NHS England launches initiative to halve stillbirth rate by 2030

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NHS England has published new guidance relating to maternity best practice with the intention of halving the rate of stillbirth.

One in every 200 babies born in the UK is stillborn and NHS England says levels of stillbirth vary across England for a number of possible reasons. It hopes to address this variation by outlining four key elements of maternal care in order to bring down stillbirth rates and spare as many families as possible the agony of losing a baby.

While stillbirth and neonatal mortality has fallen by 20% over the past decade to its current level of 4.7 per 1,000 births, the rates in England are still more than double that of the best performing nation, Iceland (1.3 per 1,000), with levels in England remaining among the highest of high-income nations. Of the 665,000 babies born in England each year, there are tragically more than 3,000 stillbirths.

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The care bundle, Saving Babies’ Lives, is intended to inform commissioners and care providers and support doctors and midwives in addressing the following four key elements of maternal care:

  • Reducing smoking during pregnancy – more than 1 in 10 women still smoke whilst pregnant – a leading risk factor for stillbirth

The guidance recommends that all women are offered a test at their first antenatal appointment to establish the level of carbon monoxide they may be exposed alongside support to help them stop smoking. Smokers and those exposed to smoke will be made fully aware of the risks to their unborn baby and will be supported to make an informed decision about quitting or actively avoiding other people’s smoke.

  • Enhanced detection of restricted fetal growth

The guidance recommends closer growth monitoring, with measurements recorded on growth charts. An algorithm will then be used to indicate the level of monitoring required on an individual basis. NHS England says of the one in 200 babies that are stillborn, growth restricted babies are the single largest preventable group.

  • Improving awareness of the importance of fetal movement

The guidance recommends that women and their partners be better informed and more empowered to self-monitor their baby’s movements with the provision of clear and consistent advice. Care providers should also have protocols in place to manage care effectively for women who report reduced movement. In support of this element, an information and advice leaflet relating to reduced fetal movement is being produced to be issued to all women by week 24 of their pregnancy.

  • Improving fetal monitoring during labour

The guidance recommends the provision of annual training and assessment for staff on cardiotocograph (CTG) interpretation and use of auscultation (monitoring of the baby’s heartbeat) during labour. A buddy system for CTG interpretation should also be implemented so that ‘fresh eyes’ can detect any potential problems during labour.

The new guidance was developed with help from expert organisations including the Royal College of Midwives, the Royal College of Obstetricians and Gynaecologists, the British Maternal and Fetal Medicine Society and Sands, the stillbirth and neonatal death charity.

Investment needed to provide “continuity of care”

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Commenting on the news, Cathy Warwick, Chief Executive of the Royal College of Midwives, says investment is needed if progress is to be made. She says: “All of the interventions and their implementation will need investment in resources, particularly in staff. Midwives and other staff must have the time to spend with women and they must have the time to attend training. Having the right number of midwives will also contribute to continuity of care and carer; in women seeing the same midwife or small number of midwives. They will be able to get to know the women better and spot changes in their condition that could go unnoticed without that consistency. England remains 2600 full time midwives short of the number it needs. So whilst this guidance is welcome and valuable, we must have the right numbers of staff to ensure it is implemented correctly.

“There are also much wider issues in society that contribute to stillbirths, including smoking and obesity. There are cuts to public health funding for local authorities - such as smoking cessation services -  and we need to see these reversed, indeed increased.”

Missed opportunities?

Charlotte Bevan, Senior Research and Prevention Advisor at Sands, says: “Sands support hundreds of parents every year, who’s baby has died before, during or shortly after birth. Many believe their baby’s death was not inevitable and opportunities were missed to save their child. 

“Recent in depth analysis of quality of care into a number of stillbirths occurring around the baby’s due date, published by MBRRACE-UK, supports that belief, telling us that 6 out of 10 of these deaths might have been prevented if basic antenatal guidelines had been implemented.

“The elements in the ‘Saving Babies’ Lives’ care bundle pick up on those clear messages by promoting best practice both in the antenatal and intrapartum period, around reduced fetal movements and monitoring growth to meet standards and guidance already established, as well as support for women who smoke in pregnancy (the leading modifiable risk factor for stillbirth) and up-to-date training in fetal heart monitoring to prevent deaths during labour.

“The UK’s progress on preventing avoidable stillbirths has, to date, been scandalously slow, four times slower than countries like the Netherlands. The focus of the care bundle provides a long-overdue opportunity to reinforce best practice and ensure safer care both in pregnancy and during labour to protect babies’ lives in the future, and we urge trusts across the country to implement it straight away.”

If your family has been affected by stillbirth and you would like to access support or more information, visit the Sands charity website here www.uk-sands.org

For more information on monitoring fetal movements during pregnancy and to access resources, visit www.kickscount.org.uk


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