Saving Babies' Lives Care Bundle - Version 2

The 2nd version of the Saving Babies Lives Care Bundle was released on Friday. Here is a brief overview of what the care bundle is and the changes in the newly released version.

The 1st version of the care bundle, based on research over previous years recognised 4 key elements to be addressed to help save future babies lives:

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

Initially, 19 participating trusts implemented the bundle to varying degrees and at the end of July 2018, an amazing 20% overall decrease in stillbirths was reported (SPiRE). The implementation of the elements of the bundle was by no means perfect or consistent as would be expected initially across trusts and it’s worth mentioning that no extra funding has been available to trusts in its implementation. Amongst other things, the review recognised that improvements could be made for smoking cessation programs and knowledge amongst frontline staff about the bundle itself (42% were unaware of the bundle, despite still implementing all or parts of it). Since then the Mind the Gap report by Baby Lifeline found a huge variation in training across trusts who implemented the bundle, which is vital for elements such as monitoring during labour. Each Baby Counts found that in 71% of relevant cases of stillbirth, neonatal death and brain injuries could have had a different outcome with different care. Concerns regarding unnecessary interventions has also been raised, in particular following the AFFIRM study.

The second version of the bundle looks to build on the learning from version one and address the issues that have been identified. Here’s a very brief rundown from the overview, however we would strongly urge any midwives / health professionals who have had concerns regarding any of the above to read the full care bundle here:

> Carbon monoxide monitoring for women at their booking appointment and where appropriate, throughout pregnancy as with version one, but importantly with a referral for support to a stop smoking specialist.

> The new version will focus more attention on identified highest risk cases of fetal growth restriction (FGR), to address possible increased interventions with women who are maybe only very marginally at increased risk of FGR related stillbirth. The importance that full training for staff who carry out symphysis fundal height (SFH) measurements to ensure this identification will be key (and acknowledged as such in the new version).

> Raising awareness of reduced fetal movement (RFM) continues to be a vital element of the bundle and this is updated to help ensure that care providers have protocols in place based on best evidence to manage care following reported RFM. Prior to 39 weeks gestation, induction of labour is only recommended where there is evidence of fetal compromise or other concerns.

> A fetal monitoring lead with the responsibility of improving the standard of fetal monitoring during labour should be appointed and there will be a standardised risk assessment tool at the onset of labour. Trusts need to be able to demonstrate that qualified staff who care for women in labour are competent to read CTG’s.

> There is a new element to the bundle which is focussing on reducing preterm birth which has been introduced following the Department of Heath’s Safer Maternity Care report. This will look at three areas and in particular prediction, prevention and better preparation where preterm birth is unavoidable.

“The second version of the care bundle includes a greater emphasis on continuous improvement with a reduced number of process and outcome measures. The implementation of each element will require a commitment to quality improvement with a focus on how processes and pathways can be developed and where improvements can be made.”

Recognition of the importance of outside interventions that can run alongside the care bundle is also included in version 2, for example, continuity of carer models, NICE guidelines and healthy pregnancy messages for women. It also highlights good communication, choice and personalisation which helps to empower women in decision making.

With safer pregnancy messages in mind, if your trust does not yet supply them, please get in touch with us about our Wellbeing Wallets. They compliment the Saving Babies’ Lives Care Bundle perfectly and help women to identify when to call their maternity units. They also help with starting the conversation about awareness messages that can otherwise be difficult to bring up. Email contact@mamaacademy.org.uk for more information.
If your trust communicates with women via Social Media, we also regularly post healthy / safer pregnancy graphics in line with the Department of Health that can be shared. Follow us @mamaacademy on Twitter, Facebook and Instagram. Watch this space on our website too as we are working hard behind the scenes on new pages sharing incredible examples of work some hospitals are doing in successfully driving their stillbirth rates down.