Intrapartum-related perinatal deaths in births planned in midwifery-led settings in Great Britain: findings and recommendations from the ESMiE confidential enquiry.

Tytuł:: Intrapartum-related perinatal deaths in births planned in midwifery-led settings in Great Britain: findings and recommendations from the ESMiE confidential enquiry.
Autorzy:: Rowe R; Policy Research Unit in Maternal Health and Care, National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK.
Draper ES; Department of Health Sciences, University of Leicester, Leicester, UK.
Kenyon S; Institute of Applied Health Research, University of Birmingham, Birmingham, UK.
Bevan C; Sands, Stillbirth and Neonatal Death Charity, London, UK.
Dickens J; Department of Health Sciences, University of Leicester, Leicester, UK.
Forrester M; Royal College of Midwives, London, UK.
Scanlan R; Royal College of Midwives, London, UK.
Tuffnell D; Bradford Royal Infirmary, Bradford, UK.
Kurinczuk JJ; Policy Research Unit in Maternal Health and Care, National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK.
Źródło:: BJOG : an international journal of obstetrics and gynaecology [BJOG] 2020 Dec; Vol. 127 (13), pp. 1665-1675. Date of Electronic Publication: 2020 Jun 10.
Typ publikacji:: Journal Article; Research Support, Non-U.S. Gov't
Język:: English
Imprint Name(s):: Publication: : Oxford : Wiley-Blackwell
Original Publication: Oxford [England] : Blackwell Science, [2000]-
MeSH Terms:: Perinatal Death*
Quality of Health Care*
Home Childbirth/*standards
Midwifery/*standards
Female ; Health Care Surveys ; Humans ; Infant, Newborn ; Pregnancy ; United Kingdom
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Grant Information:: International National Institute for Health Research
Contributed Indexing:: Keywords: Birth centres; home birth; midwifery; perinatal death; quality of health care; stillbirth
Entry Date(s):: Date Created: 20200522 Date Completed: 20201207 Latest Revision: 20210819
Update Code:: 20240105
DOI:: 10.1111/1471-0528.16327
PMID:: 32437088
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Objective: To review quality of care in births planned in midwifery-led settings, resulting in an intrapartum-related perinatal death.
Design: Confidential enquiry.
Setting: England, Scotland and Wales.
Sample: Intrapartum stillbirths and intrapartum-related neonatal deaths in births planned in alongside midwifery units, freestanding midwifery units or at home, sampled from national perinatal surveillance data for 2015/16 (alongside midwifery units) and 2013-16 (freestanding midwifery units and home births).
Methods: Multidisciplinary panels reviewed medical notes for each death, assessing and grading quality of care by consensus, with reference to national standards and guidance. Data were analysed using thematic analysis and descriptive statistics.
Results: Sixty-four deaths were reviewed, 30 stillbirths and 34 neonatal deaths. At the start of labour care, 23 women were planning birth in an alongside midwifery unit, 26 in a freestanding midwifery unit and 15 at home. In 75% of deaths, improvements in care were identified that may have made a difference to the outcome for the baby. Improvements in care were identified that may have made a difference to the mother's physical and psychological health and wellbeing in 75% of deaths. Issues with care were identified around risk assessment and decisions about planning place of birth, intermittent auscultation, transfer during labour, resuscitation and neonatal transfer, follow up and local review.
Conclusions: These confidential enquiry findings do not address the overall safety of midwifery-led settings for healthy women with straightforward pregnancies, but suggest areas where the safety of care can be improved. Maternity services should review their care with respect to our recommendations.
Tweetable Abstract: Confidential enquiry of intrapartum-related baby deaths highlights areas where care in midwifery-led settings can be made even safer.
(© 2020 The Authors. BJOG: An International Journal of Obstetrics and Gynaecology published by John Wiley & Sons Ltd on behalf of Royal College of Obstetricians and Gynaecologists.)

Comment in: BJOG. 2020 Dec;127(13):1676. (PMID: 32524741)
Comment in: BJOG. 2021 Sep;128(10):1713-1714. (PMID: 34132455)

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