Royal colleges urge trusts to act on maternity safety

Following high profile cases of babies dying or being left with permanent brain damage because of delays and mistakes in interpreting foetal heart rates, the Royal College of Midwives and the Royal College of Obstetricians and Gynaecologists have released a joint statement outlining their position and urging trusts to ensure staff practice in line with evidence.

In May HSJ highlighted widespread concerns among coroners and maternity experts after babies’ deaths were linked to poor interpretation of foetal heart rates and in some cases an inability by staff to recognise deterioration.

Data obtained from NHS Resolution, formerly the NHS Litigation Authority, showed the problems were being repeated across the NHS with hundreds of claims a year costing the service £500m.

Last month a report by the RCOG found hundreds of babies had died during or shortly after birth or who suffered serious brain damage could have had a different outcome if their NHS care had been different. The report identified serious flaws in local investigations by trusts and said more than 550 babies potentially suffered avoidable harm.

The colleges said continuous foetal heart monitoring is recommended for all mothers where there may be complications, and trusts must ensure they have evidence based policies on monitoring.

They also reiterated the need for trusts to employ a “fresh eyes” approach where different midwives and obstetricians routinely check their colleagues’ decisions over heart monitoring recordings. They said this helps “to reinforce good practice and helps with decision making”.

The statement said: “All NHS maternity providers must have evidenced based guidelines or policy on foetal monitoring which staff working in those organisations are expected to follow. Mandatory training programmes for maternity staff (including student midwives) provided in NHS trusts and health boards commonly include sessions on foetal monitoring and interpretation of the foetal heart rate.

“This may also be included in the multidisciplinary practical ‘skills and drills’ training, where the maternity team work together to identify and manage a range of obstetric emergencies. In addition, training is provided through regular multidisciplinary meetings where cases are reviewed and good practice shared.”

They added: “The RCM and RCOG support the guidance recently published by NICE that [electronic foetal monitoring] is not routinely recommended for healthy women at low risk of complications in established labour.

“The foetal heart rate is instead measured intermittently during established labour using a handheld monitor. EFM is most commonly recommended for the woman and her baby where there are complications, such as where a baby is compromised through poor placental function and the baby is growth restricted.

“As recommended in the latest Each Baby Counts report, all women who are apparently at low risk should have an initial formal assessment when they go into labour, irrespective of the place of birth, to determine the most appropriate foetal monitoring method. This will include review of antenatal history, stage and progress in labour, and any signs the baby may not be coping with labour.”