An investigation has found that changes to obstetric services during the pandemic, including the mandatory redeployment of midwives and doctors to care for infected patients, may have affected the care given to women who had stillbirths.
According to the Healthcare Safety Investigation Branch, changes in the way women are looked after during pregnancy mean that some women may not have the same level of screening while others do not have face-to-face appointments.
The safety watchdog launched an investigation after the number of stillbirths rose after the start of labor between April and June 2020. During the three months there were 45 stillbirths in 2019 compared to 24 in the same period.
The HSIB began an investigation into the care of 37 cases.
In its findings the watchdog said staffing levels had been affected by the NHS’s response to the pandemic.
In its report, it said it affected “normal work patterns and the continuity and availability of physicians.”
For example, a maternity unit was short staffed by three midwives due to illness and redeployment. Another consultant’s presence was curtailed overnight.
Both the Royal College of Midwives and the Royal College of Obstetricians criticized NHS trusts for redeploying maternity staff during the pandemic when mothers continued to need services regardless of the pandemic.
The HSIB said none of the women in its report were recorded as having the virus, but it found that pressure and changes as a result of the pandemic may have affected their care.
The study stressed that the proportion of consultations conducted remotely was not known and that “the impact of remote consultations is not clear from this review”.
However, it said there is evidence that distance counseling results in fewer opportunities for physical examinations, meaning that trends as the child grows may be missed.
The HSIB stated that after 28 weeks of gestation, all consultations did not involve the mother from the pubic bone to the top of the womb (a standard measure to inform the baby’s development), while “recording and plotting” this information. was lacking”.
Some face-to-face visits were postponed until later in pregnancy, while in some remote consultations physicians did not have access to clinical notes or ultrasound scan reports.
On three occasions this resulted in the cancellation or non-availability of ultrasound scans, and in one case there was a significant change in the intended birth plan.
In one case, the mother “opted not to attend the appointment after considering the risks of Covid-19 and chose the latter on balance”.
The HSIB said many of the safety risks identified in the review were already known to maternity services and were exacerbated by the pandemic, for example, staffing levels in maternity units.
Other issues noted were challenges in interpreting and implementing rapidly changing national guidance on COVID, difficulties in communication by phone and workforce demands in the NHS, which led to absenteeism and illness.
Lack of oxygen to the baby during delivery was found to be the cause of death of 10 babies.
When exposed to the NHS during delivery, 19 infants had no signs of life when they first arrived at the hospital.
But 11 of these women and pregnant people had contacted telephonically for health advice and were advised to stay at home.
For five infants, heart rate was identified during the hospital visit, then several hours after the next hospital visit or the next day with no signs of life.
Katherine Whitehill, HSIB’s principal national investigator, said: “We believe that the current maternity system has succeeded through national initiatives in reducing the number of stillbirths and delivered thousands of babies without problems throughout the pandemic. has gone.
“However, our review highlighted the overwhelmingly stressed maternity services – they had to balance the risks associated with uncertainty and emerging evidence on COVID-19 transmission with clinical assessments that are needed to monitor patient safety. .
“Our recommendations aim to identify where there may be gaps in safety management and support systems to take a proactive approach to ensuring the well-being and effective care of women and pregnant people and their children across the country.”
For the 10 infants in the review, the cause of death was related to the function and structure of the placenta. Two babies died after placental abruption, which is the separation of the placenta from the wall of the uterus before birth.
One died of uterine rupture, while three died after complications from the umbilical cord.
One of the recommendations made by the HSIB is for NHS England and NHS Improvement to “comprehend and act on the evidence on the risks and benefits associated with the use of remote counseling at critical points in the maternity care pathway”.
Another recommended that the Department of Health and Social Care initiate a review “to improve the reliability of existing assessment tools for fetal development and fetal heart rate to reduce risks to infants.”
Credit: www.independent.co.uk /