NHS England publishes new guidance that aims to reduce stillbirths in England.
There are currently around 665,000 babies born in England each year, but there are over 3,000 stillbirths. Despite falling to its lowest rate in 20 years, one in every 200 babies is stillborn in the UK, more than double the rate of nations with the lowest rates.
The new guidance – called Saving Babies’ Lives Care Bundle – is part of a drive to halve the rate of stillbirths from 4.7 per thousand to 2.3 per thousand by 2030, potentially avoiding the tragedy of stillbirth for more than 1500 families every year.
While the majority of women receive high quality care, there is around a 25 per cent variation in stillbirth rates across England.
The guidance addresses this variation by bringing together four key elements of care based on best available evidence and practice in order to help reduce stillbirth rates.
This is the first time that guidance specifically for reducing stillbirths has been brought together in a coherent package. It will support commissioners, providers and professionals in making care safer for women and babies.
Care bundles bring together a small number of focused interventions in order to bring about improvement. They exemplify known best practice in areas where current practice is unacceptably variable. Evidence shows that greater benefits are achieved at a faster pace when implementing those interventions together.
Building on existing clinical guidance and best practice, the guidance was developed by NHS England working with organisations including the Royal College of Midwives, Royal College of Obstetricians and Gynaecologists, British Maternal and Fetal Medicine Society and Sands, the stillbirth and neonatal death charity.
As part of this, an information and advice leaflet on reduced fetal movement is being launched and will be provided to all women by week 24 of their pregnancy. The leaflet will contain clear messaging consistent with national guidelines.
The move follows publication of the recent National Maternity Review report, which set out wide-ranging proposals designed to make care safer and give women more control.
The four key interventions outlined include:
- Reducing smoking in pregnancy – All women should be offered a test at their antenatal booking appointment to establish the level of carbon monoxide they are exposed to as well as referral to support to stop smoking. This will ensure that smokers and those exposed to smoke are fully aware of the risks to their unborn baby and are supported to make an informed decision about quitting or staying away from smoke.
The latest figures show that just over one in 10 women smoke during their pregnancy, this is below the national target set for 2015, but it masks wide geographical variation – figures from NHS Central London reveal that around one in 100 women continue to smoke, but in NHS Blackpool it is one in four.
- Enhancing detection of fetal growth restriction – Growth of babies should be monitored and recorded on growth charts and an algorithm should be used to indicate the level of monitoring required. Of the one in 200 babies that are stillborn, growth restricted babies are the single largest preventable group.
- Improving awareness of the importance of fetal movement – Women and their partners should be better informed and more empowered to monitor their baby’s movements by clear, consistent advice. An information and advice leaflet on reduced fetal movement will be provided to all pregnant women. Providers should also have protocols in place to manage care effectively for women who report reduced movement.
- Improving fetal monitoring during labour – there should be annual training and assessment for staff on cardiotocograph (CTG) interpretation and use of auscultation (monitoring of the baby’s heartbeat) during labour. A buddy system for CTG interpretation should also be implemented so that ‘fresh eyes’ can detect any potential problems during labour.
Simon Stevens, the Chief Executive of NHS England, said: “For over 650,000 families who’ll have a baby in the NHS this year, it’ll be one of their happiest and most moving experiences. NHS maternity care is now the safest it’s ever been, and most mums say they’re cared for brilliantly. But that makes it all the more tragic and heart wrenching when for a small number of families something goes terribly wrong. We could however cut the chances of this happening if all pregnant mums were encouraged to quit smoking, if proper monitoring takes place during pregnancy, and if maternity providers listen carefully when pregnant women report worries about their baby’s movements. That’s what this new NHS ‘care bundle’ – developed by obstetricians, midwives, and parents – now recommends as the best standard of care everywhere. It brings together evidence-based best practice to support midwives and doctors and is a key step in driving forward safer care as set out in the recently published national Maternity Review.”
Professor Jacqueline Dunkley-Bent, Head of Maternity, Children & Young People for NHS England, said: “Having a baby in this country is now safer than ever before, but for some mums that’s not the case, and the ‘care bundle’ and new National Maternity Review will help all families receive excellent maternity care.”
Dr Matthew Jolly, National Clinical Director for Maternity and Women’s Health at NHS England, said: “Saving babies’ Lives’ provides clinicians with the best available clinical approaches to tackling stillbirth across four key elements of care. Though many NHS maternity care providers already follow much of this best practice, this is the first time that guidance specifically for reducing the risk of stillbirth and early neonatal death has been brought together in a coherent package.”
This care bundle will be analysed and evaluated so that it can be developed and refined to ensure that it continues to reflect best practice.