Poor foetal monitoring a leading cause of death in babies in England, review finds

NHS staff do not correctly monitor a baby’s heart rate during labour in almost half of cases where serious failings lead to tragedy, a review of maternity care has found.

The Care Quality Commission identified that inadequate foetal monitoring occurred in 45 of 92 cases (49%) in which a baby died or suffered serious brain damage while being born in a midwife-led unit in England.

The findings show that correct monitoring is “critically important” to ensure care is safe in all maternity units, said Sandy Lewis, the director of the CQC’s maternity and newborn safety investigations (MNSI) programme.

It analysed four common failings in the 92 births in a report that is intended to help midwives and doctors improve the quality and safety of care.

In one case the investigation team found that “there were likely to have been abnormalities in the baby’s heart rate which were ongoing for a prolonged period of time, which were not identified during intermittent auscultation [monitoring]”.

In another, midwives were so busy dealing with a separate emergency on the unit that they failed to monitor the baby at the correct recommended intervals and the woman was left unattended.

The 92 incidents involved 62 cases in which the newborn suffered a severe brain injury, 19 in which it was alive at the start of labour but was stillborn and 11 when it died within its first six days of life.

Lewis said: “In the 92 cases analysed in this report, difficulties with carrying out or interpreting the results of foetal monitoring were a factor in 45 of them.

“We appreciate that reading this may be concerning for women who are currently pregnant, those planning a pregnancy, or their families.

“It is important to acknowledge that during the period covered by the report, thousands of pregnant women experienced a safe pregnancy, labour and birth.”

The MNSI also identified short staffing and heavy workloads at maternity units as another key factor in things going wrong. The Royal College of Midwives and the Commons health select committee have called for the NHS to recruit 2,500 more midwives to help improve care.

The NCT parenting charity said midwives not having enough time to properly monitor a baby’s heart rate is contributing to what is too often “dangerous” maternity units.

“This report is extremely concerning, as too often we are seeing women and their babies put at risk of experiencing dangerous levels of care, because of an overworked and understaffed midwifery workforce,” said Maxine Palmer, the NCT’s head of service development.

“If midwives are having to make compromises in routine one-to-one care during labour, which should include frequently listening to a baby’s heart rate, then they are not in a position to offer safe care.”

Women should receive the same standard of care whether they decide to give birth in a hospital, midwife-led unit or at home, Palmer added.