Progress towards the national ambition to reduce baby loss

Summary

There will be a debate in Westminster Hall on policy to reduce baby loss. This debate will take place on the 20th of July at 9:25am. The subject for this debate was determined by the Backbench Business Committee. Cherilyn Mackrory MP and Jeremy Hunt MP, will lead the debate.

Background

The term baby loss can describe several different types of bereavement including miscarriage, ectopic pregnancy, molar pregnancy, stillbirth, neonatal and infant death, and termination of pregnancy. Pregnancy and baby loss are defined differently around the world. In the UK, a miscarriage is the loss of a pregnancy during the first 23 weeks; a stillbirth is when a baby is born dead after 24 weeks of pregnancy. When a baby dies within the first 28 days of life it is called a ‘neonatal death’.

An ectopic pregnancy occurs when a fertilised egg implants itself outside of the uterus, typically in one of the fallopian tubes, where it cannot develop. A molar pregnancy happens when something goes wrong during the initial fertilisation process which means the baby and a placenta do not develop as they should after conception.

Further information is provided on the NHS website, and from a number of organisations offering information and support, including The Lullaby Trust, Bliss, the Miscarriage Association, and Sands, the Stillbirth and Neonatal Death charity.

The ambition to reduce baby loss

The 2015 report of the Kirkup review uncovered “serious and shocking” problems with maternity care at the University Hospitals of Morecambe Bay NHS Foundation Trust.[1] As the Health and Social Care Committee has noted, since the Morecambe Bay scandal, major concerns have been raised, at Shrewsbury and Telford Hospital NHS Trust and East Kent Hospitals University NHS Foundation Trust. The Committee state that these “…emerging findings from investigations into those trusts are a stark reminder that lessons still need to be learned and there can be no complacency when it comes to improving the safety of maternity services.”[2]

There have been a number of initiatives focused on improving the safety of maternity services in England, since the Kirkup review. These included, the National Maternity Safety Ambition, launched in November 2015 and updated in November 2017, to reduce the 2010 rates of stillbirths, neonatal and maternal deaths and brain injuries in babies that occur during or soon after birth by 20 per cent by 2020 and 50 per cent by 2025.[3] The Government also launched a Safer Maternity Care action plan in October 2016 as part of this “national ambition”.[4]

Other measures included:

• the introduction of new independent maternity safety investigations process, where every case of a stillbirth, neonatal death, suspected brain injury or maternal death that is notified to the Royal College of Obstetricians and Gynaecologists Each Baby Counts programme—about 1,000 incidents annually—will be investigated not by the trust at which the incident happened, but independently by the Healthcare Safety Investigation Branch.
• The Saving Babies’ Lives Care Bundle (SBLCB) has been provided to maternity units in England since 2019. This guidance supports services in reducing still births and early neonatal deaths. This initially included four elements are care widely recognised as evidence-based and/or best practice including: reducing smoking in pregnancy, risk assessment and surveillance for fetal growth restriction, raising awareness of reduced fetal movement and effective fetal monitoring during labour. Version 2 of SBLCB was launched in March 2019, including an additional element to reduce preterm birth.
• The Maternity and Neonatal Safety Improvement Programme (formerly known as the National Maternal and Neonatal Health Safety Collaborative), which aims to support NHS Trusts with practical improvements to make care safer in maternity units.

in February 2016, the NHS England report, Better Births: Improving outcomes of maternity services in England, set out a vision for maternity services to become safer, more personalised, kinder, professional and more family friendly.[5] NHS England’s Maternity Transformation Programme seeks to achieve the vision set out in Better Births by bringing together a wide range of organisations to lead and deliver across a number of work streams.

The 2019 NHS Long Term Plan included a commitment to work with midwives, mothers and their families to implement continuity of carer so that, by March 2021, most women receive continuity of the person caring for them during pregnancy, during birth and postnatally. It also committed to an enhanced and targeted continuity of carer model for Black, Asian and minority ethnic (BAME) women, as well as for women from the most deprived areas. This included a commitment for 75% of women from BAME background to receive continuity of care by 2024.[6]

The Maternity Workforce Transformation Strategy was published in March 2019 by Health Education England and set out plans to retain experienced and skilled maternity staff, as well as supporting employers to upskill and develop their workforces through new roles and new ways of working. This includes rolling out the ‘Maternity Support Worker’ role with a national competency, education and career framework; and new routes to becoming a registered midwife, including via apprenticeships.

[1] Dr Bill Kirkup CBE led an independent review of maternity safety incidents between 2004 and 2013 at the University Hospitals of Morecambe Bay NHS Foundation Trust. The report of the Morecambe Bay investigation was published in March 2015.

[2] Health and Social Care Committee, The safety of maternity services in England, 6 July 2021, HC 19 2021-22

[3] The original 2015 ambition was to halve rates of stillbirths, neonatal deaths, maternal deaths and brain injuries that occur during or shortly after birth, by 2030, with the target subsequently brought forward to 2025

[4] Department of Health, Safer Maternity Care action plan, October 2016, Executive summary

[5] NHS England, Better Births: Improving outcomes of maternity services in England – A Five Year Forward View for maternity care, February 2016

[6] NHS Long Term Plan, January 2019, para 3.13