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Posted on 28th August 2017
Research compiled by the Royal College of Obstetricians and Gynaecologists (RCOG) as part of the Each Baby Counts program has unearthed worrying evidence that in 76% of cases examined during 2015 relating to birth injury and child deaths, the baby might have had a better outcome if they had received better quality care. The research has potentially damning implications for the standards of maternal care in the NHS, and could mean a significant number of families may be eligible to make medical negligence claims.
Different care may have produced a better outcome
Of 1136 cases examined under the Each Baby Counts program, 11% (126 babies) culminated in intrapartum stillbirths, 14% (156 babies) in early neonatal death, and 75% (854 babies) in severe brain injuries to the child. In 76% of cases where there was sufficient investigation and evidence surrounding the circumstances of death or injury, researchers found reason to conclude that different care might have produced a better outcome for the child. If these findings were to be extrapolated to the general population – which saw more than 720,000 term babies born during the year of examination – it means potentially thousands of families nationwide have lost their child unnecessarily or had them sustain severe, long term brain injury as a result of poor care. Medical negligence solicitors point out that under such circumstances it may be possible to make birth injury to baby claims, brain injury claims, cerebral palsy claims, midwife negligence claims and hospital negligence claims, but the focus should always remain on preventing such terrible instances from happening in the first place.
Insufficient involvement in follow up investigations
Researchers also found that in 25% of cases, the investigations into the circumstances surrounding birth injuries and deaths were found to be insufficient, which raises the prospect that the levels of substandard care in our maternal services could in fact be even worse. Shockingly, of the 727 cases where the potential for a different outcome was identified, only 34% saw parents invited to be part of the review process, only 9% saw the involvement of an external (independent) panel member, neonatologists only took part in 68% of review processes, and where recommendations for improvement were made only 23% were specifically aimed at any given member(s) of staff.
RCOG recommendations
A number of recommendations were issued by the RCOG as a result of the findings, with clinical issues and human factors both taken into account in order to reduce birth injuries:
- Even pregnancies deemed to be “low risk” by physicians should be subject to formal foetal risk assessment on admission into labour units to determine the best means of monitoring the baby
- All pregnancies should be overseen by staff with continuous cardiotogography (CTG) training, who must have must have documented evidence of relevant annual trainingCTG alone should not form the sole basis for important decision-making during the birth, but should be taken as part of a wider picture considering medical history of the mother, stage and progress of labour and any other antenatal risk factors
- Where it is considered necessary to try and cool the baby down, passive measures such as fanning and switching off heaters should be considered first before therapeutic hypothermia is clinically induced, and continuous monitoring of core body temperature must be performed throughout
- Paediatric / neonatal teams must be kept informed in relation to risk factors for a compromised baby in a timely and consistent fashion
- All medical staff in attendance should be well trained and briefed in maintaining situational awareness during complex clinical procedures
- A senior member of staff must oversee procedures in a “helicopter role” as junior team members become involved in complex procedures, in order to facilitate good communication and prevent potential problems from developing further
- Medical staff should be empowered to seek the assistance and guidance of others not directly involved with or under pressure from a given situation, in a bid to reduce stress and promote a healthy sense of perspective
- “Safety Huddles” should take place between leading team members cooperating on a complex medical procedure or transfer of care, ensuring everybody involved understands their role and contributes effectively
