: "With the volume and repetition of errors in maternity care by the trust, we believe that babies and potentially mothers will continue to unnecessarily die under the trust’s care unless there is additional intervention." Read full story Source: BBC News, 4 June 2024 -
Content ArticleDespite not being indicated for lactation in the UK, the anti-sickness medicine domperidone is increasingly being prescribed or bought illegally to aid lactation, but its side-effects can include anxiety, depression and suicidal thoughts. In this account for The Guardian, Rose Stokes describes her experience of being prescribed domperidone after the birth of her son. When her milk production didn't increase and with her mental health rapidly deteriorating, Rose bought her own supply of the drug online and through a private doctor and ended up taking more than five times the NHS maximum dose. When her mental state continued to worsen, she decided to suddenly stop taking domperidone which left her suicidal. She describes receiving no guidance on the mental health risks associated with the medication or sudden withdrawal.
