Intrapartum-related perinatal deaths in births planned in midwifery-led settings in Great Britain: findings and recommendations from the ESMiE confidential enquiry.

R Rowe,M Forrester,D Tuffnell,S Kenyon,R Scanlan,J Dickens,C Bevan,Jj Kurinczuk,Es Draper

doi:10.1111/1471-0528.16327

Abstract

To review quality of care in births planned in midwifery-led settings, resulting in an intrapartum-related perinatal death. Confidential enquiry. England, Scotland and Wales. Intrapartum stillbirths and intrapartum-related neonatal deaths in births planned in alongside midwifery units, freestanding midwifery units or at home, sampled from national perinatal surveillance data for 2015/16 (alongside midwifery units) and 2013-16 (freestanding midwifery units and home births). Multidisciplinary panels reviewed medical notes for each death, assessing and grading quality of care by consensus, with reference to national standards and guidance. Data were analysed using thematic analysis and descriptive statistics. Sixty-four deaths were reviewed, 30 stillbirths and 34 neonatal deaths. At the start of labour care, 23 women were planning birth in an alongside midwifery unit, 26 in a freestanding midwifery unit and 15 at home. In 75% of deaths, improvements in care were identified that may have made a difference to the outcome for the baby. Improvements in care were identified that may have made a difference to the mother's physical and psychological health and wellbeing in 75% of deaths. Issues with care were identified around risk assessment and decisions about planning place of birth, intermittent auscultation, transfer during labour, resuscitation and neonatal transfer, follow up and local review. These confidential enquiry findings do not address the overall safety of midwifery-led settings for healthy women with straightforward pregnancies, but suggest areas where the safety of care can be improved. Maternity services should review their care with respect to our recommendations. Confidential enquiry of intrapartum-related baby deaths highlights areas where care in midwifery-led settings can be made even safer.

Highlights

Stillbirth and neonatal mortality rates in the United Kingdom remain high compared with other similar countries.[1,2] National policy aims to halve the rates of stillbirth, neonatal death and perinatal brain injury by 2025;3 intrapartumrelated perinatal deaths have been identified as a group where improvements in perinatal care have the potential to improve outcomes.[4,5,6]Confidential enquiries are an established method for assessing quality of care against national standards and guidance, usually when adverse events such as death or a 2020 The Authors
Intrapartum-related perinatal deaths in births planned in midwifery-led settings in Great Britain: findings and recommendations from the ESMiE confidential enquiry
BJOG: An International Journal of Obstetrics and Gynaecology published by John Wiley & Sons Ltd on behalf of

Summary

Introduction

Stillbirth and neonatal mortality rates in the United Kingdom remain high compared with other similar countries.[1,2] National policy aims to halve the rates of stillbirth, neonatal death and perinatal brain injury by 2025;3 intrapartumrelated perinatal deaths have been identified as a group where improvements in perinatal care have the potential to improve outcomes.[4,5,6]Confidential enquiries are an established method for assessing quality of care against national standards and guidance, usually when adverse events such as death or a 2020 The Authors. A UK-wide confidential enquiry of 78 term intrapartum stillbirths and intrapartum-related neonatal deaths, carried out in 2015 by the MBRRACE-UK collaboration as part of the national Maternal, Newborn and Infant Clinical Outcome Review Programme (MNICORP), identified overall improvements in care that may have made a difference to the outcome for the baby in 80% of the deaths.[6] Key issues included: failure to recognise the transition from the latent to the active phase of labour and institute appropriate monitoring; incomplete or inadequate maternal monitoring; errors in the method, interpretation, escalation and response to fetal monitoring; variable quality of bereavement care and poor-quality local reviews

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