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Written on 19th May 2023 by Susan Brown

The Sands and Tommy’s charities’ Joint Policy Unit have published their Saving Babies’ Lives Progress Report. The report is the first in a series of progress reports in which the charities will call on government, the NHS and professional bodies to do more to reduce the UK’s unacceptable rates of miscarriage, stillbirth, preterm birth and neonatal death.

Using data from respected sources, including MBRRACE-UK, the Care Quality Commission (CQC) and the National Perinatal Mortality Review Tool (PMRT), the charities warn that mortality rates are now heading in the wrong direction and experiences of care are deteriorating. The government’s stated commitment to act on the findings of recent maternity reviews hasn’t led to the change that is needed to save more babies’ lives.

The report emphasises that pregnancy loss, stillbirth and neonatal death must not be accepted as inevitable. Too many families are suffering the loss of a baby. With better care, many of these babies would have survived.

How many babies die during pregnancy or around the time of birth in the UK?

Every year in the UK, more than 5,000 babies are stillborn or die within the first four weeks of life, and at least 1 in 6 pregnancies end in miscarriage. In 2021, 13 babies each day were stillborn or died within their first 28 days of life.

In England, the government has set a target to halve the rates of stillbirth by 2025 compared to 2010 rates, but this target is unlikely to be achieved. An interim target of 20% reduction in stillbirths by 2020 was achieved, but stillbirth rates increased again (to 4.1 per 1000 births) in 2021.  The report notes that the impact of covid-19 on pregnancy outcomes during this time remains unclear but points out that, even before 2020, progress in England was already considered too slow to achieve the targeted 50% reduction in stillbirths by 2025.

The extended perinatal mortality rate, which includes stillbirths and neonatal (newborn) deaths, increased in 2021 after a reduction in previous years.  Newborn (neonatal) mortality for babies of 24 weeks or longer gestation also increased in 2021 after a previous reduction. England is unlikely to achieve the government’s original target of a 50% reduction by 2025 in neonatal deaths across all gestational ages which, if successful, would have led to 1,700 fewer deaths between 2022 and 2025.

There has also been little progress in reducing the numbers of babies who are born preterm (premature). Around 50,000 babies are born prematurely in the UK each year. This is significant because prematurity is a major risk factor for pregnancy loss and baby death. In 2020, nearly three quarters of the newborn babies who died in the UK had been born prematurely.

The charities point out that the outcomes for babies must also be considered alongside worsening maternal death rates, and the quality and safety and parents’ experience of their care. The report highlighted that in addition to falling behind its own national targets, the UK’s maternal mortality rate was rated one of the worst out of eight European countries in a recent study, and is almost four times higher than that of Norway and Denmark.

What causes stillbirth and neonatal deaths?

In 2021, the causes of 33% of stillbirths and 7% of neonatal deaths were unknown. The most common cause of stillbirth in 2020 was placental. Two thirds of newborn babies died from neonatal complications, including extreme prematurity, cardio-respiratory and neurological problems.

In 2021-22, nearly a fifth of stillbirths could have been avoided if the mother had received a better standard of care. The National Perinatal Mortality Review Tool (PMRT) identified 168 care issues in 2021-22 which probably affected the outcome for stillborn or newborn babies who died, with a further 642 care issues identified which may have made a difference to the fatal outcomes.  Care issues included delay in diagnosis or inappropriate management of significant medical, surgical or social problems during pregnancy, inadequate monitoring of fetal growth and information for mothers about reduced fetal movements, failures related to risk assessment, investigations, fetal monitoring, and inappropriate birth location and mode of birth, and issues with respiratory management in neonatal care. Poor observation and monitoring of the mother during labour was highlighted as a concern both by the PMRT and by a CQC maternity survey in 2022 in which a quarter of mothers reported being left alone by midwives or doctors at a worrying time whilst in labour.

What are the risk factors for pregnancy loss, stillbirth or neonatal death?

The report highlighted some characteristics of mothers and babies which are known to increase the likelihood of pregnancy loss, stillbirth or newborn (neonatal) death. Whilst these characteristics increase the risk of complications or a poor outcome, they should be recognised and managed through appropriate, personalised care. Accurate and ongoing assessment and management of the mother’s and baby’s risk factors are essential aspects of safe maternity and neonatal care.

Low birthweight has the most significant effect on stillbirth and neonatal deaths, with the highest death rates among very low birthweight babies weighing less than 1,500g. Twins and multiple birth babies have higher stillbirth and neonatal death rates and are also at higher risk of being born with lower birthweights.

Mothers’ who are younger than 20 or older than 35 have the highest age-related risk of losing a stillborn or newborn baby. Possible reasons for older women include declining uterine function affecting contractions, and increasing numbers of multiple pregnancies from fertility treatment. Adolescent mothers are at greater risk of giving birth to babies who are very preterm or have an extremely low birthweight.

Very low (underweight) or high BMI (obesity) mothers have an increased risk of pregnancy loss and baby death. In addition, obesity is associated with health conditions such as diabetes and hypertension, which increase the risk of poor pregnancy outcomes. One in five pregnant women in the UK have multiple pre-existing conditions which increase their risk, including cardiovascular disease, epilepsy, diabetes, poor mental health, special educational needs and disabilities.  Smoking is associated with increased rates of stillbirth, miscarriage and birth defects.

Ethnicity and social deprivation are also associated with stark increases in stillbirth and newborn death rates for Black and Asian babies and families living in the UK’s most deprived areas. The risk of preterm birth and miscarriage is also higher for those from minority ethnic groups. Factors which may influence these persisting inequalities include access to health services, communication, the relationship between women and their midwives, cultural and religious preferences, and social needs. The report points out that while there is a target for NHS England to reduce overall stillbirth, neonatal deaths and preterm births by 50% in 2025, there is no target to reduce inequalities for different ethnic groups. The current disparity in stillbirth and neonatal mortality rates means that the national target cannot be achieved without significantly greater reductions in baby deaths amongst the worst affected ethnic groups.

Conclusions from the Sands and Tommy’s Saving Babies’ Lives Progress Report

The Saving Babies’ Lives Progress Report highlights the disappointing lack of progress that has been made towards reducing pregnancy loss, stillbirth and neonatal mortality.

It describes an increasingly unsafe maternity healthcare environment in which nationally agreed standards of care are too often not followed, contributing to avoidable deaths. Staff are working in an increasingly under-resourced and over-stretched system which is having an impact on people’s experience of care.  NHS trusts are not learning from mistakes that have resulted in families losing their babies’ or mothers’ lives, and the voices of bereaved parents are not being heard or acted upon. National targets have done nothing to address the glaring inequalities between outcomes for families of minority ethnicity or those living in areas of deprivation, despite multiple reports highlighting their poor experience whilst accessing health services.

The report calls for:

  • Clear targets for every UK nation to save babies’ lives;
  • A stronger commitment from government to eliminate inequalities in pregnancy loss and baby deaths, backed by long-term funding;
  • Sufficient staffing capacity and resources for maternity services to respond to the changing and complex care needs of their patients;
  • A change in NHS culture to ensure openness and learning from lessons when babies die;
  • Increased investment in research and evaluation, and improvements in data collection, to include annual miscarriage rates in the UK.

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