Maternity & Midwifery Forum
Midwifery Feature Articles

Lessons from Saving lives, improving Mothers’ care 2016-18

On January 14th 2021, the next confidential enquiry into maternal deaths, Saving lives, Improving care for 2016-18 was released from MBRRACE-UK (Mothers and Babies: Reducing Risk through Audits and Confidential Enquiries across the UK) based at the NPEU in Oxford.

For those unfamiliar with these reports, since 1952 an investigation of all reported maternal deaths during pregnancy, and now up to one year post birth, in the UK have been completed on a triennial basis (for more information see Weindling 2003). The purpose has been to investigate the reasons behind maternal deaths centrally and confidentiality, to encourage reporting away from local investigation, in order for multidisciplinary learning to take place to avoid further maternal deaths in the future.

Though the number of deaths overall is small in comparison to the number of births (217/ 2235159 births; 9.7 per 100000 up to six weeks post birth), there has been minimal statistical change since the previous report, providing concerns as this report is clearly pre-COVID 2019. The report also highlights significant need to have caution when women present with previous conditions, with high rates of death related to epilepsy and cardiac disease, as well as known mental health disorders. In pregnancy itself dealing with thromboembolism, sepsis, bleeding and pre-eclampsia remain key factors. In this report a further chapter also investigates morbidity related to pulmonary embolism as well as inclusion of reporting from Ireland.

This report also addresses the wider factors underlying maternal death related to multiple problems, often living in socially deprived circumstances. It highlights again the impact of inequality of care with more than a four-fold difference in maternal mortality rates for women from Black ethnic backgrounds and an almost two-fold difference for women from Asian ethnic backgrounds compared to white women. Providing a public health focus to maternity care that is culturally sensitive and appropriate is clearly of great importance. Midwives should read this report alongside other members of the multidisciplinary team and consider how to take the learning forward for the safety of women and babies.

In addition, in the current year of pandemic, further evidence points to the disparity of outcomes in COVID-19 disease for Black and Asian groups of women The Chief Midwifery Officer, Jacqueline Dunkley-Bent, in her recent talk to the London Maternity and Midwifery festival, highlighted the importance not to ignore this knowledge and take positive action in the care provided.

Other speakers also addressed the needs of more vulnerable women and inequalities (Maria Booker, Alison Baum, Shelley McBride & Emma Roberts) and the importance to focus on the underlying issues of racism affecting provision of care (Benash Nazmeen and Illiyin Morrison). The MBRRACE enquiry once more highlights we must not ignore these factors when providing care. Over coming months we will aim to address improving knowledge on the topics underpinning the report in the Forum. If you wish to present or write about any of subjects do let us know.

Jenny Hall

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