Government pledges £2.45 million to improve childbirth care

The Department of Health and Social Care (DHSC) is awarding the Royal College of Obstetricians and Gynaecologists (RCOG) almost £2 million to lead the first phase of the Avoiding Brain injuries in Childbirth (ABC) Collaboration.

This funding will be used to survey maternity staff and parents and test out best practices for monitoring and responding to a baby’s wellbeing during labour. It will also focus on managing complications with a baby’s positioning during caesarean section to reduce brain injuries.

Maternity safety minister Nadine Dorries said:

I am determined to make sure as many mums as possible can go home with healthy and happy babies in their arms.

This new programme, which we’re supporting with over £2.45 million, aims to spot warning signs earlier and save lives, preventing families and their babies from facing the horrific ordeal of a life-changing brain injury. It will help us deliver on our ambition to halve brain injuries during birth by 2025.

Having the right maternity staff in the right place at the right time means they can learn from one another, give the best care for mums and babies and build a safe and positive environment for both staff and pregnant women in maternity teams across the country.

Due to be carried out by the end of this year, the ABC review aims to develop a nationally agreed approach for how staff monitor the condition of a baby during labour by:

• testing different approaches to monitoring babies during labour and surveying maternity staff to see how midwives and obstetricians currently identify when a baby is in distress during labour and how they then deliver babies even more safely

• interviewing women and their birth partners on these varying approaches based on their personal experiences

• agreeing on a clear process to monitor babies and record readings during labour with a flowchart guide to decide when to escalate a case to the wider multi-disciplinary maternity team

• developing a nationally agreed approach to delivering babies via caesarean section when there are complications with the baby’s positioning

The review will be carried out through a partnership with the Royal College of Midwives (RCM), The Healthcare Improvement Studies Institute at the University of Cambridge and the RCOG.

The 3 organisations will aim to agree the best clinical practice for managing deteriorating conditions of babies during labour and test how this could be rolled out across maternity services in England in future.

The DHSC has also provided almost £450,000 to the RCOG to develop a new workforce planning tool to improve how maternity units calculate their medical staffing requirements, to better support families and babies.

Over the next year, RCOG will collaborate with and gather data from the health sector, determining how the tool can help NHS Trusts to understand their own medical staffing needs, and provide standardised, safe and personalised care tailored to their communities.

Due to be freely available to NHS Trusts across the country next year, the tool will aim to:

• provide maternity staff with a new methodology that calculates the numbers, skill sets and grades of medical staff required within individual maternity units based on local needs

• help Trusts tackle inequalities by taking into account local factors such as birth rates, age of population, the socio-economic status of the area, and geographical factors

• calculate the number of obstetricians at all grades required locally and nationally to provide a safe, personalised maternity service within the context of the wider workforce

• identify innovative ways of working to better utilise the current workforce

• help gain a better understanding of the factors that promote safety and positive culture within maternity teams and how these can be rolled out nationally

Dr Edward Morris, President at the Royal College of Obstetricians and Gynaecologists, said:

We’re delighted to receive funding for a new workplace planning tool and project to reduce brain injuries in childbirth. This investment will go a huge way to improving the quality of care provided to pregnant women and their babies.

We recognise that appropriate maternity staffing is fundamental to providing safe care for women and we hope this tool will give maternity units in England a clear guide to determine how many medical staff they require in their specific setting.

The new project to avoid newborn brain injury in childbirth aims to address the challenges around effective foetal monitoring, building on the great work already being done in this area. We understand that the impact of avoidable newborn brain injury is profound and we want to do everything we can to ensure no family has to experience it.

Gill Walton Chief Executive at The Royal College of Midwives (RCM) said:

Every avoidable brain injury leaves families devastated and affects midwives and maternity staff. For the vast majority of women and their babies, the UK is a safe place to give birth. However, tragically avoidable brain injuries do happen. It’s imperative we work together in maternity services to do all we can to reduce avoidable brain injuries during birth.

Partnership working is the key to improving safety for women and their babies. This funding will enable the RCM and RCOG, in partnership with the Department of Health and Social Care, to review approaches to monitoring babies during labour. More multi-disciplinary training in this area will ultimately go towards improving safety for women and their babies. Crucially, this review will also include the voices and personal experiences of women and their birth partners to enable maternity to inform better, safer care.

The RCM also welcomes the funding that has been allocated to the RCOG to develop a new maternity obstetric workforce planning tool. Far too many maternity reviews have cited understaffing and the impact that has on safety in maternity services. The development of such a tool will bolster safety and improve on the current maternity staff skill mix, which is key to delivering safe, high-quality maternity care.

Chief Midwifery Officer for England, Jacqueline Dunkley-Bent, said:

Providing safe and effective care to babies and their mothers is a key priority for the NHS and this new support will bolster our own Maternity Transformation Programme to prevent brain injury during birth – which we aim to reduce by at least half over the next 5 years.

The government’s maternity safety ambition is to halve the 2010 rates of stillbirth, neonatal and maternal death and brain injuries that occur during or soon after birth by 2025.

While good progress has been made in reducing the mortality elements of the ambition, the brain injury rate has fallen to 4.2 per 1,000 live births in 2019, since rising from 4.2 to 4.7 per 1,000 live births between 2012 and 2014.

Several independent inquiries into maternity safety, most recently the Ockenden Report, have highlighted the need to gain a deeper understanding of what constitutes safe staffing in maternity care. Rota gaps are reported by 90% of obstetric and gynaecology junior doctors in their units, and attrition and burnout rates are high at all career stages.