“Saving Babies’ Lives Care Bundle”: NHS England’s Stillbirth Guidelines
On 21 March 2016, NHS England published new guidelines entitled, “Saving Babies’ Lives Care Bundle” aimed at reducing the worrying high stillbirth rate in the UK.
The Guidelines were developed by NHS England in conjunction with the Royal College of Obstetricians, the Royal College of Midwives and Sands, the neonatal death and stillbirth charity.
In this post, we ask why guidelines were needed, what the guidelines say and, finally, whether they will help prevent stillbirths in the future.
The UK has one of the highest stillbirth rates of all high income countries. There are 3,000 stillbirths in the UK every year, which equates to 1/200 babies or 4.7% of all births (according to 2014 data). In Iceland, only 1.3% of babies are stillborn.
NHS England, along with many in the medical profession, had become increasingly concerned about the high rates of often preventable stillbirths. The aim of the Guidelines is to reduce the stillbirth rate substantially with the Government aiming for a 20% reduction by 2020 and a 50% reduction by 2030.
What do the Guidelines Say?
The Guidelines set out 4 key ‘interventions’:
- Provide advice to women about the risks of smoking and encourage those who do smoke to stop. Women will have their carbon dioxide levels tested at the initial booking appointment with their midwife to assess their exposure to smoke. Appropriate advice will then be given about the risks of smoking and, for those who need it, assistance will be given to stop.
- Enhance the detection of fetal growth restriction. Fetal-growth restricted babies are the single largest group of preventable stillbirths according to a recent report. The Guidelines aim to facilitate better monitoring of babies during pregnancy through the use of charts and algorithms. There is also improved information for midwives on the action to be taken where there are concerns about a baby’s growth.
- Improve the awareness of fetal movement by expectant mothers and their partners. NHS England believes that stillbirth levels could be reduced if women and their partners were better able to monitor their baby’s movements and recognise when something may be wrong. The Guidelines state that all pregnant women will be issued with an information leaflet offering clear advice about what they should be looking for. The leaflet must be issued by the 24th week of pregnancy at the latest. Midwives will also be required to ask expectant mothers about their monitoring and the Guidelines contain a checklist to be completed at antenatal appointments. Finally, there will be clearer protocols to manage the care of women who report reduced fetal movement.
- Improve fetal monitoring through labour. The Guidelines say that there should be a greater focus on training and the sharing of information between different groups of medical professionals in order to increase the benefits of CTG monitoring during labour. Midwives will also have to undergo annual training and competency tests to improve their ability to use CTG equipment effectively.
Will the Guidelines Work?
The new Guidelines have rightly been welcomed by the medical profession and those who work with parents who have suffered a stillbirth. As medical negligence solicitors we have seen too often the terrible pain that a stillbirth causes and anything that can be done to reduce this from happening can only be a good thing. The big question is, “will the Guidelines actually make any difference?”
The greatest concern has to be that NICE and the professional bodies already have guidelines and/or protocols for midwives and doctors that cover all 4 of the ‘interventions’, but this simply often isn’t followed. As an example, midwives are aware that they must plot a baby’s growth on the chart at antenatal appointments. However we have dealt with cases involving issues of fetal monitoring where the chart has simply been left blank. This suggests that there will need to be something different about the new Guidelines to prompt a change.
That being said, there are many aspects of the “Saving Babies’ Lives Care Bundle” that could make it easier to follow and adhere to than the pre-existing protocols. The 3 features that stood out to us were:
- It’s Concise: Unlike much medical guidance, this is a relatively short document with just the 4 key interventions to remember.
- It’s Clear: The Guidelines include charts and algorithms that midwives should follow to ensure that they ask all necessary questions and to determine the best way to proceed in a variety of scenarios. Rather than a midwife having to decide for themselves whether to refer a pregnant woman for further assessment (for example), the charts clearly guide them through the appropriate course of action. This has the potential to reduce the chance of errors being made.
- It’s Inclusive: The Guidelines have a greater focus on actively including patients in their care and in the fetal monitoring process than other protocols. By ensuring that expectant mothers are better informed about the risk factors for stillbirth and given are advice about monitoring their baby’s movements, they can take an active role in reducing the risks of stillbirth.
Overall, we think that it is fantastic that NHS England has made a commitment to reducing the rate of stillbirth and our initial impressions of the “Saving Babies’ Lives Care Bundle” is positive. Only time will tell whether it will work in practice. We are all keeping our fingers crossed that the reduction targets for 2020 and 2030 are met and fewer parents have to go through the trauma of a stillbirth.
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