Given the launch of the NHS Long Term Plan, which committed to expanding the Saving Babies' Lives Care Bundle (SBLCB), and the Government's target to halve the rates of stillbirth by 2025, this conference was a timely update for the range of health professionals in attendance. Nevertheless, Jane Brewin, Chief Executive of stillbirth charity Tommy's, challenged delegates further, to cut the incidence of stillbirth to less than 1000 per year, and making the UK the safest place in the world to give birth.
This was followed by a talk from David Monteith, who delivered an emotional and evocative account of his daughter Grace, whose death inspired the charity Grace in Action. Beginning the day with a parent's story was an effective reminder of the difference that data, funding and training can make.
It seemed only appropriate that this very personal account was followed by two of the leading authorities in stillbirth policy and research, Matthew Jolly, National Clinical Director for Maternity and Women's Health at NHS England, and Professor Elizabeth Draper, leader of the MBRRACE-UK collaborators. The first of these talks outlined how the new Long Term Plan would improve safety through greater continuity of carer, an expanded SBLCB, and improved review procedures. While it was positive to see so many solutions, it was also acknowledged that improvement would require a life course approach, based on a long-term aggregation of marginal gains.
This theme was continued in Prof Draper's presentation on the lessons learnt from MBRRACE and how data could be better reported in future. With the accuracy of sweeping trends dependent on the accurate reporting of individual events, Prof Draper detailed changes to the Perinatal Mortality Review Tool (PMRT) that would enable services to provide better data and receive better reports in turn.
The final talk of the morning was given by Professor Jason Gardosi and Mandy Williams, both of the Perinatal Institute in Birmingham. This session focused on the implementation of the SBLCB, emphasising managing early intrauterine growth restriction (IUGR) or identifying IUGR later in pregnancy. The speakers also shared how Growth Assessment Protocol training has increased identification of IUGR and, by extension, reduced UK stillbirth rates.
Afternoon sessions began with a presentation on risk factors by Professor Alex Heazell, Clinical Director of Tommy's Stillbirth Research Centre. Prof Heazell began by outlining risk factors for stillbirth, many of which cannot be treated. However, as the majority of stillbirths occur to women with no risk factors, studies are still required to identify and prevent likely stillbirths. Research into sleep position, educational interventions and maternal age may illustrate part of the picture, but there is still much to be done to reduce non-medical risk factors such as poverty and unemployment, which also show strong correlations with stillbirth.
This was followed by two speakers who addressed data recording and review. Celia Burrell, consultant obstetrician at Barking, Havering and Redbridge NHS Foundation Trust, detailed how feedback from both clinical governance and midwifery teams enables her to oversee reviews and ensure that parents are kept informed. The Trust has also produced ‘top tips’ for PMRT reports, and has empowered ultrasonographers to highlight IUGR, so that there have been no stillbirths as a result of missed IUGR since May 2018.
Next, Dr Edward Prosser-Snelling, Each Baby Counts Improvement Lead at Royal College of Obstetricians and Gynaecologists, outlined the lessons from Each Baby Counts and the National Maternity and Perinatal Audit, before discussing barriers to effective reporting. These include a lack of time and/or resources, as well as failure to follow up statements taken as conclusive, such as ‘guidelines not followed’.
To conclude, presentations focused on turning data into practice. Gaynor Armstrong, Risk Manager and Governance Lead at George Eliot Hospital, shared how the stillbirth rate was reduced by 70% through systems of referral and reporting. Women in the service were referred to smoking cessation services to address the high rate of smoking in the area, and their records coded with stickers to alert other clinicians to risk factors. Women were also encouraged to attend hospital when they had concerns, thereby reducing the time taken for women to ‘wait and see’ and travel by public transport—time that could be crucial. Finally, Marc Harder and Nileema Vaswani from Sands advised delegates of the need to support parents in subsequent pregnancies, when grief could be ongoing or reignited. In addition, an update was provided on the national bereavement care pathway for pregnancy and baby loss. The results have been positive, and the pathway is due to be rolled out nationwide in 2019/20—a fitting conclusion to a day of talks that brought together research and best practice with the common goal of ending stillbirth.