Baby Lifeline welcomes the release of the Sands & Tommy’s Joint Policy Unit’s Saving babies’ lives 2023: A report on progress. Published on 15th May, the report brings together the themes from research reports to outline key areas where action is required to reduce rates of miscarriage, stillbirth, preterm birth and neonatal death in the UK.
The report highlights that the current scale of pregnancy loss and baby death is not inevitable – sometimes there are things that can be done to change these outcomes. For example, in 2021-22, nearly 1/5 of stillbirths were found to be potentially avoidable if better care had been provided.
Though analysis suggests that there has been a downward trend in pregnancy loss and baby loss in recent decades, stillbirth and neonatal death rates are not on track to meet the 2025 target for England. Saving babies’ lives: A report on progress argues that there is actually a risk of ‘going backwards’: progress is slowing or reversing, and, importantly, this perceived ‘downtrend’ does not account for nuance across regions or groups.
There is still important work that needs to be done to reduce preventable deaths and inequalities in outcomes – pregnancy loss and baby loss is not just ‘one of those things.’
Equality must be prioritised
Though it is now widely known that there are stark inequalities in outcomes for different ethnicities, babies with Black skin are still almost twice as likely to die in the first 28 days compared with babies with white skin. Meaningful action is needed to address inequality by ethnicity and deprivation.
Saving babies’ lives: A report on progress highlights that people living in the most deprived areas of the UK are almost twice as likely to experience a stillbirth as people living in the least deprived areas. Many of the risk factors associated with stillbirth are modifiable, for example by supporting women and birthing people to reduce smoking during pregnancy. However, healthcare professionals need the capacity and resource to be able to provide care that is tailored to people’s needs.
These findings align with Baby Lifeline’s Mind the Gap research into training for healthcare professionals in maternity services across the UK. We found significant gaps in training related to NHS England’s priorities on achieving equity and equality. For example, fewer than one third of providers included identification of clinical signs in Black and Brown skin. This varied widely by region: even in the most ethnically diverse areas of the UK, only 55% of Trusts surveyed told us that they provide this training for their maternity professionals.
We also found that fewer than three quarters of organisations considered the needs of the local population when deciding training priorities, and only one maternity service provided training in all relevant topics which relate to NHS England’s Equity and Equality guidance.
Systemic issues need to be addressed
The Sands and Tommy’s report argues that systemic issues in maternity and neonatal services need to be addressed in order to provide personalised, safe care. Though initiatives designed to improve safety have been introduced, the report shows that quality and safety ratings for maternity services are currently declining.
Boards must support culture change, take ownership of the safety of their maternity services, and use data to understand variation in outcomes. Serious incidents should be reviewed appropriately and consistently, and services should engage with and listen to women and birthing people, including those most likely to experience poor outcomes.
The report shows that midwives in England are less happy with the standard of care they are able to provide compared with other staff in the NHS. Midwifery staffing levels are also declining, suggesting that current issues in maternity services may get worse. Sands and Tommy’s recommend that all staff must have access to the relevant multi-professional training that is required for them to carry out their roles safely and effectively.
However, our Mind the Gap report found that, on average, multi-professional training was provided in just over half of training topics in the UK. This is clearly a key issue for improvement, as over two-thirds of maternity services identified barriers to providing multi-professional training. Providers frequently mentioned staff shortages, redeployment, staff and venue availability, and funding as barriers to providing multi-professional training.
Though it is important to point out that our information was gathered during the Covid-19 pandemic, many of these barriers to multi-professional training persist.
Baby Lifeline is committed to supporting change
The Times recently reported on analysis provided by Baby Lifeline which showed that the cost of compensating mothers and their families for harm caused by NHS maternity services is more than double what the health service spends on maternity care each year. Saving babies’ lives: A report on progress similarly touches on the economic argument for greater investment in improving maternity services. The report shows that only 1p in every £1 spent on maternity care in the NHS goes towards pregnancy research. Such research is needed to understand the causes of pregnancy loss and baby deaths, in order to be able to reduce these instances and translate findings into practice.
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Baby Lifeline is proud to work with Sands and Tommy’s as part of the Health and Wellbeing Alliance’s Maternity Consortium. The aim of creating a Maternity Consortium is to use our collective expertise to join up national and local voices behind a common agenda: to reduce health inequalities for families throughout the whole pregnancy journey from pre-conception and through the first year of a baby’s life.