Saving babies’ lives by reducing Scotland’s stillbirth rate
The loss of a child is something no parent should ever have to go through. But, sadly, it's a devastating reality for many families. In the UK, around one in 225 pregnancies ends in stillbirth – when a baby dies in the womb after 24 weeks gestation. One of the key aims of the Maternity and Children Quality Improvement Collaborative (MCQIC) is to reduce the Scottish national stillbirth rate.
Evidence showed that:
- Pregnant women delay seeking advice when they become aware of altered fetal movement.
- Escalation and management of reduced fetal movement continues to be a
challenging area of maternity care in the effort to reduce stillbirth.
- Midwives are reluctant to mention the risk of stillbirth to pregnant women for fear of provoking anxiety. They’re also anxious that they lack knowledge on the risks and causes of stillbirth.
- The risk of stillbirth is 47% higher in women who smoke during pregnancy than in women who do not smoke while pregnant.
In 2017-18, MCQIC’s nationwide work focused on supporting front-line staff to make improvements, where necessary, to the care they deliver. MCQIC has supported midwives, obstetricians, neonatologists, paediatricians and nurses to develop their skills in quality improvement methodology to bring about sustained improvements to care. The focus of the improvement work included:
- Increasing the percentage of midwives who have a documented discussion with pregnant women on fetal movement and ensuring evidence-based advice is used to inform women about fetal movement and who to contact when problems or concerns arise.
- Ensuring midwives have supportive conversations about the dangers of smoking in pregnancy, and introducing the monitoring of all pregnant women for carbon monoxide levels, which is now routine practice across Scotland.
- Supporting midwives and obstetricians to consistently measure the growth of babies and follow up quickly if problems are noted. Electronic fetal heart rate is monitored by a cardiotocograph (CTG). This detects poor oxygen supply to the baby. The MCQIC CTG package of care was designed to reduce stillbirth and harm by monitoring fetal wellbeing.
Implementing this person centred care means women have reliable, accurate information about how to manage concerns. This instils the knowledge and confidence required to seek support when needed. In addition, the programme has developed tools and resources to support frontline staff to respond and support women appropriately.
This story demonstrates how, at NHS Lanarkshire, work from the MCQIC programme helped result in a happy outcome for one family.
Anna is mum to three children: Rosie, Scott, and Alice. All pregnancies were deemed high risk and unfortunately her son Scott was stillborn. Understandably, given the sad passing of her son, Anna was extremely anxious when she later became pregnant with Alice.
While under the care of the multi professional team, Anna and her midwife had a discussion regarding fetal movement, the importance of monitoring her unique pattern of movement and who to call if she had any concerns. This was documented in her care plan.
Anna became concerned about her fetal movements when she was 35 weeks pregnant. Something was not quite right and Anna contacted her local maternity unit. In the hospital, she had a scan and a CTG to determine fetal wellbeing. These indicated a healthy baby and Anna was discharged home with a care plan.
However, Anna was still anxious, and she was admitted for observation two days later. Over the next 24 hours, the CTG detected potential deterioration in her baby and the fetal movements remained altered, with the CTG showing some cause for concern. The decision was made to deliver the baby by caesarean section to reduce stress on the baby.
Baby Alice was safely delivered later that night, weighing a healthy 5lb 7oz. After a cuddle with her mum, Alice was transferred to the neonatal intensive care unit for observation. Both were discharged home a week later.
Anna attributes the safe, early delivery of her daughter to the advice she received about fetal movement. This gave Anna the confidence to contact the team. She also suggests the regular CTG monitoring had ultimately detected possible deterioration in Alice’s wellbeing, which resulted in the decision to deliver her early. These interventions in care mean Alice is here today – safe, healthy, and thriving.