If current guidelines on standards of care were actually delivered in practice, over 500 babies a year could go home in their parents arms, rather than in a coffin.
Too many babies are dying because doctors and midwives are not doing their jobs properly. The findings of the stillbirth confidential inquiry in 2015 were appalling.
The review looked at full term, normally formed babies who tragically died before labour. If they had been delivered in the days prior to death there would be every chance of the survival of a healthy infant and negligible risk associated with induction of labour for the woman. Astonishingly, it found that :
There was evidence of a failure to monitor fetal growth in line with NICE guidance, either by not taking symphysis fundal height measurements, not plotting the measurements on a chart or not responding when growth was abnormal
There was evidence of a failure to respond appropriately to attendance and repeat attendance by women with reduced fetal movements; either a lack of investigation, misinterpretation of the fetal heart trace or a failure to respond appropriately to additional risk factors.
There was evidence of a failure to identify risk factors for gestational diabetes and to refer women for testing as per the NICE Guideline on Diabetes in Pregnancy.
Unforgivingly, nothing has changed in 15 years
An extensive review of antenatal and postnatal care of over 400 cases by CESDI in 1996–97 found that 45% of stillbirths were associated with suboptimal care. So standards may have actually got worse since then.
Even the issues remained the same:
The NHS wastes billions due to negligence in maternity care
Maternity is by far the biggest cause of compensation claims for the NHS, responsible for over 40% of claims by value. If just a tiny fraction of this was invested on preventing stilbirths, so many lives could be saved, along with billions of pounds.
A low risk primigravid woman reported an absence of fetal movements at 39+1 weeks gestation when she attended the community midwifery unit. CTG monitoring, appeared to be within normal limits and she was reassured that all was well. She attended at 40+1 weeks gestation for a membrane sweep and reported a reduction in her baby’s movements and spontaneous rupture of membrane. She was discharged home without a CTG or further investigation. She attended again at 41+0 weeks gestation with irregular contractions. She was prescribed analgesia and discharged home. At 41+5 weeks she attended with irregular contractions and on admission, intrauterine death was confirmed by ultrasound scan.Example from MBRRACE confidential enquiry, Nov 2015