The latest MBRRACE-UK annual report shows a continued reduction in perinatal deaths across all 4 nations, which reflects the impact of a range of national initiatives to address safety in maternity and neonatal care – but it also highlights the fact the UK is not on track to meet its own reduction targets. In good news, there were 670 fewer baby deaths across the UK in 2018 than 2013. However, the report demonstrates that more work is needed to turn the Government target of halving stillbirth and neonatal death rates nationwide by 2025 from an ambition into a reality.
Death rates are falling faster for White babies than in other ethnic groups, showing unacceptable inequalities which suggest that national safety initiatives aren’t reaching some of the mothers who need them most. Stillbirth rates for Black and Black British babies are more than double those of their White counterparts, and neonatal death rates are 45% higher. Similarly, stillbirth and neonatal death rates for Asian and Asian British babies are both around 60% higher. The report also continues to show the connection between risk and poverty, with mothers living in the most deprived parts of the UK facing 80% higher risk of their baby dying – and neonatal death rates vary even more than stillbirth rates, which raises questions about inequalities in the care mothers and babies receive from place to place.
Neonatal deaths are falling more slowly than stillbirths, with late stillbirths seeing the highest reduction, highlighting the need to focus on preventing pre-term birth. Premature birth rates in the UK are higher than similar countries in Europe, and three-quarters of babies who died in 2018 were born before 37 weeks. This is why our work to understand and prevent premature birth is so vital. Babies’ chances of survival were much higher in the most specialist neonatal units, demonstrating the need to improve care for premature babies at a national level.
In light of these stark statistics, the MBRRACE-UK report authors have called for urgent action and significant investment to help care providers identify and support mothers at risk of losing babies. We fully support their recommendations, which include:
- more public health measures targeted at mothers facing the highest pregnancy risks
- focusing on national programmes that already exist to reduce baby deaths, and their impact on reducing the number of babies born before 37 weeks
- supporting poorer mothers throughout pregnancy, childbirth and early parenting by ensuring different agencies (from social care to health services) work together
- looking into the support that mothers from Black and Asian communities specifically need around conception, pregnancy and childbirth
- finding out which neonatal deaths are potentially avoidable in areas where rates are high
- ensuring an examination of the placenta is carried out by a specialist pathologist for every baby who dies in a neonatal unit
- all care providers notifying MBRRACE-UK of any baby deaths within a week, completing a full report within 2 months so that a local hospital review can be carried out to help parents understand why their baby died, and using the real-time data monitoring tool to analyse their own information and better understand the impact of their care
Our chief executive Jane Brewin said: “Everyone should be entitled to the best care for themselves and their baby, no matter who they are or where they live, so all those involved in providing maternity services need to work together to address the disproportionately high risks facing certain families. While the MBRRACE report acknowledges that pregnancy and childbirth is be a safe experience for most UK mothers, it also highlights deeply troubling inequalities that need to be addressed.
“The Government will not reach its goal to halve rates of stillbirth and neonatal death by 2025 without taking urgent action to address pre-term birth rates and understanding why Black and Asian mothers are more likely to lose their babies – and putting in place things we already know make a big difference to pregnancy safety, like having the same midwife throughout the journey to parenthood with ongoing risk assessments and frequent check-ups if needed. Tommy’s has recognised this need for some time and we urge all those involved in maternity care to make use of our freely available resources to help make pregnancy safer.”
Lizzie D’Angelo, our research and policy director, went on: “Tommy’s echoes the MBRRACE report authors’ calls to focus on improving support throughout the pregnancy journey for mothers facing the highest risks, as our research centres and clinics are designed to do, and fulfilling the potential of national programmes we’ve already co-developed such as the Saving Babies’ Lives Care Bundle v2 to reduce stillbirth rates while also preventing premature births and neonatal deaths.
“This report raises a lot of questions, but research will find answers to prevent more baby deaths. Our stillbirth experts are studying the placenta and umbilical cord problems which the Perinatal Mortality Review Tool found were linked to more than a third of stillbirths in the UK, as well as the complex social risk factors also highlighted in the report, and our National Centre for Maternity Improvement is working with and within the NHS to bring about changes that will reduce current variations in care and save babies’ lives.”
Dr Clea Harmer, chief executive of Sands (Stillbirth and Neonatal Death Society), added: “Amid the challenges of 2020, we mustn’t lose sight of the ambition to act to reduce baby deaths; bereaved parents and families expect no less. We endorse the report’s recommendation to use this MBRRACE real-time data monitoring tool to support the delivery of safer care.
“Getting data to the national audit programme without delays is essential to understand, in the here and now, which deaths are occurring and why. It’s disappointing that a third of baby deaths (around 1,200) in 2018 weren’t notified to MBRRACE within the 30-day benchmark. Without timely notification, the potential to respond rapidly to emerging issues is lost – and a review with the Perinatal Mortality Review Tool, which will provide answers for parents about why their baby died, can’t be started.”