Premature Births: Death

Commons Written Answers – House of Commons – Health

Mr. Andrew Smith:

To ask the Secretary of State for Health what progress the NHS is making in reducing the number of babies who die following premature birth.

Ann Keen:

Advances in technology and health care expertise have led to increasing survival rates of very premature babies over the last 20 years. Over the past decade, survival has improved dramatically for babies born at 26 weeks of gestation and above so that now over 80 per cent. survive.

The EPICure Study (led by the university of Nottingham, Department of Child Health) was established in 1995 to determine the chances of survival and later health status by following up children who were born in the United Kingdom and Ireland at less than 26 weeks gestational age during a 10-month period in that year. This is now an ongoing study, which it is hoped will not only show survival and rates of disability but also identify factors at birth, which could give an indication as to the long-term outcome for the survivors.

A new study, EPICure 2, covers all babies born in England at 26 weeks of gestation or less during 2006. This study will demonstrate how effective advances in neonatal care have been since the first study in 1995. Preliminary findings, published in May 2008, found that babies born above 24 and 25 weeks of gestation were significantly more likely to survive in 1995 compared with 2006.

Details of the EPICure studies can be found on the EPICure website:

www.epicure.ac.uk

NCT reveals crucial choice guarantee set to be missed by a mile

Over 95% of women in the UK are not able to choose where to give birth, a new report released today by the NCT (National Childbirth Trust) has found. Offering women choice of where to give birth is government policy across the UK as it is proven to have a positive effect on birth outcomes.

The NCT’s report, ‘Location, location, location’ highlights the benefits of choice to parents and calls for governments and health professionals to act quickly to ensure women have these choices available to them.

The ‘Location, location, location’ results show:

95.8% of women do not yet have access to a real choice between the three options of home birth with a midwife, a local midwifery facility (birth centre) either stand-alone or attached to a hospital and an obstetric unit in a hospital (the choices defined in Maternity Matters1)

89% of women live in areas that realistically do not offer the choice of a home birth with a midwife2

With greater encouragement of home birth, choice could be offered to many more women without any significant investment or shift in the way maternity services are structured.3

Over 40% of women live in areas without reasonable access to both a birth centre and an obstetric unit in a hospital

Women are lacking in the information and support needed to make these choices.3

The research for the report was commissioned in light of the Government’s Maternity Matters1 promise that all women in England will have access to choice of place of birth by the end of 2009. NCT wanted to ascertain how many women in the UK actually have access to choice. Scotland, Wales and Northern Ireland have also made similar policies that support the provision of choice for women.

Belinda Phipps, Chief Executive, NCT, says:

“There is a huge task ahead for trusts and boards as many are very behind in implementing this policy. For every ten pregnant women, nine are not able to choose where they want to give birth. We know across the UK, government policies support women with this choice. However, in reality this is not even close to being delivered yet.

“We want the governments to act now. Although in a few cases more investment in maternity services will be needed, with a simple re-thinking of the way their maternity services are delivered every trust and board can ensure choice is available to all women.

We know there are some financial policy obstacles hindering the achievement of choice the NHS could make much faster progress if it corrected these.

“There are a few trusts and boards in the UK that are succeeding in offering women a real choice and these successes are to be celebrated. We now need the rest of the UK to catch up.”

As part of the ‘Location, location, location’ campaign launched today, the NCT is calling for the commitment to guarantee choice of place of birth by the Department of Health to be implemented fully, and for the governments of Scotland, Wales and Northern Ireland to make a similar commitment to guarantee choice.

To achieve this local and national governments will need to:

Review the financial framework surrounding maternity services

Recognise the importance of midwives in reducing costs and delivering choice

Make sure that women are aware of the options and understand that for healthy women with a low-risk pregnancy, all three options are equally safe places to give birth

Ensure all in the maternity services work together and have sufficient training so they are experienced and comfortable in all three settings.

Make sure parents are provided with unbiased information to help them make their choice

Sarah Banks from Derby says:

“The first thing the midwife asked me was ‘which hospital do you want to go to?’  There was no discussion about other options and no mention of the birth centre nearby.  I told her that I wanted to have my baby at home and she refused to discuss it as she said it was too early and wouldn’t be advisable as it was my first baby.”

Both women and maternity services benefit from choice of place of birth being available. For women it leads to better birth outcomes, increased likelihood of straightforward births and improves their satisfaction with the birth. This in turn leads to higher self esteem and can increase parents’ confidence in being able to look after their baby.

For maternity services, offering these choices is likely to lead to reduced costs. Currently most women give birth in an obstetric unit in a hospital which is an expensive option3. With greater choice provided for women, more are likely to give birth in a birth centre or at home with a midwife. Therefore the effort necessary to deliver all three options will be outweighed by the savings made through less women giving birth in hospitals.

Note:

Please follow link to access: Location, Location, Location report

http://www.dodsmonitoring.com/downloads/PlaceofBirthFINALFORWEB%5B1%5D.pdf

Please ofllow link to access: Research report

http://www.dodsmonitoring.com/downloads/Investigation%20into%20choice%20of%20place%20of%20birth.pdf

Location, location, location’ details access to obstetric units, birth centres and home births in the UK and calculates the rate of women of childbearing age in each area with choice. See below for the results of the top and bottom five Trusts.

Local Authorities that offer the least choice

Local Authority	% of women of childbearing age who have choice
Middlesborough	0.0%
Boston	0.0%
Copeland	0.0%
Carlisle	0.0%
Coventry	0.0%

 

Local Authorities that offer the most choice

Local Authorities	% of women of childbearing age who have choice
South Cambridgeshire	100%
Southwark	100%
Cambridge	100%
Derbyshire Dales	91%
Bath and North East Somerset	91%

Norman Lamb: Number of caesareans deeply worrying

Commenting on figures showing that one in four babies in England is delivered by caesarean section, Liberal Democrat Shadow Health Secretary, Norman Lamb said:

“The staggeringly high number of caesarean sections being performed in this country is a serious cause for concern.

“The fact that the rate is nearly double that recommended by the World Health Organisation is deeply worrying, especially given the concerns about the increased risks of the procedure.

“We urgently need to increase the number of midwives in this country so that mothers are given all the advice and support they need during and after pregnancy.”

NHS Maternity Statistics, England: 2008/09

The new NHS maternity statistics for England 2008-9 were released today.

Belinda Phipps, Chief Executive, NCT, says;
“Again we have a release of figures that show the situation for women and babies is getting worse – high caesarean section rates, increased medical interventions, and fewer women giving birth in a place appropriate to them.

“This clearly demonstrates the effect of the lack of progress on Maternity Matters, the governments choice of place of birth promise, which was highlighted in the NCT’s  Location, location, location research report this week. Choice of place of birth leads to better birth outcomes for women, increased likelihood of a straightforward birth and improved satisfaction with the birth. “

Key Points

The caesarean rate has remained the same at 24.6%, with a rise in the numbers of elective caesareans (0.1%) and a decrease in the number of emergency caesareans (0.1%).  This shows a halt in the trend of increasing caesarean rates.
The instrumental delivery rate has increased by 0.1% to 12.2%, with a rise in the forceps rate from 5.0% to 5.5% and a decrease in the use of ventouse of 0.4%.  This continues the trend of increasing instrumental rates.
The induction rate is down 0.2% to 20.2%.  This reverses the recent upward trend.  Since 1999-2000 there had been an overall downward trend, with a low in 2005 but the rate has subsequently risen again.
Normal delivery rates are not available at the moment.  It is hoped the Information Centre will make these available in due course.

68.8% of women had a spontaneous onset of labour, similar to the previous year which was 68.6%.  [Note: this calculation uses a different source for caesarean as method of onset of labour, which is shown as 11%, rather than the 9.8% shown in Table 32, and does not reflect the rise of 0.1% in elective rates over the year]

62.9% of women had a spontaneous delivery, the same as from 2007-08.  This is at an all-time low.

	2006/07	2007/08	2008/09
Caesarean Rate	24.3%	24.6%	24.6%
Elective	9.5%	9.7%	9.8%
Emergency	14.7%	14.9%	14.8%
Instrumental Delivery Rate	11.5%	12.1%	12.2%
Forceps	4.5%	5.0%	5.5%
Ventouse	7.0%	7.0%	6.6%
Induction Rate	20.3%	20.4%	20.2%
Care on GP/Midwife Ward	10.6	11.7	10.8%
Normal Delivery Rate	n/a	n/a

 

Highs and Lows

There are 8 trusts/maternity units with caesarean rates above 30%:

 

Chelsea and Westminster Hospital	33.3%
Imperial College Healthcare NHS Trust (St Mary’s Paddington and Queen Charlotte’s)	33.1%
East Surrey Hospital	30.9%
Barnet Hospital	30.8%
University Hospital, Lewisham	30.6%
University College Hospital, London	30.6%
Royal Sussex County Hospital, Brighton	30.5%
Royal Free Hospital, Hampstead	30.4%

 

There are 5 trusts/maternity units with caesarean rates below 19%.

Kings Mill Hospital, Sutton-in-Ashfield, Notts	15.8%
Royal Shrewsbury Hospital	16.9%
Pontefract Hospital (part of Mid Yorkshire Hospitals NHS Trust)	17.8%
Barnsley Hospital	18.1%
Salford Royal Hospital	18.8%%

Midwife led care

Data for the current years show no increases in births in NHS midwifery facilities – 9.5% in the current year compared to 9.6% in 2007-08.  Care on consultant wards has increased from 44.7% to 48.8%.

Background – Since 1989-90, data have been collected on the place of delivery.  This uses the following categories:

1. NHS consultant ward
2. NHS GP ward
3. NHS combined consultant/GMP/midwife ward
4. NHS midwife ward/other ward or with delivery facilities associated with midwife ward or unit without delivery facilities

These categories are historical and do not necessarily represent current configurations of alongside birth centres, standalone birth centres, midwife led care beds in an obstetric.  Nonetheless, they can indicate changes in patterns of care.

Year	Total deliveries	Total with known place of delivery	Record completeness	Consultant Ward	Consultant / Midwife / GP Ward	GP ward	Midwife ward / Other ward	Total of midwife plus GP led care
2005-06	611,337	360,273	59%	49.4	41.5	1.6	7.4	9.0
2006-07	629,207	378,439	60%	45.9	43.5	2.3	8.3	10.6
2007-08	649,837	305,930	47%	44.7	43.6	2.1	9.6	11.7
2008-09	652,638	495,535	76%	48.8	40.4	1.3	9.5	10.8

 

This shows a decrease in GP/midwife led care in the previous year, and an increase consultant led care. However, record completeness is much higher than in previous years and changes may reflect a more representative sample than in previous years rather than changes in configurations.

Popular pregnancy and parent guides updated

New advice on storing breast milk and the best medicines to take during pregnancy are some of the updates the Department of Health has made to its popular Pregnancy and Birth to Five books being relaunched today.

The books have been a vital source of information for mums-to-be and new parents for over ten years, offering the latest information on issues that matter to them. The books will be given free to all expectant women and new parents by their midwives and health visitors.

The Pregnancy and Birth to Five books have now been updated to reflect latest advice and evidence and include extra information parents have told us they need.  Some of the changes include:

– Increasing the amount of time it is recommended breast milk can be stored in a fridge from 24 hours to 5 days

– Reflecting latest Food Standards Agency advice that:
– it is safe for mothers to eat peanuts during pregnancy, but babies shouldn’t be given them for the first six months of life
– pregnant women should not drink more than 200mg of caffeine a day – that’s two mugs of instant coffee

– Introducing a step-by-step breast feeding guide and information on medicines for common ailments while pregnant or breast feeding

All of this information has been updated in online resources on NHS Choices as it has changed, but these books bring it all together in one handy reference tool for parents.

Commenting on the new books, Health Minister Ann Keen said:

“Parents have told us how useful they find these books and the advice they give, and we’ve listened to their feedback on what extra information they need.  That’s why we’ve updated the Pregnancy and Birth to Five books to include more advice on the topics parents find most difficult including post natal depression and breast feeding.  I would encourage all parents to use these books and their midwife and health visitor to ensure they have all the information and support they need through pregnancy and early years.”

Commenting on the new books, General Secretary of the Royal College of Midwives Cathy Warwick said:

“The RCM is pleased to have helped update these publications and feels that they will be a vital new resource for pregnant women and their families. We believe that they will help empower and educate pregnant women to make informed choices and decisions about their unborn baby and their newborn child’s health.”

As well as offering advice and guidance, the books let parents know what support and contact they can expect from the NHS at every stage of pregnancy and early years.

First time mum-to-be Hannah Plumridge said:

“The new Pregnancy book is really easy to dip in and out of. It’s good to read something that is written from the NHS point of view so you don’t just learn about what is happening physically, but what you can expect at each midwife appointment and what the NHS can offer at each stage of the pregnancy. I thought the section on the labour was the most informative I have read – I now know more about the process once labour begins and what happens afterwards, rather than just physically giving birth.”

Should dads be at the birth?

Leading obstetrician, Michel Odent, says the father’s presence at the birth can lead to his partner needing a caesarean delivery, marriage break-up or mental illness in this weekend’s Observer (18 October).

Michel Odent, a childbirth specialist, also believes the mother-to-be’s labour can be longer, more painful and more complicated because she senses his anxiety and becomes nervous. Next month, Odent will discuss his views at the Royal College of Midwives’ annual conference.

Mary Newburn, Head of Research and Information, NCT, says,

“The NCT believes it’s important that women in labour are given support throughout so they can feel calm, relaxed and reassured. For most women, this means they would like to have some sort of birth companion with them, whether it’s the father, doula, friend or all three.

“Many women feel that having their partner or father of the child present at the birth will enable them to feel calm, secure and supported during the birth.

“However, some women feel that having their partner at the birth will not lead to a calm atmosphere and would prefer them not to be present. Or some partners will not feel comfortable themselves in providing physical and emotional support during labour.

“So, if both parents agree, it can be great for women if their partners are present. For many fathers being present at the birth allows them the opportunity to bond with their new baby and to feel a part of the new baby’s life from the start. Otherwise mothers-to-be should talk about who they would like as their birth companion during labour.”

Folic acid and colorectal cancer risk update

The Agency’s Chief Executive, Tim Smith, has written to the Chief Medical Officer (CMO), Sir Liam Donaldson, with updated information on folic acid and cancer.

In December 2006, the Scientific Advisory Committee on Nutrition (SACN) published its report Folate and Disease Prevention in response to a request from the Department of Health and the FSA. In its report, SACN recommended mandatory fortification of flour in order to reduce the number of pregnancies affected by neural tube defects.

In June 2007, after considering this report and options for improving folate intake of women of child bearing age, the FSA Board recommended mandatory fortification of bread or flour with folic acid. The recommendation to Health Ministers was made with the condition that there are controls on voluntary fortification and clear guidance on the appropriate use of supplements containing folic acid.

In October 2007, the CMO of England, on behalf of UK CMOs, asked SACN to consider in further detail two studies on folic acid and colorectal cancer risk that had not been published at the time of the SACN report.

A working group, comprising members of SACN, the Committee on Carcinogenicity and an external cancer expert, considered these studies and the combined results of trials that had investigated the effect of B-vitamins (including folic acid) on cardiovascular disease, which also reported effects on cancer.

SACN has concluded that the new evidence does not provide a substantial basis to change its previous recommendation for the introduction of mandatory fortification with folic acid, with controls on voluntary fortification. However, SACN’s recommendation has been amended to clarify the advice on supplement use for particular population groups.

Since SACN’s advice regarding mandatory fortification has not changed significantly, the Agency’s advice of June 2007 remains unchanged. Now that the Agency has notified the CMO of SACN’s updated conclusion, the UK CMOs will advise Health Ministers.

Nurses, midwives and public to share their views on tomorrow’s healthcare

Prime Minister’s Commission hold national event

Around 150 nurses, midwives, public and patients from across England will have the opportunity to discuss key themes around transforming the quality of nursing care by the Prime Minister’s Commission on the Future of Nursing and Midwifery, at a national event today.

The event is part of the Commission’s extensive engagement exercise, which has seen the Commission seeking views throughout the summer, compiling hot topics and a vision statement for the profession and organising a series of events to give interested parties an opportunity to respond.

The Commission’s ultimate goal is that all nursing and midwifery staff fulfil their potential to help people who use NHS services, families and communities achieve the best possible health and well being; that in the future nurses and midwives will take centre stage in all aspects of health care and that nursing and midwifery practice will be rooted in compassion.

The Commission will be debating its hot topics at the national event as well as at events taking place in every SHA area, before making its recommendations to the Prime Minister in the New Year. Table discussions will seek reactions and views on the hot topics and views on ways to resolve issues that may prevent nurses and midwives from fulfilling the vision.

Health Minister and Commission Chair Ann Keen said:

“We have had an overwhelming response to the first stage of our crucial work in shaping the future of nursing and midwifery and this has helped the Commission identify a vision statement for the future of the profession and ten hot topics where we want to hear more views during the autumn.

“Today’s national event is an opportunity for the public, patients and staff to let us know what they think of our vision statement and to debate together the responses to the hot topics we have identified.

“It is essential that we hear views from those our work will directly involve and impact on as we help shape the future of nurses and midwives and ensure that they continue to take centre stage in improving the quality of patient care.”

The final engagement phase will run until mid November and will include meetings with nurses and midwives, stakeholder meetings, public events and seeking views online through the Commission’s website.

A final report will be produced by the Commission in early 2010 and presented to the Prime Minister.

Weight management in pregnancy: consultation on the evidence

The National Institute for Health and Clinical Excellence (NICE) has launched a consultation regarding weight management in pregnancy.

NICE was asked by the Department of Health to develop guidance on dietary and physical activity interventions for weight management in pregnancy. Comments are now invited on the evidence that will inform the development of the guidance. The evidence will be used by the public health interventions advisory committee to develop draft recommendations.

The consultation closes on November 19 2009.

Weight management in pregnancy: consultation on the evidence (right click and open in new window)

http://www.nice.org.uk/guidance/index.jsp?action=folder&o=45843

NCT response to BMJ cot death research

A report out today in the British Medical Journal (BMJ) regarding cot death has found that there is a possible link between cot death and socio-economic deprivation.

A team of researchers at the Bristol and Warwick universities studied all unexpected infant deaths – aged from birth to two years old. Of the 80 cot deaths analysed, more than half (54%) occurred while co-sleeping compared to one-fifth (20%) co-sleeping rate among both control groups. Much of this risk may be explained by the combination of parental alcohol or drug use prior to co-sleeping (31% compared with 3% random controls), and the high proportion of co-sleeping deaths on a sofa (17% compared with 1% random controls).

Quote

Rose Dodds, Senior Public Policy Officer says:

“While this study reaffirms the risks of falling asleep with a baby on a sofa, or if you have been drinking or taking drugs that affect arousal. The risks for babies whose parents had not drunk alcohol, taken drugs, fallen asleep on the sofa with their baby and did not smoke but who did sleep with their baby were not different from that for babies in a separate cot.

“However, it is not appropriate to tell all parents not to sleep with their babies. It is clear from many surveys that around half of parents sleep with their babies at some point in the first six months, and around a quarter do so routinely, so we need to help them to do this in the safest way possible. If we demonise the parents’ bed we may be in danger of the sofa being chosen. A better approach may be to warn parents of the specific circumstances that put babies at risk.

“Parents need to be advised never to put themselves in a situation where they might fall asleep with a young infant on a sofa and that they should never co-sleep with an infant if they have consumed alcohol or drugs.

“Mothers who breastfeed and bed share with their baby, are more likely to continue breastfeeding and there is good evidence that breastfeeding helps to protect against cot death.”

For the NCT position statement on co-sleeping, please visit http://www.nct.org.uk/press-office/position-statements/transitionparenthood