Britain’s leading obstetrician says it is legitimate to ask whether understaffing of maternity care and labour wards is contributing to Britain’s stubbornly high rates of baby death and brain damage.
Dr David Richmond, president of the Royal College of Obstetricians and Gynaecologists, has voiced alarm that nearly 300 babies a year are dying during or soon after birth with a further 1,200 ending up with brain damage or other serious health problems.
The infant deaths, Richmond said, were due to a range of issues. But with maternity units struggling to cope with a baby boom over the past 10 years and a shortage of midwives and doctors, Richmond said it was “a legitimate question to ask” whether pressure on resources was contributing to the tragic toll.
“We need to look at the possibility that understaffing, labour wards that are under pressure and busy, and stretched facilities may be a factor in some of these poor outcomes,” Richmond told the Guardian in his first interview since taking up the post.
The obstetrician, who represents the UK’s 6,000 maternity doctors, also conceded that errors by doctors and midwives were to blame for some of the terrible outcomes.
There were instances where staff made “small, relatively innocuous mistakes [which], when combined, lead to a disaster”, he added.
Richmond said that Britain’s high rate of stillbirth – almost 4,000 a year or about 10 a day – was an “appalling” and largely preventable loss of life. He voiced particular concern about the 144 babies who died during labour in 2009, the last year for which figures are available, and the 134 who died within the week after birth, despite not having a major congenital anomaly.
The UK had the third-worst stillbirth rate among 35 high-income countries, according to a study in the medical journal the Lancet in 2011. While the numbers of stillbirths had gone down slightly, “it’s still a lot of mums in the 21st century that are losing their babies unnecessarily”, Richmond added.
Data from the Office for National Statistics show that there were 4.9 stillbirths for every 1,000 live births in England and Wales in 2012.
The royal college’s new president said the 22% increase in births over the past decade meant maternity units were being “squeezed” because midwife and doctor numbers have not been increasing at the same rate.
Labour wards are having to cope with too few midwives and 800 fewer consultants than are needed to provide 24-hour care in the 62 units that handle at least 5,000 births a year in which complications arise.
“If you need to have a consultant there at three in the afternoon, why is it not equally important to have a consultant there at three o’clock in the morning? In my view, it is,” Richmond added.
But the NHS‘s tight finances meant there was no realistic possibility of consultant numbers rising from 2,200 to the ideal of 3,000, he said.
Action was also needed, Richmond said, to reduce the 1,200-a-year rate of “near misses”, in which complications occur during labour and birth that often leave the baby temporarily but dangerously deprived of oxygen. Babies who become “severely hypoxic” face the risk of brain damage and profound lifelong disability.
“These are babies that are born in very poor condition and may have a very slow heartbeat or very restricted breathing or not respond to stimulation,” he said.
Each such case can leave the NHS having to find millions of pounds in compensation to pay for the substantial cost of providing lifetime care for the child.
The loss of life and very serious medical consequences for newborns in all these deaths and near-misses, totalling almost 1,500 a year, constituted “an ongoing tragedy involving potentially avoidable very serious outcomes” and represented “1,500 individual tragedies”, said Richmond.
Asked why the baby deaths occur, Richmond replied: “The best analogy is to describe them as plane crashes.
“Lots and lots of women travel through pregnancy and labour safely but occasional tragedy occurs. These tragedies are always ‘multifactorial’ and require thorough investigation to establish why.
“It is not uncommon that a series of small relatively innocuous mistakes, when combined, lead to a disaster. There are often no easy fixes.
“The challenge is to be willing to share these experiences, to learn from each other and invest in safety. There is a big difference: flights are often cancelled for safety reasons – medical emergencies during pregnancy and labour can’t be cancelled,” he said.
Sands, a stillbirth and neonatal deaths charity, said the often chronic shortage of midwives in the NHS, in which some hospitals have almost one in five posts unfilled, and potentially inferior care at weekends, when often less experienced doctors are on duty, were factors in the UK’s relatively high baby death rates.
“It is a travesty that so many babies die every year in labour in the UK, devastating the lives of families,” said Charlotte Bevan, the charity’s senior research and prevention adviser.
“In many cases, these are tragedies that happen at term, when the baby is ready to start new life outside the womb, and they should never happen. We need more midwives so that women can have continuity of care in pregnancy and one-to-one care in labour.”
The NHS had to provide “a maternity service that works as well at the weekend as it does during the weekday, that can respond to an increasingly complex pregnancy population”, she added.
Dr Dan Poulter, the health minister, said childbirth on the NHS was safe and perinatal mortality was declining.
“The numbers of stillbirths and infant mortalities are at the lowest levels since 1993, but there is still more to do. The NHS is a safe place to give birth, with women reporting high levels of trust and confidence in staff,” said Poulter, who is also an obstetrician.
The NHS in England has more than 1,500 more midwives than in 2010 and a record 6,000 more in training, he added.
Since 2012, the NHS has measured hospitals on their progress in reducing stillbirths and baby deaths, and is trying to better identify unborn babies who are smaller than average for their gestational age. Many babies who are stillborn are of below normal size.