Long Term NHS Plan to Reduce Stillbirth Rates by 50% by 2025

Published on: 10/01/2019

NHS England launched a long term plan on 7th January 2019 and within that, the plans in reducing stillbirth rates, maternal morbidity, neonatal mortality and serious brain injury by 50% by 2025.

The plan pulls together the recent findings such as the Each Baby Counts report by RCOG that found that during 2016, 71% of relevant cases of stillbirths, morbidity and brain injury (i.e cases that fit a certain criteria to enable a full assessment) could have had a different outcome with different care.

The first important thing to mention is that the Saving Babies Lives Care Bundle (SBLCB), which was previously trialed in 19 Trusts and resulted in a 20% decrease in stillbirths, will now be rolled out to every maternity unit in England during 2019.

Not heard of the SBLCB? You’re not alone! The SPiRE review published back in July 2018 (an independent review of the Saving Babies Lives Care Bundle) reported that 42% of mainly frontline staff were unaware of the care bundle despite implementing parts or all of the elements. We want to make sure that ALL frontline staff are aware of the bundle, what it is and why it is so important in saving little lives. This is one of our missions for 2019! Here is a brief overview of the 4 elements involved:

> Reducing smoking in pregnancy.
> Risk assessment and surveillance in growth restriction.
> Raising awareness of reduced movements.
> Effective monitoring during labour.

The SPiRE report recognised that further huge improvements could be made with the reducing smoking in pregnancy and effective monitoring during labour elements of the bundle. Baby Lifeline’s Mind the Gap report found that less than 8% of trusts provided all of the training needed to fully implement the care bundle. With a 20% reduction in stillbirths despite this, imagine what can be achieved with standardised training across trusts implemented too? Baby Lifeline provide training on implementing the Saving Babies Lives Care Bundle, the details of which can be found here. We will be pushing the importance of this training throughout 2019 and feel this is vital if we are to see the rate of stillbirths fall further.

Regarding the raising awareness of reduced movements element, we must also look to the AFFIRM report that showed only a marginal effect of this awareness in reducing stillbirth. Research is vital in working out what can be done to reduce stillbirths, so the findings are important in looking to the future. We know from previous research that experiencing reduced movements does play a part in an increased risk of stillbirth (see the MiNESS study here), but it’s where that piece of the puzzle fits in with prevention that is key. The 20% reduction in stillbirth results from SPiRE indicate that awareness in conjunction with the other elements really can work. We strongly believe that women should continue to be empowered with the knowledge of the importance of monitoring changes in their baby’s movements. Time and time again we hear from mums who experienced reduced movements before a loss. The new NHS plan will see an expansion on SBLCB (which will be published in 2019) which will focus on preventing pre-term birth by minimising unnecessary intervention and define a more holistic approach. We look forward to seeing this expansion as it could help in finding the balance in awareness and anxiousness towards pushing for interventions (that may be unnecessary). We believe that language is absolutely key here and that we should not be looking at awareness being harmful (therefore disempowering parents), but rather midwives and health professionals receiving support and specific training in having these difficult conversations. There is already a movement away from disempowering language during pregnancy and labour and we believe this can be built upon for important awareness aspects, such as monitoring babies movements too.

Continuity of Carer is being developed around the country with the aim of 20% of pregnant women being offered the opportunity of having the same midwife caring for them throughout their pregnancy in 2019. We know that there are mixed feelings amongst the midwife community about this and how it could possibly be acheived, however with stats showing that women are 16% less likely to lose their baby, 19% less likely to lose a baby before 24 weeks and 24% less likely to experience a pre-term birth, it’s an initiative we as a stillbirth prevention charity wholeheartedly back. We will be following midwives experiences within the different models of CoC over time and will be writing these up to be shared. Watch this space!

Continuous improvement on how lessons are learnt when things go wrong is another pledge in the long term plan. The Perinatal Mortality Review Tool is now used by all maternity providers which supports high quality reviews. The tool can be found here.  

Other important parts of the longterm plan for maternity and neonatal services include:

> Every trust in England with a maternity unit will be part of the National Maternal & Neonatal Health Safety Collaborative with a named maternity safety champion.
> Maternity digital records are currently being offered to 20,000 women. This will rise to 100,000 by the end of 2020. By 2023/24 all women will be able to access their records securely online.
> There will be an increase in access to evidence based care and therapies for women with moderate to sever mental health difficulties.
> Partners / Fathers will receive increased support too.
> Maternity outreach clinics will integrate maternity, reproductive health and psychological therapy for women experiencing mental health difficulties directly arising from, or related to, the maternity experience.
> Improved access to postnatal physiotherapy.
> Infant feeding programs.
> Redesign and expansion of neonatal critical care services.
> Development of expert neonatal workforce.
> Enhancing the experience of families during the worrying period of neonatal critical care.

MAMA Academy CEO, Heidi Eldridge said “We are part of the Baby Loss Charity Network which is a collaboration of over 20 charities including Sands, Tommy’s, TAMBA, Child Bereavement UK, Bliss, NCT and The Miscarriage Association. We are putting together a Manifesto that asks for our government to compliment the NHS Forward Plan that will ensure the safe arrival of babies in the UK.

We welcome the national rollout of the Saving Babies Lives Care Bundle and our Wellbeing Wallets are the most efficient way of reminding women to monitor their babies movements as well as raise awareness of other complications such as pre-eclampsia. We remain committed to end preventable stillbirths so that the UK can become one of the safest countries in which to have a baby.”