On the 5 July 2018, the NHS turned 70 and this was marked by celebrations across the UK. It was humbling to hear the experiences and reflections of many midwives, support staff, obstetricians and neonatologists, whose careers in the NHS span its entire existence. We have so much to be proud of!
My most profound memory of maternity care and how far we have progressed since the inception of the NHS is of a midwife I met at Bournemouth Birth Centre's first birthday in 2015. The midwife, who was guest of honour at the event, celebrated her 100th birthday that year. She spoke candidly about her work during the Second World War and the skills required to provide safe, high quality care at a time when there were frequent air raids and limited resources. She proudly stated that, regardless of the challenges she faced, she put mothers and babies first and that care was based on individual needs, a dose of common sense, resilience and a good listening ear; an approach that has not changed today.
The childbirth experiences of women and their families have improved demonstrably over the past seven decades, often as a result of research and policy. The most recent maternity strategy for England, Better Births (National Maternity Review, 2016), is transforming maternity care based on the principles of safety and personalisation. In fact, before its publication, the neonatal mortality rate in the UK had decreased from 1.84 to 1.72 deaths per 1000 live births between 2013 and 2016. The stillbirth rate had decreased from 4.20 to 3.87 stillbirths per 1000 total births during 2013–2015, but increased slightly to 3.93 in 2016 (Draper et al, 2018). While these data are encouraging, we have much more to do if we are to meet the national ambition (Department of Health and Social Care, 2017) to reduce stillbirth, neonatal death, brain injury and maternal death in England by 50% by 2025.
Improved outcomes for all?
Despite improvements in maternal and infant mortality rates for most, there continues to be an increase in the rate of stillbirth for black women in the UK, which has increased from 7.02 per 1000 births in 2013 to 8.29 between 2014 and 2016. In comparison to babies born to white families, babies of Asian ethnicity have also been shown to have increasing neonatal mortality rates, from an increased risk of 38% in 2014 to 66% in 2016 (Draper et al, 2018). These data highlight the stark, reality of inequality and that is why commissioning organisations are required to review their mortality rates to identify high-risk residents and target interventions towards inequalities (Draper et al, 2018).
Anecdotal evidence suggests that interventions developed to target inequalities are not new, but these need to be consistent if we are to successfully reduce unwarranted variation in mortality rates for babies of black and Asian ethnic origin.
Getting involved at a local level
We all have an opportunity to contribute to the national plans to improve the safety of maternity services, regardless of seniority. There are many ways in which you can improve the safety of maternity care, by getting involved in initiatives that are being driven by Better Births. You could, for example try the following:
The NHS' 70th birthday celebrations are a moment of pause and reflection. As we celebrate its successes, which are predominantly down to the talent of its staff, we should continue to use past experiences to achieve future success for mothers and babies.