Pressure on understaffed neonatal and maternity units and a lack of funding
for research into stillbirth is contributing to the avoidable deaths of
almost 500 babies a year, according to researchers.
In a report to be presented to the Scottish Parliament today, Sands, the
stillbirth and neonatal death charity, claims that the lives of many babies
could be saved by improved services and increased funding for research.
The charity says that despite the figure of 325 babies stillborn in Scotland
in 2008 — one of the highest per capita in Europe — there is currently no
research into understanding stillbirth issues underway, a situation that it
described as a “national tragedy”.
The number of babies stillborn in Scotland is equal to four times the overall
deaths from MRSA, twice the number of adults who are killed in car accidents
and ten times the number of cot deaths.
Sands has called on the Scottish government to ensure that stillbirths and
neonatal deaths are recognised as a major health issue and addressed as a
matter of urgency and priority.
Neal Long, chief executive of Sands, said: “Almost 500 babies dying every year
in Scotland is a national tragedy. For too long these deaths have been
ignored and yet here is compelling evidence to suggest that many babies’
lives could be saved with improved delivery of maternity services and
increased funding for research.”
The report, Saving Babies’ Lives, reveals that Scotland has one
of the highest perinatal mortality rates in Europe — that is, babies who are
stillborn or die within the first seven days of life. Mortality is highest
in urban areas with the worst social deprivation and poorest general health
indicators.
The stillbirth rate is 1 in every 200 babies born in Scotland, a figure which
has not changed significantly since the 1980s.
Over half of all stillbirths are unexplained, the majority of unexplained
deaths occurring in low-risk pregnancies. The campaigners want midwifery and
obstetric training to focus more attention on the possibility that things
can go wrong in pregnancy and how to recognise signs of risk and minimise
those risks.
The report provides evidence that although per capita funding of maternity
services in Scotland is comparably better than for England and Wales, there
are still staffing pressures in maternity units and antenatal clinics.
“There is increasing evidence that many deaths related to events in labour are
potentially avoidable,” it states. “Quality Improvement Scotland’s recent
audit of intrapartum deaths (babies dying during labour) revealed alarming
failures of care: in 44 per cent of cases where the baby died there was
evidence of ‘major sub-optimal care’, which may have contributed to the
death.”
Of the 53,000 babies born in Scotland every year, around 8,000 — one in seven
— are admitted to neonatal units. Scotland’s premature birth rate is higher
than in England and Wales and is increasing. Yet while the pressure on units
is increasing, Scottish neonatal units continue to be understaffed and
overstretched resulting in unnecessary transfers of babies and the closure
of units to new admissions.
Babies in Scotland, the report claims, are not guaranteed one-to-one nursing
care in intensive care units and says Health Boards must commit to a
long-term recruitment and training strategy for the whole neonatal workforce
to achieve minimum standards of care for babies.
There is also failure to accurately identify and understand risk factors for
stillbirth, which include obesity, smoking, social deprivation, teenage
pregnancies and older mothers. All these factors are high and rising in
Scotland.
Gillian Smith, of the Royal College of Midwives, said: “The RCM in Scotland
welcomes this report and recognises that more work and research has to be
carried out around the loss of these babies.
“We share concerns around the reorganisation of maternity services and would
support Sands in their request to make sure that during these
reorganisations we do not lose the valuable input not just from midwives who
specialise in providing support to parents and families at this time but
also for onsite facilities which help families come together and start the
grieving process.”
Case study
Not once, but twice Marion Currie has experienced the devastation of losing a
baby at an advanced stage of pregnancy. Her daughter, Lesley, was stillborn
in 2002, and her son, John, in 2006.
Both pregnancies had apparently been proceeeding quite normally and she had no
reason to worry. With better knowledge, she believes, it might have been
possible to anticipate problems and her babies might have lived.
“With my son, it was believed to be placenta failure. With my daughter, the
cause was unknown, but perhaps in both instances if simple tests had been
available, and there was more knowledge, it might have been different, it’s
difficult to say,” said Ms Currie, 47, from Musselburgh, who edits a
newsletter for the charity Sands. She has two other healthy children aged 14
and 4.
“If you could just identify which pregnancies are high risk, but appear to be
low risk, then I’m sure babies’ lives could be saved. We need more research.
“There is an expression that says a new mother is born with every child. When
the child is born, the mother is born. When the child is lost, that mother
is left. I have two living children but I am very much aware that two
children are missing from my life.
“No children are interchangeable or replaceable and every child is an
individual. There are Lesley and John-shaped holes that will never be
filled. And of course life goes on, you have to care and nurture your living
children, but the holes remain. ”
