Saving Babies Lives Care Bundle

In 2015, the government announced it’s national ambition to halve the number of stillbirths in the UK by 2030 which has since been brought forward to 2025.

The NHS Saving Babies Lives Care Bundle was first launched in March 2016, and the second version was released in March 2019, introducing an additional element as well as emphasising the importance of maternal choice, continuity of carer, and providing essential safer pregnancy information to women and families (MAMA Academy’s primary purpose) – all hugely significant factors in maternity services.

Saving Babies’ Lives was introduced to offer a template of key elements to focus attention on with the aim of reducing preventable stillbirth. It identified key evidence-based risk factors that would have the most significant impact.

  •  Reducing smoking during pregnancy
  •  Risk assessment, prevention and surveillance of pregnancies at risk of fetal growth restriction (FGR)
  •  Raising awareness of reduced fetal movements (RFM)
  •  Effective fetal monitoring during labour

A study reviewing the impact of Saving Babies Lives was published in 2018 by researchers from the University of Manchester. In 2019, a fifth element was added based on further analysis since the original launch.

  • Reducing pre-term birth
  • Reducing smoking during pregnancy

Smoking has long been identified as a risk factor in stillbirth, miscarriage, pre-term birth, low birthweight, placental problems, and SIDS. The SBL Care Bundle calls for a combination of informing, educating, monitoring and supporting, and identifies key measures to address this issue.

  • Risk assessment, prevention and surveillance of pregnancies at risk of fetal growth restriction (FGR)

Fetal growth restriction is thought to be the single largest risk factor, but is a complex issue to address. The Care Bundle recognises that the key is to better identify the babies most at risk of growth restriction-related stillbirth, whilst avoiding unnecessary interventions for others. The Care Bundle provides detailed guidance on how to achieve this delicate balance in order to best reduce perinatal mortality.

  •  Raising awareness of reduced fetal movements (RFM)

Multiple reports and studies have shown a link between episodes of RFM and stillbirth. The Care Bundle provides a suggested checklist for the management of RFM, and explores the challenges associated with addressing this issue, including scanning capacity and appropriate timing of the offer of interventions.

  • Effective fetal monitoring during labour

The SBL Care Bundle recognises the benefits of effective CTG monitoring and interpretation for reduction of stillbirth and other serious brain injuries, particularly in high risk labours, but acknowledges the challenges of achieving consistent and maintained training levels and clear guidelines for interpretation, communication and escalation.

  • Reducing pre-term birth

Recent changes in stillbirth rates have seen significant reductions in the rates of term stillbirth, but shown that more work needs to be done in reducing pre-term stillbirth and neonatal death. Pre-term birth is associated with increased mortality, and is described in the Care Bundle as “the most important single determinant of adverse infant outcome with regards to survival and quality of life”. Thus a strategy to reduce it was incorporated into the newer version of the bundle.

 

One of the key points that’s really important to consider is that this initiative has been designed as a bundle of elements that complement each other. The different elements are interconnected – smoking during pregnancy can be a contributory factor for growth restriction. So because the elements are all interconnected, tackling one but not the rest will not produce the most effective outcome. A unit’s strategy for maximising the impact of the Saving Babies’ Lives Care Bundle therefore needs to include measures to address each of the different elements in turn.

The full publication – including further detail on the different elements, risk factors, and implementation – can be read here.