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Insight

To prevent mistakes, the government must not ignore the stats on birth injuries

Jane Weakley
15/05/2017

The alarming figures revealed by the BBC this week detailing the number of mistakes routinely occurring in maternity wards around the country must be taken very seriously by the Government.

Because of the impending election, the Department of Health could not respond to the report that 1,400 mistakes were recorded on average EVERY WEEK in NHS maternity wards between 2013 and 2016. It did, however, reiterate that 'plans were in place' to halve rates of stillbirths, neonatal deaths and brain injuries in babies by 2030.

Forgive me for sounding cynical, but 13 years is simply too long to wait to reduce the devastation inflicted on families whose babies are left severely disabled or who die because of errors made by medical professionals during labour.  The mistakes may be routine but the effects are far from it.

The Chief Executive of the Royal College of Midwives Cathy Warwick is absolutely right that safety is being compromised by a lack of midwives in our wards and a declining number of students in training. We desperately need better levels of funding for maternity wards. But she, and the health secretary, must also take responsibility for the fact that many of these errors are very basic mistakes that should never be allowed to happen, however busy the ward is.

I have been dealing with birth injury cases for more than 20 years and, depressingly, the same mistakes recur again and again, too often resulting in a tragedy from which a parent never fully recovers. Their strength and resilience in caring for their severely disabled children or coming to terms with their loss is, however, generally remarkable.

Sometimes mistakes are exceptional rather than routine, such as a case I settled against Lewisham Hospital NHS Trust where mistaken identity meant midwives mixed up two women and one did not proceed to an immediate C-section, a delay which caused the baby girl to be born with severe brain injuries causing cerebral palsy. This girl, now 8 years old, will need specialised care for life.

In another settled case against Imperial College Healthcare NHS Trust a mother in advanced labour was advised over the phone to stay at home. The delay in her arriving at the hospital meant complications could not be managed property and the baby was born in a very poor condition and now has cerebral palsy. The Trust accepted that a call was made to the labour ward but has never been able to identify the person who gave the advice other than to say it was not given by a midwife.

These are the more unusual cases. But, generally, birth injury claims centre on fundamental errors - common types of mistakes – such as excessive force in delivering a baby, mixing up the mother's heart rate with the babies or poor CTG monitoring during what usually begins as a straightforward labour. 

CTG monitoring records the fetal heartrate of the baby. When that rate does not fall within certain parameters, it is considered pathological since it suggests the baby's condition is deteriorating. The guideline response to such distress is to proceed to delivery as quickly as possible. Delay in delivery can cause the baby to be starved of oxygen, resulting in stillbirth or brain injury, generally resulting in cerebral palsy.

Too often, adverse CTG readings are simply not picked up, reacted to or communicated properly between staff – the reason behind cases I have brought against far too many hospital trusts – Lewisham and Greenwich, Imperial Healthcare, North West London, Brighton and Sussex University, West Hertfordshire – the list goes on.

Similar patterns are birth injuries occurring due to the overstimulation of the uterus in an attempt to speed up the labour. Or during the neonatal period where babies are discharged without breast feeding fully established, leading to hypoglycaemia and brain damage. None of these cases are because of understaffing or poor resources, they are simply due to human error, likely caused by lack of training.

Each time a trust prepares an internal report the promise to the family, or the coroner, when involved, is that lessons have been learnt and new policies and procedures implemented to prevent similar mistakes happening again. And yet they do.

It goes without saying that no medical professional goes to work with the intention of causing harm. But the awful truth is that the UK has one of the worst records for birth and neonatal injuries and stillbirth in Western Europe, and that is simply not good enough.

Until we can offer with certainty a standard of care that includes the basics as a matter of course, the Government is simply not fulfilling its promise to take birth statistics seriously.

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