Most births in England are safe despite growing pressures on maternity services, says an independent inquiry published this week. But it warns that the lack of a systematic approach to ensuring safety creates unnecessary risks.
The inquiry focused on the safety of mothers and babies during birth rather than the quality or efficiency of maternity services. It found that stillbirths, infant mortality rates, and maternal deaths related to pregnancy or birth have decreased or remained stable in the past 10 years even though birth rates and the complexity of pregnancies have increased.
However, it also found several problems that it considered undermined a systematic approach to safety. These included insufficient focus on maternity services and safety by some NHS trust boards; staff overburdened by too many separate sets of guidelines and by guidelines that are too complex; tension between obstetricians and midwives, leading to problems with team working and communication; poor management of maternity teams, particularly at crunch points such as shift changes and in emergencies; and inadequate numbers of staff with the right skills on duty.
Onora O’Neill, president of the British Academy and chairwoman of the inquiry, said, “Despite concerns about the safety of maternity services, maternal and perinatal death rates have remained low in the face of growing pressures and a rising birth rate. This is something to build on, so that all births are as safe as possible.
“Maternity services are fortunate to have a dedicated workforce, but I believe they could work in ways that are less burdensome for them and would, on balance, be safer for mothers and babies.”
The inquiry, which was commissioned by the King’s Fund, an independent foundation that reviews health policy, recommended that trust boards strengthen their accountability for maternity safety by prioritising safety; communicating that priority to staff and patients; and making data on the safety of their maternity services publicly available.
It proposed that standards for the safety of maternity services should be set and monitored by a single body, the Healthcare Commission (in future, the Care Quality Commission). National guidelines should be adapted to produce short summaries and one page protocols that can be used easily by staff for training and practice.
It also called for better collaboration between different professionals, with consistent ways for handing over between shifts. There should also be more on the job training, such as “skills and drills” training for dealing with emergencies. In addition, trusts should ensure that maternity services are properly staffed and that staff are deployed more effectively at the same time as giving more priority to the safety of maternity services.
The inquiry was based on written and oral submissions from a broad range of organisations and professionals; visits to selected maternity units in England; research into the views of women with recent experience of childbirth; and the wider literature on safety in general and maternity services, in particular. It follows a review of maternity units by the Healthcare Commission last month that found significant variations in the quality of care across the country (BMJ 2008;336:238-9 doi: 10.1136/bmj.39475.348218.DB).
The King’s Fund plans to explore and test the inquiry’s recommendations with maternity units that are interested in improving safety standards.
Safe Births: Everybody’s Business is at www.kingsfund.org.uk.