Intrapartum-related perinatal deaths in births planned in midwifery-led settings in Great Britain: findings and recommendations from the ESMiE confidential enquiry

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Intrapartum-related perinatal deaths in births planned in midwifery-led settings in Great Britain : findings and recommendations from the ESMiE confidential enquiry. / Rowe, Rachel E.; Draper, Elizabeth ; Kenyon, Sara; Bevan, Charlotte; Dickens, Joanne; Forrester, Mandy; Scanlan, Rachel; Tuffnell, Derek; Kurinczuk, Jennifer.

In: BJOG: An International Journal of Obstetrics & Gynaecology, 21.05.2020.

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Rowe, Rachel E. ; Draper, Elizabeth ; Kenyon, Sara ; Bevan, Charlotte ; Dickens, Joanne ; Forrester, Mandy ; Scanlan, Rachel ; Tuffnell, Derek ; Kurinczuk, Jennifer. / Intrapartum-related perinatal deaths in births planned in midwifery-led settings in Great Britain : findings and recommendations from the ESMiE confidential enquiry. In: BJOG: An International Journal of Obstetrics & Gynaecology. 2020.

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@article{c1da49ad96e947099adc2fbf4533f286,
title = "Intrapartum-related perinatal deaths in births planned in midwifery-led settings in Great Britain: findings and recommendations from the ESMiE confidential enquiry",
abstract = "ObjectiveTo review quality of care in births planned in midwifery‐led settings, resulting in an intrapartum‐related perinatal death.DesignConfidential enquiry.SettingEngland, Scotland and Wales.SampleIntrapartum stillbirths and intrapartum‐related neonatal deaths in births planned in alongside midwifery units, freestanding midwifery units or at home, sampled from national perinatal surveillance data for 2015/16 (alongside midwifery units) and 2013–16 (freestanding midwifery units and home births).MethodsMultidisciplinary panels reviewed medical notes for each death, assessing and grading quality of care by consensus, with reference to national standards and guidance. Data were analysed using thematic analysis and descriptive statistics.ResultsSixty‐four deaths were reviewed, 30 stillbirths and 34 neonatal deaths. At the start of labour care, 23 women were planning birth in an alongside midwifery unit, 26 in a freestanding midwifery unit and 15 at home. In 75% of deaths, improvements in care were identified that may have made a difference to the outcome for the baby. Improvements in care were identified that may have made a difference to the mother's physical and psychological health and wellbeing in 75% of deaths. Issues with care were identified around risk assessment and decisions about planning place of birth, intermittent auscultation, transfer during labour, resuscitation and neonatal transfer, follow up and local review.ConclusionsThese confidential enquiry findings do not address the overall safety of midwifery‐led settings for healthy women with straightforward pregnancies, but suggest areas where the safety of care can be improved. Maternity services should review their care with respect to our recommendations.Tweetable abstractConfidential enquiry of intrapartum‐related baby deaths highlights areas where care in midwifery‐led settings can be made even safer.",
keywords = "Birth centres, home birth, midwifery, perinatal death, quality of health care, stillbirth",
author = "Rowe, {Rachel E.} and Elizabeth Draper and Sara Kenyon and Charlotte Bevan and Joanne Dickens and Mandy Forrester and Rachel Scanlan and Derek Tuffnell and Jennifer Kurinczuk",
year = "2020",
month = may,
day = "21",
doi = "10.1111/1471-0528.16327",
language = "English",
journal = "BJOG: An International Journal of Obstetrics & Gynaecology",
issn = "1470-0328",
publisher = "Wiley",

}

RIS

TY - JOUR

T1 - Intrapartum-related perinatal deaths in births planned in midwifery-led settings in Great Britain

T2 - findings and recommendations from the ESMiE confidential enquiry

AU - Rowe, Rachel E.

AU - Draper, Elizabeth

AU - Kenyon, Sara

AU - Bevan, Charlotte

AU - Dickens, Joanne

AU - Forrester, Mandy

AU - Scanlan, Rachel

AU - Tuffnell, Derek

AU - Kurinczuk, Jennifer

PY - 2020/5/21

Y1 - 2020/5/21

N2 - ObjectiveTo review quality of care in births planned in midwifery‐led settings, resulting in an intrapartum‐related perinatal death.DesignConfidential enquiry.SettingEngland, Scotland and Wales.SampleIntrapartum stillbirths and intrapartum‐related neonatal deaths in births planned in alongside midwifery units, freestanding midwifery units or at home, sampled from national perinatal surveillance data for 2015/16 (alongside midwifery units) and 2013–16 (freestanding midwifery units and home births).MethodsMultidisciplinary panels reviewed medical notes for each death, assessing and grading quality of care by consensus, with reference to national standards and guidance. Data were analysed using thematic analysis and descriptive statistics.ResultsSixty‐four deaths were reviewed, 30 stillbirths and 34 neonatal deaths. At the start of labour care, 23 women were planning birth in an alongside midwifery unit, 26 in a freestanding midwifery unit and 15 at home. In 75% of deaths, improvements in care were identified that may have made a difference to the outcome for the baby. Improvements in care were identified that may have made a difference to the mother's physical and psychological health and wellbeing in 75% of deaths. Issues with care were identified around risk assessment and decisions about planning place of birth, intermittent auscultation, transfer during labour, resuscitation and neonatal transfer, follow up and local review.ConclusionsThese confidential enquiry findings do not address the overall safety of midwifery‐led settings for healthy women with straightforward pregnancies, but suggest areas where the safety of care can be improved. Maternity services should review their care with respect to our recommendations.Tweetable abstractConfidential enquiry of intrapartum‐related baby deaths highlights areas where care in midwifery‐led settings can be made even safer.

AB - ObjectiveTo review quality of care in births planned in midwifery‐led settings, resulting in an intrapartum‐related perinatal death.DesignConfidential enquiry.SettingEngland, Scotland and Wales.SampleIntrapartum stillbirths and intrapartum‐related neonatal deaths in births planned in alongside midwifery units, freestanding midwifery units or at home, sampled from national perinatal surveillance data for 2015/16 (alongside midwifery units) and 2013–16 (freestanding midwifery units and home births).MethodsMultidisciplinary panels reviewed medical notes for each death, assessing and grading quality of care by consensus, with reference to national standards and guidance. Data were analysed using thematic analysis and descriptive statistics.ResultsSixty‐four deaths were reviewed, 30 stillbirths and 34 neonatal deaths. At the start of labour care, 23 women were planning birth in an alongside midwifery unit, 26 in a freestanding midwifery unit and 15 at home. In 75% of deaths, improvements in care were identified that may have made a difference to the outcome for the baby. Improvements in care were identified that may have made a difference to the mother's physical and psychological health and wellbeing in 75% of deaths. Issues with care were identified around risk assessment and decisions about planning place of birth, intermittent auscultation, transfer during labour, resuscitation and neonatal transfer, follow up and local review.ConclusionsThese confidential enquiry findings do not address the overall safety of midwifery‐led settings for healthy women with straightforward pregnancies, but suggest areas where the safety of care can be improved. Maternity services should review their care with respect to our recommendations.Tweetable abstractConfidential enquiry of intrapartum‐related baby deaths highlights areas where care in midwifery‐led settings can be made even safer.

KW - Birth centres

KW - home birth

KW - midwifery

KW - perinatal death

KW - quality of health care

KW - stillbirth

UR - http://www.scopus.com/inward/record.url?scp=85086258072&partnerID=8YFLogxK

U2 - 10.1111/1471-0528.16327

DO - 10.1111/1471-0528.16327

M3 - Article

JO - BJOG: An International Journal of Obstetrics & Gynaecology

JF - BJOG: An International Journal of Obstetrics & Gynaecology

SN - 1470-0328

ER -