The Government recently announced its plan to create more than 3,000 places on midwifery training courses over the next four years (with an extra 650 places expected to be created by 2019) to help meet NHS staffing demands, particularly in maternity services. The announcement is part of health and social care secretary Jeremy Hunt’s ambition to make the NHS safer and halve the rate of stillbirths, neonatal and maternal deaths and brain injuries during birth by 2025. In addition to the increase in training places, Mr Hunt will also promise mothers that they will be seen by the same midwife throughout their pregnancy, labour and birth by 2021. Research suggests that women who benefit from continuity of care are 19% less likely to miscarry, 16% less likely to lose their baby and 24% less likely to give birth prematurely.
Gill Walton, chief executive of The Royal College of Midwives (RCM), said: “This is a very long overdue acknowledgement by the Government that England’s maternity services need more midwives. The RCM has been campaigning to get successive governments to eradicate the midwife shortage for well over a decade...” However, she added: “…Whilst we welcome the commitment to continuity of care, it is ambitious. The additional midwives who start training next year won’t be qualified midwives working in our maternity services until 2022…it will not transform maternity services right now. It will take seven or eight years before all of the new midwives announced today will be actually working in our maternity services.”
Tragically, and despite medical advances, it is estimated that 15 babies are stillborn or die soon after birth every day in the UK, in addition to those who suffer brain injuries during birth. In 2016 Britain was ranked 33 out of 35 in the developed world for its stillbirth rates, with more than 3,600 stillbirths reported in the UK every year. Although a large proportion of stillbirth and neonatal deaths are unavoidable, there are still a significant proportion of deaths that could have been avoidable if expectant mothers had been appropriately monitored throughout their pregnancies.
Some of the well known causes of stillbirth include:
Amy Milner, an associate in the clinical negligence team at Penningtons Manches, comments: “While the Government’s plan for more training courses for new midwives will not transform maternity services immediately, it must be seen as a step in the right direction in trying to tackle staffing demands in the NHS and specifically with regards to the shortages in maternity services. We often come across mothers who have lost a baby and want answers about what went wrong and whether the death could have been avoided. Frequently it is clear that a significant proportion of these mothers have had a lack of continuity of care throughout their pregnancy which could, in some situations, have made a difference in the management they received and subsequent outcome.
“An example of a recent case we advised on relates to advice given by a midwife to an expectant mother when she presented to hospital at 37 weeks with a history of spontaneous rupture of membranes. The mother was not given the appropriate advice by the midwife to return within 24 hours for an induction of labour, nor was any follow up procedure put in place. When she returned to hospital two weeks later, intrauterine death was confirmed. A number of concerns regarding the mother’s care were highlighted during our investigation, which included a failure to ensure that there was any follow up when she did not attend routine appointments, or to arrange further appointments. In addition, there was a failure to give the mother a date to return for review following the spontaneous rupture of membranes. It was accepted that this was a negligent failure and had she been properly advised a plan would have been made for induction of labour within 24 hours and her baby would have been born alive.
“There were a number of failings in this case, but it did highlight that the mother did not have any continuity of care throughout her entire pregnancy which could have made a difference to the overall outcome. We therefore hope that the Government’s plans to increase the number of training courses and improve continuity of care will have a positive impact on the NHS maternity services.”