Sara Ledger, Head of Research and Development
Abaigh McKee, Training Development and Research Executive
Baby Lifeline is committed to supporting safer and better care in maternity and neonatal services. Our thoughts remain with the families of the 241 mothers that died from 2019 to 2021, the 2,473 families that had a stillborn baby in 2021, and the 1,151 families that suffered a neonatal death that year.
MBRRACE-UK has recently published its latest surveillance reports which examine mortality for mothers in 2019-2021, and babies in January-December 2021. For both mothers and babies, leading causes of death remain the same as previous surveillance reports. Both reports show a continued need to really focus on investing in solutions and implementing the reports’ recommendations.
What the reports told us:
- There was an increase in the deaths of both mothers and babies during the COVID-19 pandemic when compared with previous years
- In both reports, women and babies who live in deprived areas or who are Black or Asian are significantly more likely to die than others in the population
- The main causes of mothers and babies dying remain unchanged.
What needs to happen to improve care and save lives:
- There needs to be a continued focus and targeted action on improving care and outcomes for those living in deprived areas, and who are Black or Asian.
- Pregnant, recently pregnant, and breastfeeding women should be treated the same as a non-pregnant person unless there is a very clear reason not to:
- Include pregnant women in vaccine and medicine research
- Tailor care after pregnancy to meet the individual needs of women and their babies
- Develop training resources and ensure that professionals have the skills to care for complex physical, mental and social care needs.
- There should be increased focus on and investment in predicting and preventing premature births (before 37 weeks gestation)
- Pregnant women need to be properly informed about and offered vaccinations for both COVID-19 and flu, at any stage of pregnancy.
State of the Nation Report (September 2023)
This report presents the perinatal mortality rates (including stillbirths and neonatal deaths) in the year 2021. The report found that perinatal mortality rates increased across the UK in the period surveyed, following seven years of a year-on-year reduction.
Inequalities in care
Sadly, inequalities in mortality rates by deprivation and ethnicity have not improved. The report showed notable increases in stillbirth and neonatal mortality rates for babies born to mothers from the most deprived areas and for babies of Black or Asian ethnicity.
Prematurity
Though stillbirth and neonatal mortality rates increased in almost all gestational age groups, the report found wide variation across different Trusts and Health Boards, and between UK countries. Significantly, babies born early (before 37 weeks’ gestational age) accounted for 3 in 4 of stillbirths and late fetal losses and neonatal deaths. Like reports before it, these data show an unequivocal need for an increased focus on preterm birth prediction and management.
We need to find out more about the causes of stillbirth
The most common causes of stillbirth and neonatal death are unchanged. Sadly, a third of stillbirths are classed as ‘unknown’, and a further third result from problems with the placenta.
Saving Lives, Improving Mothers’ Care (October 2023)
This report assesses progress towards the government ambition to reduce maternal mortality by 50% between 2010 and 2025 (Department of Health 2017) by comparing maternal death rates between the 2009-11 and 2019-21 triennia. Over this period, maternal mortality has increased by 15%.
Causes of death remain the same
Amongst the 241 women that died, COVID-19, cardiac disease and blood clots were the leading causes of death. The rise in deaths cannot be solely attributed to COVID-19, as when maternal deaths directly attributable to COVID-19 were excluded from the data, maternal mortality over this period has decreased by just 1%. More needs to be done to implement the recommendations from this report, and the reports before it.
Inequalities in maternal mortality
Women from Black ethnic backgrounds remain four times more likely to die, and women from Asian ethnic backgrounds are twice as likely to die, compared with White women. Women living in the most deprived areas are twice as likely to die when compared with women living in the least deprived areas. Twelve percent of women who died during or up to a year after pregnancy in the UK in 2019-21 had multiple severe disadvantages.
Equity of care for pregnant and postpartum women
The report also advocates for equity of care for pregnant and breastfeeding/postpartum women, and contains recommendations for women and families, including a reminder that many vaccinations (including the COVID-19 vaccine and the flu vaccine) are completely safe in pregnancy, and should be taken up by pregnant women and birthing people.
However, the report acknowledges that it is not just healthcare professionals that have a duty to keep families safe; government and NHS leaders must improve messaging and medical systems in order to keep women, birthing people and their babies safe. The report calls for a “need to prepare a route for the rapid delivery of advice and data on new vaccines and treatments, alongside a sustained focus on the risks of flu, COVID-19 and sepsis.”
What Baby Lifeline is doing to improve care and save lives
Education
Baby Lifeline improves care and saves lives through the development of training programmes based on key themes from reports, inquiries and guidelines. We collaborate with experts, organisations, families with lived experience, and frontline professionals to ensure that the programmes are relevant, evidence-based and impactful.
Much of the training topics are based on the themes from the MBRRACE-UK reports, and we regularly update our courses in line with up-to-date research and recommendations. Our aim is to educate the frontline in pertinent topics shown to be directly or indirectly related to avoidable harm and death. We want care to be better and safer for every mother and baby using maternity and neonatal units in the UK.
We know from our own research – Mind the Gap – that there are detrimental training gaps which exist in relation to avoidable harm and death. We use this research to support and advocate for frontline professionals.
Campaigning for change
Baby Lifeline raises awareness to drive improvement in maternity and neonatal services and improve safety for every mother, birthing person and baby. The charity is fortunate to be involved in several collaborative groups, advising on national policies and initiatives.