The latest MBRRACE-UK Perinatal Confidential Enquiry reports, released on 14th December 2023, investigate stillbirths and neonatal deaths between 1st July 2019 and 31st December 2019. The reports compare care received by Asian, Black and White women and birthing people whose baby was stillborn or died in the 28 days following birth.
The MBRRACE team also published their fifth report using data from the Perinatal Mortality Review Tool (PMRT), which reviews baby deaths in the UK.
All three reports show opportunities for improving care to save lives.
Baby Lifeline fully supports the recommendations made by MBRRACE-UK and the PMRT team, and our thoughts are with the families of the babies that died.
Perinatal confidential enquiry reports comparing the care of Asian, Black and White women whose babies died
The overall proportion of babies dying has reduced over the past five years. However, there are still significant differences in the proportion of babies dying from different ethnic groups: Black babies have the highest rate of stillbirths and deaths in the first 28 days after birth, and Asian babies are over 1.5 times more likely to be stillborn or die within the first 28 days after birth than White babies.
The reports found that most of the deaths reviewed may have been prevented with better care:
- For White women and Black women, care was assessed as poor (meaning that better care may have affected the outcome) in around 1 in 2 baby deaths
- For Asian women, care was assessed as poor in around 1 in 4 baby deaths
- For around 3 in 5 mothers, care after their baby died was assessed as poor (meaning that better care may have made a difference to the mothers’ physical or emotional health).
Differences in care
The reports also found differences in care offered to the women whose babies died:
- Tests for gestational diabetes were more likely to have been offered appropriately to White women than Black or Asian women
- Medication to stop breast milk was more likely to be offered to, and accepted by, Asian and Black women than White women
- All the Black women should have been offered a high dose of Vitamin D to take during their pregnancy, but none of them were.
The MBRRACE team found that women’s ethnicity, nationality and citizenship status was not always recorded well, and an interpreter was not always provided when needed. Where women faced challenges in their personal lives, these challenges were not always recognised, which meant that extra support was not offered. These challenges were more common for White women.
Learning to prevent stillbirths and neonatal deaths
The report offers key learning points and reminders for healthcare professionals relating to antenatal and bereavement care, and a checklist for pregnant women.
Messages for healthcare professionals and maternity services providers:
Antenatal care:
- All women should be asked about their ethnicity, nationality and citizenship status.
- Women should be offered information about maternity care in different ways. An interpreter should be offered at each appointment, if the woman needs it.
- Information about women’s personal and social risk factors should be recorded, and updated throughout the pregnancy, so that extra support can be provided if it is needed.
- Maternity care should be personalised to the needs of each woman.
- Women should be given information about antenatal screening tests, translated where necessary.
- All women with risk factors for gestational diabetes, which includes all Asian and Black women, should be offered a test between 24 and 28 weeks of pregnancy.
- All women should be offered Vitamin D to take during pregnancy, and women with darker skin or a BMI over 30 should be offered a higher dose.
Bereavement care and reviewing deaths:
- Family-centred bereavement care, in line with the National Bereavement Care Pathway, should be offered to all parents.
- Hospitals should make sure that reviews are carried out by enough people from the right specialties. At least one of these people should be from another hospital.
- As part of the review process, parents should be supported to ask questions and talk about their experience, to ensure they receive answers about why their baby died.
- All parents should have a follow-up meeting (jointly with their obstetrician and neonatal doctor, if appropriate) to review their and their baby’s care, and a clear and personalised written summary should be given to the parents.
Messages for women and families:
Addressing gaps in training to save lives
The reports published by MBRRACE show significant areas for improvement that would save lives. Recommendations include training for healthcare professionals to accurately record ethnicity, nationality and citizenship, and language needs. The report also recommends the development of training and resources to support staff to provide culturally and religiously sensitive care.
Baby Lifeline’s Mind the Gap research investigated training for maternity professionals in April 2020-March 2021 – the financial year following the period covered by these MBRRACE reports.
Our research found significant gaps in training for clinical signs on darker skin in an emergency, social complexities, communication, and cultural awareness:
- Very few organisations provided training relating to cultural proficiency, ethnic diversity and improving communication with those whose first language is not English
- Only one in ten organisations mandated training in Cultural Competency; this is now a recommendation from NHS England
- Half of UK organisations provided all main elements of the training relating to personal and social risk factors
- Fewer than one third of maternity service providers included training in the identification of clinical signs in people with Black and Brown skin in their emergency skills & drills training.
Learning from Standardised Reviews When Babies Die: National Perinatal Mortality Review Tool Fifth Annual Report
The PMRT report found improvements in the quality of reviews since the PMRT was launched in 2018, but calls for:
- Further efforts to increase parent engagement
- Inclusion of external professionals in reviews
- Multi-disciplinary reviews with relevant staff and adequate administrative support
- Improvements to action planning
Training to improve investigations
When Baby Lifeline surveyed training for maternity professionals, we found that training in Learning from Adverse Events was mandatory for relevant staff in one third of organisations. We recommended that this training should be attended by all relevant professionals working across maternity and neonatal services, and that family engagement should be included in the training.