From 2014–16, data from some 450,000 pregnant women across the UK was analysed as part of the AFFIRM trial, which aimed to find out whether a simple ‘care package’ could reduce stillbirths by raising awareness of, and then acting on, reduced baby movements in the womb.
Using data collected during the trial, researchers from the Tommy’s Maternal and Fetal Health Research Centre, led by Dr Elizabeth Camacho at the University of Manchester, estimate that there is a 74% chance that these changes in care could prevent stillbirths and neonatal deaths.
It would have an even greater effect when combined with other care packages or interventions, and other ongoing research into stillbirth prevention, our research suggests.
There were fewer stillbirths than expected during the trial which made it difficult to measure how well the care package worked. But, following this research, a new study, published in the journal BMC Pregnancy and Childbirth, looks at the cost to the NHS of providing the AFFIRM care package for one year.
With around 639,000 births in the UK each year, calculations were based on the costs of leaflets, staff training, extra hospital visits, scans, and labour inductions that happened in the study.
How much would it cost the NHS?
Providing the AFFIRM care package for one year across Great Britain would cost just under £62 million, the study found, which is 2.5% of the total maternity budget and equivalent to around £100 per birth.
Dr Elizabeth Camacho, Senior Research Fellow at the University of Manchester said:
“£62m might sound like a lot of money, but it is just a fraction of the UK’s total one-year maternity budget of around £2.5 billion.
“The people who decide what should be funded in the NHS don’t have a predetermined amount of money that they consider to be ‘good value’ to prevent perinatal deaths but, for comparison, the costs and benefits of AFFIRM are similar to the Saving Babies Lives Care Bundle which is already being promoted to all Trusts by NHS England.”
Kath Abrahams, Tommy’s Chief Executive said:
“At Tommy’s we believe it is vital to make pregnancy and birth safer to reduce rates of stillbirth and neonatal death, while also making the best possible use of NHS resources. The Tommy’s team hope this economic study will support decisions around making changes to care which will save lives.”
What is AFFIRM?
After AFFIRM was introduced in hospitals, women were given a leaflet about noticing their baby’s movements and when to seek medical help. Healthcare professionals also received extra training in what to do when women told them about their baby’s changed movements.
Healthcare professionals were also encouraged to send women for an additional ultrasound scan, if one hadn’t been done recently, to make sure their baby was growing as expected.
If they were more than 37 weeks pregnant and had more than one episode where their baby’s movements changed, they were offered a drug which would cause labour to start. Altogether, these steps are known as the AFFIRM care package.
The study included a comparison between what was happening in hospitals before the care package was put in place (i.e. standard care) with what happened afterwards.
After the AFFIRM care package was introduced, more pregnant women went to hospital because they had noticed a change in their baby’s movements. As a result, more ultrasound scans were done, and more women had their labour induced.
It also looks like there may have been fewer stillbirths afterwards. On average, there were 5 fewer stillbirths for every 10,000 births – although because the overall number of stillbirths was lower than expected, it is difficult to say whether this was seen in the trial by chance. More research which includes a much larger number of pregnant women would help to understand this better.
Tommy’s research continues to look at how we can reduce the number of stillbirths and neonatal deaths, and give every family the best possible chance of a healthy pregnancy and birth.
Find out more about our stillbirth research here.