Good news reached us at the end of last year with publication of the Saving lives, improving mother’s care report (Knight et al 2014), which forms the UK and Ireland Confidential Enquiries into Maternal Deaths and Morbidity by a group of academics and experts known as MBRRACE-UK.
The report suggests that there was a statistically significant fall in the number of maternal deaths in UK and Ireland during 2009-2012. The drop has been attributed to a reduction in deaths due to pregnancy complications, such as eclampsia or blood clots, whereas the rate of mothers dying from indirect causes, for example heart disease or mental health problems, has remained constant over the last ten years.
The researchers identified key areas in the health service that could be improved in order to reduce the number of deaths from indirect causes, namely better pre-pregnancy advice, and also specialist as well as maternity care throughout pregnancy and birth for those that need it. Other possible improvements identified were: an increased awareness amongst health care staff that an unwell woman may have sepsis, as early diagnosis and swift antibiotic treatment are crucial to improved survival rates; and an increase in the number of pregnant women receiving the flu vaccine.
Louise Silverton, Director for Midwifery at the RCM, responded that the UK needs “more midwives and maternity support workers to deal with the increasing complexity of pregnancy and better teamwork with doctors to provide seamless maternity care. Midwives need to have time to listen to and protect women in their care. The NHS needs to do more to prioritise these women’s care in its already overstretched maternity services”.
The call for more investment in the maternity sector, in the form of higher numbers of midwives, is borne out by a new report by Maruthappu et al (2014) that looked at the association between government health care spending and maternal mortality in 24 European countries. The retrospective study examined spending over a 30-year period from 1981-2010 and findings suggest that for each annual 1% decrease in spending there is 10.6% annual increase in maternal mortality and this association remained significant, even after accounting for economic infrastructure, hospital resource controls, private health spending and total fertility rate. The association remained significant for one year after the spending cut, but it may be of particular interest to maternity care workers that ‘when accounting for the percentage of births attended by skilled health professionals, defined as people trained to give the necessary supervision, care and advice to women during pregnancy, labour and the postpartum period, the effect is no longer significant’ (Maruthappu et al 2014).
Both reports came out against a backdrop of headlines about ‘conveyor-belt’ maternity care in the UK in the Telegraph and Daily Mail. These were inspired by an annual report Health at a glance: Europe 2014 (OECD 2014), which showed that UK mothers who had a normal birth in hospital, spent on average 1.5 days in hospital — the shortest length of stay in the EU. This contrasts with Finland, listed as the best place to be a mother according to Save the Children’s State of the world’s mothers’ report in 2014, where the average length of stay is three days.
Knight M, Kenyon S, Brocklehurst P et al (2014). Saving lives, improving mothers’ care: Lessons learned to inform future maternity care from the UK and Ireland Confidential Enquiries into Maternal Deaths and Morbidity 2009-2012. Oxford: NPEU, University of Oxford.
Maruthappu M, Ng KYB, Williams C et al (2014). The association between government healthcare spending and maternal mortality in the European Union, 1981-2010: a retrospective study. BJOG: An International Journal of Obstetrics and Gynaecology, 10 December [online ahead of print].
OECD/European Union (2014). Health at a glance: Europe 2014. Paris: OECD Publishing.
Save the Children (2014).