MAMA responds to MBRRACE-UK enquiry

MBRRACE-UK (Mothers and Babies: Reducing Risk through Audits and Confidential Enquiries across the UK) have released their latest report based on a review of the notes of 133 cases of stillbirth, 85 of which were reviewed in detail by a panel of midwives, obstetricians and pathologists.

Some of the key findings of the report were:

In almost half of the cases, the women had contacted their maternity units concerned by a change in their baby’s movements. In half of these cases there were missed opportunities to potentially save the baby.

Half of all full-term, singleton stillbirths without genetic abnormalities had at least one element of care that required improvement which might have made a difference to the outcome.

National guidance for screening and monitoring growth of the baby was not followed for two thirds of the stillbirths reviewed.

Evidence of an internal review following the stillbirth was only present in one quarter of cases and the quality of these reviews was highly variable.

Although  the majority of post mortems were of satisfactory or good quality only half of the stillbirths selected for confidential enquiry had one.

Heidi Eldridge, Chairman of MAMA Academy, said: “It is truly distressing to hear that in 2013, 1000 babies lives could have been saved if they had been delivered earlier. Stillbirth rates in the UK have mostly remained unchanged for 20 years and there are still critical gaps in antenatal care. Lessons are still not being learnt from past mistakes. Maternity care should be consistent throughout the country with every trust adhering to clinical guidelines. There is clearly not enough emphasis or incentive for trusts to improve to bring their stillbirth numbers down.  Last week we welcomed Jeremy Hunt’s pledge to halve the number of stillbirths by 2030, making stillbirth a national priority. However, it is clear from this report that so much can be done already to save hundreds of babies’ lives, just by following current clinical guidelines.

We were surprised to hear just how many women were not appropriately assessed when reporting reduced fetal movements. Our Wellbeing Wallets that are being given to expectant mums by their midwife in over 20 trusts state “If you think your babies movements have changed, call your maternity unit straight away. You should be asked to come in for assessment.” We are fundraising hard to enable us to provide every trust with Wellbeing Wallets in the future.  The report also showed that lack of growth is also not being detected. Our Made to Measure campaign is highlighting the GAP programme which has had huge results to better detect growth restricted babies. It is estimated that if all trusts run GAP with comprehensive training, 1000 babies lives could be saved next year.

We believe that when a baby dies, the whole maternity unit should grieve and a full independent review be carried out. It is essential for trusts to learn from mistakes which may have happened to prevent other parents experiencing similar heartache in the future. The SCOR tool is readily available and free for trusts to use.

We very much hope this report will act as a wake up call for trusts to make stillbirth a priority and we hope our response will highlight the programmes and resources that are already available for trusts to use to help save babies lives.”

Learn more about our “Made to measure” campaign  and out “Well being wallets”.

To learn more about the SCOR tool for reviewing stillbirths and neonatal deaths, see here.

Visit here to see the MBRRACE-UK report

BBC report available here