Each Baby Counts - the recommendations. So, what's new?

In a recent post I commented on the RCOG’s report, Each Baby Counts. The report, published in June, reiterated the commitment of the Royal College of Obstetricians and Gynaecologists to reduce by half the number of stillbirths, neonatal deaths and serious brain injuries which occur during childbirth of term babies by 2020.

The RCOG’s analysis of over 700 cases of stillbirth, neonatal death and severe brain injury in 2015 led them to make evidence-based recommendations in relation to critical areas of care which their panel had identified as key causes of the injuries. The recommendations included formal fetal risk assessments both on admission to hospital in labour and at regular intervals during the labour, with history and risk factors considered at all stages of decision-making, along with appropriate CTG monitoring by staff properly trained in its use.

From my experience of helping families recover compensation in these tragic cases, the RCOG’s Each Baby Counts clinical recommendations all ring true. Most are already enshrined in the NICE Guidelines for Intrapartum Care but it is these errors which continue to form the basis for our clients’ claims. Every client is unique and every case has its differences but when it comes to the point at which poor care led to permanent injury it is rare that our term baby cases are based on much that is new. The power of the RCOG’s approach is not in its novelty but in its forthright simplicity which enables the RCOG to be confident in their assertion that by identifying and enforcing change in the critical areas of maternity care, improved practice will result in positive change.

The importance of the RCOG’s recommendations for improvements in key areas of maternity practice become all the more compelling when considered in the context of a recent case where adherence to the Each Baby Counts recommendations would have avoided our client’s severe dyskinetic cerebral palsy.

Our client’s mother was sent home when she attended hospital after the due date in her pregnancy with a history of reduced fetal growth, reduced fetal movements and heavy bleeding. However, an informed fetal risk assessment on the mother’s admission to hospital in labour would have resulted in an ultrasound scan and placed the mother under obstetric review. Her history of lack of fetal growth and bleeding would have resulted in earlier induction of labour.

When she returned in labour her history was not taken into account when deciding upon fetal monitoring methods or throughout the management of her labour. Using intermittent auscultation rather than continuous CTG monitoring the midwife failed to recognise fetal heart abnormalities, failed to switch to CTG monitoring and failed to call for obstetric help which would have led to an earlier delivery. When the fetal heart-rate finally dropped to a persistent bradycardia, indicating that the baby was suffering brain-damaging hypoxia, the midwife again failed to call for an obstetrician. She failed to warn the paediatric and neonatal team that a baby was about to be born who would need resuscitation immediately after birth to reduce the severity of her injury. Each of these errors forms the basis of an Each Baby Counts recommendation. In their absence, the baby would have been delivered before she suffered her hypoxic injury.