Mums, you have a 1:200 risk of stillbirth – what can you do about it?

Sorting out the figures from the office of National Statistics is not easy. Comparisons between the 4 different jurisdictions are not obvious. Different countries produce figures in different years and the speciality is changing rapidly. Concentration of specialist services has been shown to work, provided transport links are good. Even remote areas of Canada and Australia can have good figures given the right infrastructure. The latest (2013) BBC report from Wales indicates there is a lot to be done in our poorest region. (Stillbirth rate ‘unacceptably high’ in Wales say AMs) The rates for the different Welsh regions are summarised and available in real time, and show that Cardiff and Vale trust is worse than Hywel Dda. 15 babies a year die daily (The SANDS charity) in the UK. It is time to address this, and locally led midwifery units at a distance from specialist centres may not help. Deprivation and smoking go together…

So what can you do about it? Mums can stop smoking, stop alcohol, stop drugs, reduce weight if obese, eat a better diet, keep active and fit, go to antenatal classes, and meet other mums for support. Moving to a richer area would not affect an individual’s risk, but if moving meant the specialist services for a high risk pregnancy were closer this might be well worth considering… The governments job is to treat populations and the illiberal success of the anti-smoking lobby is a major gain. Going privately may increase your chances of intervention (perverse incentives) and figures for private outcomes are not available from the UK. Australian results suggest worse outcomes.. Its an option not only to make the baby on holiday, but to have it away from home..

Image result for clever baby cartoon

There is good news in the latest statistics, but the BBC announced yesterday that there was only one country worse in the EU and that was Malta. There is much to be done.. The Times leader on Stillbirths – by Janet Scott of SANDS.

Chris Smyth reports in the Times 21st June 2017: Better care during birth could have prevented hundreds of baby deaths

Three quarters of babies who die or are brain damaged during birth could have been saved with better care, a study has concluded.
Hundreds die each year because mistakes are repeated and hospitals must improve heart-rate monitoring and staff communication, the report by the Royal College of Obstetricians and Gynaecologists said…. almost one in 200 babies is born dead…

and on June 22nd: Stillbirth rates decline for the first time in a decade

Stillbirth rates have started to fall for the first time in a decade, according to figures that underline the importance of pressing hospitals to take action.

In 2015 about 250 babies survived who would have died two years earlier, figures that recorded an 8 per cent drop in stillbirth rates suggest. Experts said that the fall would have to speed up to meet a target to halve stillbirths by 2030.

There are also still big variations, with death rates a third higher in the worst-performing areas than in the best-performing.

The Royal College of Obstetricians and Gynaecologists (RCOG) said yesterday that three quarters of babies who died or were brain damaged at birth could have been saved had they received better care.

It was the latest in a series of reports and safety initiatives underscoring repeated errors in maternity units that have appeared since The Times highlighted complacency in the NHS over stillbirths in 2012. The latest figures suggest that such messages are starting to filter through, with stillbirth rates falling from 4.2 per 1,000 births in 2013 to 3.87 in 2015, according to the most authoritative academic study…

…Overall in the UK the number of stillbirths fell to 3,032 in 2015 from 3,252 the year before, but deaths before and soon after birth still vary around the country, from 5 to 6.5 per 1,000…. Disappointingly, the findings show only a small reduction in neonatal death rates.”

…Deaths within the first week of life were 1.74 per 1,000 in 2015, compared with 1.84 two years before….

Image result for stillbirth rates europe

Infant Mortality and Stillbirth in the UK – Parliament UK (2014) .pdf

Infant death rate ‘lowest ever’ recorded – BBC News (best in the affluent areas, and some areas saw worse results).

It does  not help when a charity (Kicks Count) is reported in the South Wales Argus 20th June:  Baby heartbeat detectors should be banned, says pregnancy charity when they really mean for unqualified patients.

In Scotland the Herald on 15th June reported the main reason for improvement: Smoking rate in UK second lowest in Europe after 25 per cent fall …

The long term results of rationing midwives and doctors in training…

“Reducing the ratio (of maternity staff in Surrey) to balance the books is the worst of all decisions.”

Stillbirths in all different UK systems are still too high

50,000 short – not £millions but staff…. 

and now we need more despite Brexit: (Chris Smyth June 22nd – NHS in talks to recruit Indian nurses to deal with staff crisis).

Michael Safi in the Guardian 2014: Babies born in private hospitals ‘more likely’ to have health problems – The Study, which looked at 700,000 ‘low-risk’ births in NSW, suggests higher rates of medical intervention could be the cause

Image result for baby delivering tourists cartoon

The Times leader on Stillbirths – by Janet Scott of SANDS.

 

 

 

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This entry was posted in A Personal View, Good News, Midwives, Perverse Incentives, Post Code Lottery, Stories in the Media on by .

About Roger Burns - retired GP

I am a retired GP and medical educator. I have supported patient participation throughout my career, and my practice, St Thomas; Surgery, has had a longstanding and active Patient Participation Group (PPG). I support the idea of Community Health Councils, although I feel they should be funded at arms length from government. I have taught GP trainees for 30 years, and been a Programme Director for GP training in Pembrokeshire 20 years. I served on the Pembrokeshire LHG and LHB for a total of 10 years. I completed an MBA in 1996, and I along with most others, never had an exit interview from any job in the NHS! I completed an MBA in 1996, and was a runner up for the Adam Smith prize for economy and efficiency in government in that year. This was owing to a suggestion (St Thomas' Mutual) that practices had incentives for saving by being allowed to buy rationed out services in the following year.

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