RCM Guidance for Midwifery care in labour
The royal college of Midwives has launched new guidance ‘Midwifery care in labour guidance for all women in all settings’.
The document provides evidence-based recommendations for care of women during labour and birth. The guidance cover topics including eating and drinking in labour, Fetal heart rate assessment and preventing severe genital trauma. It covers recommendations for practice and good practice points.
Some of the recommendations include:
The RCM has published a document for midwives and also for women and their companions.
US Obstetric Trauma for vaginal deliveries is decreasing
The Agency for Healthcare Research and Quality has released their ‘Chartbook on patient safety report’ which reviews data across a number of areas to highlight areas of strength and weakness. Included in this report is data measuring obstetric trauma from 2000 to 2015.
Over the period obstetric trauma for deliveries both with and without an instrument has decreased. The overall rate in 2015 was , the rate of obstetric trauma was 119.3 for instrument-assisted vaginal deliveries and 17.7 per 1,000 vaginal deliveries without instrument assistance.
There were some disparities across age groups, ethnicities and states with Vermont having the lowest obstetric trauma rate and Nebraska the highest.
The full report an be viewed here.
RCOG Clinical Guidance – Care of Women with obesity in pregnancy
The RCOG has published an update of its green top guideline ‘Care of Women with Obesity in Pregnancy’. The guideline includes recommendations for interventions prior to conception, during pregnancy and the period after.
The recommendations cover:
The document provides specific guidance as to what actions can be taken on the above topics and also outlines the evidence for that particular recommendation.
Read the full guideline here.
Each Baby Counts Report published – UK review of safe maternity care
The recently published Each Baby Counts report provides recommendations and key findings from the analysis of data for care given to mothers in 2016. The report focuses on 3 different areas – Guidelines, Anaesthesia and barriers to reporting.
In 2016 there were almost 700,000 babies born, of those, 1123 met the Each Baby Counts criteria. The report identified 124 stillbirths, 145 babies who died early and 854 babies who sustained severe brain injuries during labour at term. 674 of those babies (71%) may have had a different outcome if their care had been different. An increase compared to the report for 2015 data that identified a possible different outcome for 556 babies.
The report identifies that many factors contribute to care outcomes with an average of 7 factors for each baby, both clinical and non-clinical. It provides key recommendations for improvement focusing on 2 clinical areas:
Also identified in the report are areas where reporting can be improved including improved resource (IT available, correct people involved), Neonatal input and education of all teams to highlight the importance of an effective review.
The full report, available here, provides examples of where things have gone wrong and details what you can do to improve care.
What We Can Do about Maternal Mortality — 4 actions all hospitals can take
An article has been published in the New England Journal of Medicine recommending 4 actions that can be taken by hospitals providing obstetric care to help reverse the trend in pregnancy related deaths.
The goal is to provide high-quality care, creating a culture of safety with a management system and training to support.
The full article available here provides more details on the 4 actions that can be taken.
You can also listen to this interview with Dr Susan Mann who is discussing these actions.
Maternity Outcomes Matter – Website Live
The Maternity Outcomes Matter project is working to reduce avoidable harm to mothers and babies that occurs during maternity care. It provides the perspective and experiences of families who have experienced harm, charities working on the avoidance of harm and health care professionals.
The website shares stories of the families who have experienced harm, provides resources on current maternity projects and blogs on all things relevant to reducing harm. The latest post highlights the study working on providing better care for grieving parents with the below video.
Visit the website here.
Mental Health: Speak out, seek help, get treatment
An Australian doctor has spoken out about his experiences with mental health to encourage other health care professionals to speak out and get help.
The Professor, President of RANZCOG, wrote about his experiences as a young doctor and his attempt to take his own life.
He highlights the importance of seeking help and providing support for colleagues writing:
‘For every doctor, especially our juniors, it is important to understand that mental health and emotional issues are nothing to be embarrassed about or ashamed of. They are important and need acknowledgement and treatment. We need to support each other and make this message abundantly clear.’
Read about his experiences in full here.
MBRRACE-UK has published its most recent report ‘Saving Lives, Improving Mothers’ Care’ which reviews lessons learned to inform maternity care from the UK and Ireland Confidential Enquiries into Maternal Deaths and Morbidity 2014–16.
Between 2014 – 16 there were 225 women who died during or up to 42 days of the end of pregnancy with a direct or indirect cause being pregnancy. The top 3 causes of direct deaths were thrombosis & thromboembolism, major obstetric haemorrhage & suicide. There were an additional 286 women who died between 6 weeks and 1 year of the end of pregnancy with the main cause being suicide. Improvements in care may have made a difference to the outcome for 38% of women who died.
Key areas for action highlighted are:
The full report included a number of recommendations and can be viewed in full here.