HSIB highlights impact of pandemic on safety of maternity services
The pandemic has had a significant and detrimental impact on many aspects of healthcare, including maternity care the Royal College of Midwives (RCM) has said in response to a new report into stillbirths during COVID-19 by the HSIB.
The rates of stillbirths among women from Black, Asian and minority ethnic communities has once again highlighted the inequalities that exist, the College said, adding that urgent investment is needed to improve services for these women.
The latest report from HSIB (the Healthcare Safety Investigation Branch) looked at 37 stillbirths and contains recommendations for NHS England and others. The review was prompted by an increase in referrals of intrapartum stillbirths we received, that fitted specific criteria between April and June 2020 (45 compared to 24 in the same period in 2019).
Findings in the report suggest that many safety risks that were identified in the review were already known to maternity services and these were further exacerbated by the pandemic, for example, the sustainability of staffing levels in maternity units. It also highlighted that COVID-19 created specific safety risks including the impact of limiting face to face interactions and increasing remote consultations.
Kathryn Whitehill, principal national Investigator at HSIB said: “We recognise that the current maternity system has had success through national initiatives in reducing the number of stillbirths and that throughout the pandemic, thousands of babies were delivered without any problems. However, our review did highlight the extreme pressure maternity services were under – they had to balance the risks associated with uncertainty and emerging evidence on COVID-19 transmission with the clinical assessments that are needed to monitor the safety of patients. We also felt it was crucial to reflect the experience of women and pregnant people to emphasise how the changes to services affected them and their families.
“As the NHS continues to tackle COVID-19 and deal with the impact on services, it is important that learning is shared across the system. Our review provides an independent examination of the factors that influenced care during the first wave. Our recommendations are aimed at identifying where there might be gaps in safety management and supporting the system to take a proactive approach in ensuring the wellbeing and effective care of women and pregnant people and their babies across the country.”
Responding, the RCM’s director for professional midwifery, Dr. Mary Ross-Davie said: “While this report doesn’t reflect the full national picture it is nonetheless devastating for the women and their families who have lost their babies. Ethnicity and language barriers are a big issue in this report with only a quarter of those that needed interpretation services getting them. Investment in this area and service improvements are urgently needed so women and their families have access to 24/7 translation or interpretation services.”
The pandemic has required midwives and maternity services to adapt to new care practices and ways of working. This, said the RCM, has put additional pressure on services already buckling under existing midwife shortages and staff absences, which COVID-19 has only served to exacerbate.
Mary added: “In some respects, the ability to provide some maternity care virtually has been a silver lining of the pandemic and has enabled women to access advice and support by virtual means. We know many women have benefited from this, particularly those living in remote and rural areas who may have to travel long distances to in-person appointments or those with other children and caring responsibilities. That said the RCM has been clear in its advice throughout COVID-19 that its crucial women attend in person appointment with their midwife so observations such as blood tests and fetal growth can be measured.”