I start with a few parish notices, as it were. First, we do all continue to wear a mask, apart from when we are speaking. Secondly, I am told that we are now allowed to intervene, if we are physically in the room, on one another, although perhaps we want to keep such interventions to a relatively minimal number. Thirdly, let me remind those who are with us virtually—welcome to you all—that you have to remain in the room with your television camera on throughout. You cannot turn the TV camera off and go off for a cup of coffee; you have to be here in the debate throughout—from beginning to end.
Thank you, Mr Gray. I had just promoted you. It is a pleasure to serve under your chairmanship.
The ambition is to halve the rate of stillbirths and neonatal deaths by 2025 and to have achieved a 20% reduction in these rates by now. Every day in the UK, about 14 babies die before, during or soon after their birth. Baby deaths need to fall much faster if the Government’s national maternity safety ambition is to meet that important target. The ambition also includes halving maternal deaths and brain injuries in babies that occur during or soon after birth by 2025, and reducing the pre-term birth rate from 8% to 6% by 2025.
Earlier this month, the Health and Social Care Committee published its report about maternity safety. I co-chair the all-party parliamentary group on baby loss with the Chair of the Health and Social Care Committee, my right hon. Friend Jeremy Hunt. The Select Committee report echoes much of what we have been hearing from hospital trusts, health professionals, bereavement charities, bereaved families and others throughout our work in the APPG. I pay tribute to everybody who speaks out on this most upsetting of topics. It is a crucial issue on which we must all work together to achieve success.
The Select Committee report notes that progress towards reducing the rate of stillbirths and neonatal deaths has been “impressive”, with its external expert panel rating it as good, although it notes that the baseline for the progress was low in comparison with other countries, such as Sweden, and that there is still a “worrying” level of variation in the quality of care. On stillbirth, the report from the expert panel notes:
“The Department has achieved the interim target of a 20% reduction earlier than the 2020 deadline. However, increased efforts are required to meet the final target” of a halving in 2025. On neonatal deaths, the report states:
“Good progress has been made towards achieving a 50% reduction…by 2025. However, it has been difficult to determine the full extent of the Government’s progress due to a change in the measure of progress against the National Maternity Ambition on neonatal deaths, with concerns expressed about the validity and unintended consequences of this change. This change in measuring progress has potentially inflated the achievement in the data analysed and may inadvertently exclude extremely pre-term babies from the on-going national efforts to improve neonatal outcomes. We encourage the Department to continue to measure and drive progress towards reducing mortality in both the population of babies born before and after 24-weeks’ gestation.”
On maternal deaths, the report concludes:
“No discernible progress has been made towards reducing the 2010 rate of maternal deaths by 50% by 2025”,
which I find alarming. It continues:
“The factors contributing to maternal deaths are predominantly indirect, such as existing disease, and therefore complex to address. Tackling the causes of maternal death will require concerted efforts, with a focus on pre-conception interventions and improved post-natal support, particularly relating to mental health support…In addition, the worsening disparity in risk of maternal death for women from minority ethnic and socio-economically deprived backgrounds needs to be urgently addressed.”
On pre-term births, the report acknowledges that
“this target was only added to the National Ambition in 2017. Therefore, the window for newly introduced measures to impact on the data is very narrow…While the initiatives currently being implemented by the Department are welcomed, we anticipate that increased efforts will be required to counteract the setbacks to reducing pre-term” deaths arising from the COVID-19 pandemic.
Great strides have been made in this vitally important space, and it is important to acknowledge that, but there is still more to do. Last week, I had the pleasure of speaking to some members of our excellent midwifery team at the Royal Cornwall Hospital in Treliske, in Truro. Because of continuing covid restrictions, that was conducted remotely, and it was a bittersweet meeting for me, not least because the tech let me down after about 20 minutes. I had a conversation with the fabulous consultant obstetrician, Karen Watkins, who was able to tell me how things were going at Treliske and what further things the team felt needed to be done to accelerate the national ambition.
It was Karen who had delivered the shattering news to my husband and me that our baby could not be saved, that she would have no chance of life. It was Karen who performed the procedure to humanely end Lily’s life—the most frightening point of mine. Last week, I had the privilege of thanking her, as face to face as we could get online, for her kindness, compassion and professionalism in such devastating circumstances. Not everybody gets the chance to do that. The entire bereavement midwifery team at Treliske are outstanding, and I continue to be in awe of our local team, of how they do such a difficult job, are able to support families at their lowest ebb, and continue to take special care of our babies after they have died.
The impact of covid on those issues seems to be a mixed bag, which is against the expectation. There was a peak in stillbirth and neonatal death in March 2020 and another in January 2021. Our team in Cornwall points to a slow and steady decline in the numbers since 2010. This year, there have been two stillbirths so far. In a so-called usual year, there would have been between eight and 12 by now. It is difficult to commend this figure, however, as the team do not yet really know what to attribute it to, apart from natural peaks and troughs. It could be a temporary irregularity; more research will need to be done to see whether we can find a pattern. This is no comfort at all to the two Cornish families who have suffered that unbearable loss.
The APPG has heard evidence from the sector about how covid has exacerbated existing inequalities. Inequality is the biggest issue that needs to be tackled to reduce the number of babies dying and to improve maternity safety. The Health and Social Care Committee report highlights the need to tackle “unacceptable inequalities in outcomes”. The report by the health and social care expert panel report notes that
“improvements in rates of stillbirths and neonatal deaths are good but are not shared equally among all women and babies. Babies from minority ethnic or socioeconomically deprived backgrounds continue to be at significantly greater risk of perinatal death than their white or less deprived peers.”
It is fair to say that mums and babies should not be at an unfair risk just because of their background.
The Select Committee’s recommendation that the Government introduce a target to end the disparity in maternal and neonatal outcomes, with a clear timeline for achieving that target, is exactly right. Work must be done urgently to identify a suitable target and ways to evidence the gap closing nationally, supported by the evidence of progress locally. The target must aim to achieve equity among all groups and ensure that those who currently have the least good outcomes have the best outcomes.
What needs to be done? I have taken it down to five or six points. First, on staffing, action is needed to address staffing shortfalls in maternity services. At a minimum, we need nearly 500 more obstetricians and nearly 2,000 more midwives. I welcome the recent increase in funding for the maternity workforce, but there will need to be further funding commitments to deliver the safe staffing levels that expectant mothers should receive. In Cornwall, when Karen Watkins started 14 years ago, there were eight consultant obstetricians. Today, there are still eight. None of them are dedicated bereavement obstetricians, and staff need to take on this role as part of their existing duties.
Secondly, on training, the 2016 maternity safety training fund has delivered positive outcomes. More funding is required to embed ongoing and sustainable access to training for all maternity staff, given changes in the practice, developments on how to deliver safely and aspects related to covid-19. Funding for backfill cover when training takes place is also desirable.
Thirdly, on parent involvement, after a patient safety incident, too often families are not provided with the appropriate, timely and compassionate support that they deserve. Involving families in a compassionate manner is a crucial part of the investigation process. The Healthcare Safety Investigation Branch has taken considerable steps to improve family engagement but must continue to pursue improvements in that area.
Fourthly, on clinician confidence, this is related to the earlier point about training, but is also about giving clinicians the confidence to report issues without worry. I welcome the Government’s proposal to review clinical negligence in the NHS more broadly. Elements of the rapid resolution and redress scheme have been implemented, but the scheme has not yet been implemented in full. Until it is, there is a high risk that the fundamental changes needed to improve the safety of maternity services may fail to be achieved.
Fifthly, carer continuity is close to my heart. I am a huge advocate for this, and it has been shown to improve the outcomes of those who currently have the worst outcomes. I would like to ensure that those involved in delivering carer continuity have received the appropriate training, and that all professionals are competent and trained in all the work they are able to do, particularly in relation to black mothers, where the disparities are the greatest. Carer continuity helps to point out other issues that might not be specifically or medically looked for such as domestic violence.
Sixthly, we need more research. If a baby dies at term, the parents ask why, and often there is no answer. I would like to see more money put into research and development so that we can understand more about this horrific phenomenon. There is more to say, and I am sure colleagues will add to the discussion today. I thank the Minister for her continued support in this area, and I know she is listening.
Group B strep is the most common cause of life-threatening infection in newborn babies, causing a range of serious infections including pneumonia, meningitis and sepsis.
Screening could save 50 babies a year, and protect a further 70 from life-changing issues. Our Minister has been a force in trying to ensure that all women can ask for the group B strep screening and that all hospital trusts can offer it.
We have just passed the halfway point in this important journey to 2025, and I would like to thank all the healthcare professionals who have contributed to the successes so far. I call on the Government to work with them to achieve the rest and save as many lives as possible in the future.
It is a pleasure to serve under your chairship, Mr Gray. I congratulate Cherilyn Mackrory on securing this timely and important debate, and on continuing to campaign on these issues. Her bravery in sharing her story is inspiring, and the work of the APPG should be commended. I agree with all her final points wholeheartedly. I was contacted by a number of constituents before today’s debate, and hundreds of people over the past year have shared harrowing stories of their own experiences of baby loss and miscarriage. I would like to thank all those who are campaigning for change.
The overwhelming feeling from all of those I have spoken to is that baby loss, like many other women’s health issues, still does not receive the attention, research or funding it deserves and so desperately needs. As a result, not nearly enough progress is being made. As the hon. Member for Truro and Falmouth mentioned, every day in the UK, around 14 babies die before, during or soon after birth. An estimated one in four pregnancies end in loss during pregnancy or birth. These statistics are difficult to read, but what is much, much worse is the fact that many of these deaths are preventable. According to the recent report by the Health and Social Care Committee, 1,000 more babies a year would survive in England’s maternity services if those services were as safe Sweden’s.
While it is good to hear about improvements that have been made, my constituents and those who have experienced baby loss or miscarriage are more concerned about what more needs to be done to reduce the numbers experiencing loss, especially when the Committee’s report has shown that we are far from meeting our 2025 ambitions. Services are seriously overstretched, underfunded and understaffed, and huge health inequalities in perinatal outcomes remain unaddressed. If we are to buck this trend, the Government need to take the opportunity to reset and refocus perinatal services across England on meaningful and long-lasting transformation.
To begin this transformation and to ensure it results in meaningful change for all women, we need immediately to introduce enhanced data collection and sharing of all adverse perinatal outcomes. During my Adjournment debate earlier this year on the findings of The Lancet series, “Miscarriage matters”, the Minister committed to include the report’s recommendation to record every miscarriage in England in the Government’s women’s health strategy. This is a huge win for campaigners and a really welcome step, which I hope will come to fruition very soon.
However, we must ensure that there is consistent data collection on all adverse perinatal outcomes, including brain injury, and on loss during pregnancy before 24 weeks’ gestation. We must also ensure that all perinatal deaths are recorded within a 24-hour period, rather than the seven-day period that we currently have, to allow for more accurate and timely data collection.
Finally, and most importantly, we must ensure that data are consistently collected on ethnicity and social factors in pregnancy and the post-natal period, so that we can identify groups whose outcomes are worse than the average and set more robust targets. We know from the available data that stillbirth rates for black and black British babies are twice as high than those for white babies, and that the rates for Asian and Asian British babies are 1.6 times higher than those for white babies. Stillbirth rates for babies from the most deprived families are 1.7 times higher than those for the least deprived.
It is deeply upsetting that we still have no evidence-based interventions to reduce the risks that black, Asian and socioeconomically disadvantaged women face. I think we can all agree that we need a strategy in place to end the disparity in maternal and neonatal outcomes, but without available data on specific targets, we do not stand a hope of reducing the inequalities. Consistent data must be recorded and made accessible, so that collectively we can sound the alarm and set specific, tailored targets and strategies for meeting them. Although I welcome the forthcoming confidential inquiry into the deaths of black and black British babies, I am disappointed that Ministers feel unable to fund a similar inquiry into the deaths of Asian and Asian British babies, and I call on the Minister to look at that again.
For too long, baby loss has not received the focus it deserves, and it is dismissed all too often as an inevitability. Only by properly tracking baby loss will we be able to break the taboo, properly address the inequalities in health outcomes, and ensure that we have a foolproof strategy to reach our 2025 ambitions and improve outcomes. For those going through baby loss or still living with the trauma of prior experiences, progress cannot come soon enough.
It is a pleasure to serve under your chairmanship, Mr Gray. I pay tribute to my hon. Friend Cherilyn Mackrory for securing the debate. Her personal story, which she bravely told today and in a previous and moving Westminster Hall debate, has shone a spotlight on the pain and anguish faced by parents who suffer the tragedy of baby loss.
Almost 60,000 babies were born prematurely in 2019, with one in five pregnancies ending in miscarriage during the same period. The effects of miscarriage, stillbirths and neonatal deaths are devastating for parents, with impacts that can and do last a lifetime. It is essential that the Government continue with their 2015 ambition to reduce the rate of stillbirths, neonatal deaths and maternal deaths in England by 50% by 2030. I welcome the provision in the NHS Long Term Plan to bring forward that ambition to 2025. To this end, the Government announced only this month, on
As the son of an NHS community midwife, I know the care, dedication and effort that our amazing midwives, such as the incredible team serving my community in Darlington, put into their vocation. They are on the frontline of safety, bringing new life into the world, and all too often they are at the side of parents who have suffered the worst loss imaginable. We must ensure that our midwives are provided with the skills to give the most appropriate care to parents at their time of bereavement.
In Darlington, I recently met Claudia and her husband, Andy, who have suffered two late-term losses—first, at 20 weeks of pregnancy and, more recently, at 18 weeks. Although Claudia was thankfully entitled to statutory sick leave to recover, Andy was not entitled to leave and had to negotiate with his employers to take time off. I am thankful to the two of them for meeting me to talk about their experience, the impact of those losses and the challenges they have faced. I am glad that they have continued to work with me to gather information and understand the patchwork of provision by UK companies whose employees suffer miscarriages. For the sake of Claudia and Andy, I am hopeful that the threshold for statutory bereavement leave will be revisited. The impact of a loss in the second trimester will almost always be just as painful, devastating and hard to overcome as a loss in the third trimester.
Another constituent, Angela, has shared her tragic story with me. Angela suffered two ectopic pregnancies and two miscarriages, and now feels that she will never experience one of the most natural things in the world: the honour of giving birth. Angela described to me that she feels crushed, and would like to see more support for people in her position than was available to her in the first years of the 2000s.
Improving maternity safety, delivering personalised care and improving training will all help to improve outcomes for future expectant parents across the UK. I sincerely hope that a future review of bereavement leave will be extended to those parents who suffer a miscarriage in the second trimester of pregnancy. I look forward to hearing from the Minister what more the Government are doing to achieve our national ambition to reduce baby loss.
I am thankful that the Government have taken and are taking firm action towards reaching the 2025 ambition that will reduce the number of future parents experiencing the pain that Angela, Claudia, Andy and my hon. Friend the Member for Truro and Falmouth have experienced.
I would like to focus on the progress towards safe births at my local trust. I wish I did not need to speak in this debate; I wish that Nottingham’s hospitals, Queen’s Medical Centre and Nottingham City Hospital, were safe places to have a baby. That is what parents in my constituency need and have a right to expect. But right now, that is not what they are guaranteed, as the trust’s chief executive admitted a few weeks ago:
“We fully accept that, although our staff are passionate about what they do, we have not created an environment where these same staff can provide a positive and safe experience for every family in their care, every time.”
A recent investigation by The Independent and “Channel 4 News” found that since 2010, there have been 201 clinical negligence claims against the trust’s maternity services—almost half lodged in the past four years. In those claims are 15 deaths, 19 stillbirths, 46 cases of brain damage and 18 cases of cerebral palsy. The trust has already paid out £79.3 million in compensation but, of course, the human costs are much higher.
In September 2019, Wynter Sophia Andrews was born at the QMC. She died 23 minutes later. It was only after the healthcare safety investigation branch’s findings were published that the trust admitted failings and that earlier intervention would have avoided Wynter’s death. Wynter’s death was the subject of an inquest, and in her verdict the coroner was highly critical of Nottingham University Hospitals NHS Trust. The coroner said that Wynter would have survived if action had been taken sooner. I will not read the detailed quote from the coroner, but she said that the incident reports and staff accounts demonstrate that
“this was not an isolated incident. An unsafe culture had been allowed to develop as these systemic issues had not been adequately addressed by the leadership team.”
During the inquest, it also emerged that a letter from maternity staff at the trust was sent to the hospital board in 2018 asking for help and raising serious concerns about safety.
“During the inspections, several serious concerns were identified. For example, risk assessments which women were expected to have undertaken during their care were not always completed in line with national guidance. Staff did not always use a nationally recognised tool to identify women at risk of deterioration. n addition, the service did not always have enough midwifery staff with the right qualifications, skills, training and experience to keep women safe from avoidable harm and to provide the right care and treatment. Managers regularly reviewed and adjusted staffing levels and skill mix but were limited to the resources available. Following this inspection, maternity services at Nottingham City Hospital and Queen’s Medical Centre are rated Inadequate overall. The services are rated Inadequate for being safe, effective and well-led. Maternity services were previously rated Requires Improvement.”
The worst thing about the situation is that it did not need to be like this. When I read Gary and Sarah Andrews’s account of Wynter’s death, I felt sick—not just because it is tragic and heart-breaking for anyone to lose a much wanted baby, but because there were striking similarities to an earlier case.
My constituents Jack and Sarah Hawkins’s daughter was born dead at Nottingham City Hospital in April 2016. Harriet was a healthy, full-term baby. She died as a result of a mismanaged labour. The trust initially claimed that her death was caused by an infection. Jack and Sarah were told to “try to move on.” It was only thanks to their incredible courage and determination to fight for the truth that the trust was finally forced to admit gross negligence.
I sat with Jack and Sarah in a meeting with the trust’s then chief executive, with photos of Jack, Sarah and their dead daughter on the table in front of us. He apologised and promised that the trust would learn the lesson. Following the coroner’s verdict in Wynter Andrews’s case, I read the comments from senior staff at the trust, apologising and promising to learn the lessons. They were the exact same promises that I had heard more than three years earlier.
Gary and Sarah Andrews wrote to me in March. They said:
“All we want is for other parents to be taking their children home.”
They, Jack, Sarah and other parents are calling for a public inquiry into maternity services at Nottingham University Hospital Trust. I am sure that the Minister will tell me, and them, to put their faith in the Care Quality Commission and the Healthcare Safety Investigation Branch, but they do not share her confidence that that will be effective. In Harriet’s case, there were numerous investigations, both internal and external, but things did not change or did not change enough.
As the Health and Social Care Committee report notes,
“Involving families…is a crucial part of the investigation process…Families must be confident that their voices are heard and that lessons have been learnt to prevent the tragedy they have endured being repeated.”
When I met the CQC investigation team in April, I was shocked to hear that they have not contacted bereaved parents or sought to hear their views. They claimed to be unaware of Harriet Hawkins’s case.
When I raised concerns with the Minister, her reply contained the news that NHS England, NHS Improvement and the clinical commissioning group are
“finalising the terms of reference for an independent thematic review of maternity cases going back to 2016”.
As Jack Hawkins told me, this has happened without any input from families. The review was due to go back to only 2016, although we know there were many improperly investigated baby deaths and harmed babies before then. That is why they want a truly independent review, not one where it is too easy to suggest that Nottingham University Hospital Trust has a hand in it, and where parents of dead and damaged babies are ignored and excluded from the process of deciding what needs looking at.
I hope that when the Minister meets me and other MPs she will also hear from the parents affected by some of these tragic failures to improve maternity services at Nottingham University Hospital Trust. I look forward to hearing her response both today and on that occasion.
It is a pleasure to serve under your chairship, Mr Gray, and to follow my hon. Friend Lilian Greenwood. I congratulate and thank Cherilyn Mackrory for securing this incredibly important debate. I am so sorry for her loss but I thank her for her bravery in sharing it and for her ongoing campaigning in this area.
I also thank campaigning organisations, including the Stillbirth and Neonatal Death Society, Tommy’s and the Lullaby Trust, and all the members of the Pregnancy and Baby Charities Network, as well as bereavement organisations such as the Good Grief Trust for all they do to support parents and families and for their continued campaigns for change.
I thank all my constituents who have recently written to me about this important debate, underlining the reason for having this debate now and why we need to look again at the plan for the national ambition to reduce baby loss and at progress towards that. I am certain that all Members present share my ambition that the UK should be the safest place in the world to have a baby. However, as broken-hearted mothers and fathers across the UK can testify, it is not, and that is the reason for the debate today.
There are stark inequalities: background makes a difference, as well as where mothers have their babies. That should not be case—the highest standards should be equally available across our country. Recent reports from the Health and Social Care Committee, the Ockenden review of maternity services at Shrewsbury and Telford Hospital NHS Trust, the ongoing investigation at East Kent Hospitals University NHS Foundation Trust, and the devastating revelations from Nottingham University Hospitals NHS Trust—which have been outlined by my hon. Friend the Member for Nottingham South—plainly demonstrate just how much more there is to do.
Although huge strides have been made over the past two decades, that progress has now plateaued and we need to know why and address this. In 2019, the neonatal mortality rate in England and Wales was 2.8 deaths per 1,000 live births, the same as it was in 2017—the third consecutive year of no change. The latest statistics for neonatal mortality published by the World Bank rate the UK as the 37th country globally, making us one of the worst-performing countries in the developed world in this area. As the hon. Member for Truro and Falmouth highlighted, the recent report into progress on maternal mortality said that
“No discernible progress has been made towards reducing the 2010 rate of maternal deaths by 50% by 2025.”
There are huge inequalities in the experience of maternal mortality and baby loss that have gone unaddressed for too long. Babies from minority ethnic and socioeconomically deprived backgrounds remain at an increased risk of death: if a woman is black or poor, it is more likely that she will die or that her baby will die, which is absolutely unacceptable. In 2017, babies born to black or black British parents had a 67% increased risk of neonatal death compared with babies of white ethnicity, and babies born to Asian parents had a 72% increased risk of neonatal death compared with babies of white ethnicity. The 2020 MBRRACE-UK “Saving Lives, Improving Mothers’ Care” report shows that the risk of maternal death in 2016 to 2018 continued to be four times higher among women from black ethnic minority backgrounds than among white women, and that that risk is twice as high for women from Asian backgrounds as it is for white women.
The Office for National Statistics’ latest “Births and infant mortality by ethnicity in England and Wales” report, published in May this year, highlighted substantial inequalities in infant mortality rates among black and other ethnic minority groups. Some of this variation may be explained by other areas of inequality, including deprivation, but the association between social deprivation and child mortality is clear, and there are modifiable factors that can make a difference. This can be addressed—it can be changed. I have raised this issue with NHS South West London Clinical Commissioning Group, and it must be addressed in partnership with those who have relevant lived experience and build on the knowledge of specialist agencies in each area.
Two further issues that need action have been raised with me by constituents. The first is miscarriage: a constituent has raised with me the issue of access to information and support following a miscarriage, and Tommy’s is campaigning on this issue as well. I met with a constituent yesterday who told me that women in the UK have to endure three consecutive miscarriages before they are referred for full investigation. She feels very angry about this situation and how it has affected her and women across the country. It is simply unacceptable for a couple to go through that much suffering and uncertainty and for it not to be addressed until there have been three miscarriages.
Another issue is that of culture. We are talking a lot today about funding: there is a need for increased funding, for staffing in particular, but there is also the issue of culture, which was raised by my hon. Friend the Member for Nottingham South. One constituent wrote to me to say that there had been a lack of investment over a long period of time and that that had played a big part in why the services are what they are today, but she also wanted to highlight behavioural issues within maternity—with bullying and hostile attitudes among members of staff. She said that trainees in obstetrics and gynaecology report a high rate of being undermined, higher than other medical specialities.
It is also well known that, in some services, hostility between midwives and obstetricians contributes to services being unsafe. These issues, not only about resources but about culture, need to be addressed and understood: there needs to be a cultural shift. Reporting should be welcomed within NHS trusts, and change should result from such reporting.
I have some requests for the Minister today. First, I underline the calls from Members earlier in the debate about the need for enhanced data collection and sharing. What gets counted counts, and the first thing anyone sitting down and looking at this area sees is that there are big gaps. Secondly, there should be a review of the impact of covid on our neonatal services.
Thirdly, there should be a plan to increase staffing levels; as has been outlined, we need to increase those. How much will they be increased by next year, the year after and the year after that, so we can achieve those 2025 levels? There needs to be action on ethnic disparity and much more focus within every clinical commissioning group on why those differences exist, learning from each other and from best practice and building on that, with a change in culture where needed.
What additional measures is the Minister taking to achieve the national ambition to halve stillbirths, neonatal deaths, maternal deaths and brain injuries by 2025? As we have seen in the debate and from the recent reports and statistics, business as usual is not going to achieve those aims at all. Will the Government commit to publishing specific national targets before the end of 2022—earlier, ideally—that reflect a bold commitment to action on inequalities due to ethnicity and deprivation, underpinned by specialist pathways and workstreams in every local maternity system?
I pay tribute to all the midwives working so hard across our country for all that they have had to change and go through in the last year, and to all the families affected by the issue. Ambition is all well and good, but it needs to be matched by action and boldness. A lack of both is currently letting down parents and babies across the country and it has to change, starting today.
It is an honour to serve under your chairship, Mr Gray. I pay tribute to Cherilyn Mackrory for securing this important debate, for her incredibly moving contribution and for her work on baby loss. I also pay tribute to my constituents in Liverpool, West Derby who have been in touch to ask me to speak today and raise their concerns, and to all those affected by the devastating loss of a baby. Nothing I can say here can do justice to the heartbreak they have been through, but I hope to do my best to raise some of the issues that constituents have shared with me.
It is truly heartbreaking that every day about 14 babies in the UK die before, during or soon after birth. The recent report by the Health and Social Care Committee notes the good progress made, but stresses the urgency with which actions must be taken to achieve the Government’s ambitions of reducing baby loss by 2025. The expert panel also raised serious concerns about aspects of continuity of carer, personalised care and safe staffing, and the Committee has made a series of recommendations, including for a Government commitment to funding the maternity workforce at the level required to deliver safe care to all mothers and their babies.
The report also states that the improvements in rates of stillbirth and neonatal deaths are good but are not shared equally among all women and babies. Babies from minority ethnic or socioeconomically deprived backgrounds continue to be significantly at greater risk, and as the charity Sands says in its report:
“Babies should not be at a higher risk of death simply because of their parents’ postcode, ethnicity or income.”
I wish to raise a case on behalf of one of my constituents today and to pay tribute to her. Can the Minister provide an update on the progress made since the important debate on covid-19 and baby loss in November and outline the steps the Department is taking on research and actions to make sure that nobody has to go through what my constituent has experienced?
My constituent is a health worker who became poorly last year with covid, 36 weeks into her pregnancy. At 37 weeks, she attended hospital with reduced foetal movement, and her daughter was monitored for five hours. When she got to the delivery suite, her daughter had died.
The hospital completed an investigation and found that there were many lessons to be learned. Policies and procedures were not correctly followed. My constituent should have been reviewed by a senior consultant and was not. There were delays of hours in transferring her to the delivery suite due to low staffing levels. The cardiotocography traces showed that her daughter was in distress, but unfortunately at the time that was not acted upon or escalated. If it was, she would have been taken for a caesarean section earlier in the day.
I close with the words of my constituent:
“I have spoken to other women who have been in the same position as me with covid at the same time but their hospitals have acted fast and thankfully their babies have survived. I have also spoken to women in other areas who have sadly lost their babies because their hospitals did not act appropriately. A gold standard of care should be followed nationally. It should not be a postcode lottery if your baby lives or dies.”
It is a pleasure to serve under your chairship, Mr Gray. It is an honour to follow my hon. Friend Ian Byrne, who spoke wholeheartedly on behalf of his constituents. I thank Cherilyn Mackrory for her courage and compassion, and for her campaigning throughout. She is an inspiration to so many women out there.
The last time we debated this subject, although it was in Westminster Hall, as opposed to here, we had a very emotional debate on baby loss. It was Parliament at its best. MPs from across the House brought their life experiences—and, yes, painful experiences—to benefit the people we seek to serve. That is Parliament at its best.
This has been a painful year for many women and families. We have heard from constituents who were forced to receive bad news apart, were unable to grieve losses together or were even unable to hug a friend or a loved one they saw in pain. Those of us who have experienced baby loss and miscarriages know the pain and anxiety that appointments and scans can cause. I remember breaking down into bits at just the first appointment. It was just a question-and-answer session with a midwife during my second pregnancy, but it can be a horribly anxiety-provoking, triggering experience to go back to a place you have received bad news in the past, let alone doing that during a pandemic. Many women this year have been robbed of the joys of pregnancy.
Although I have had two pregnancies that ended in miscarriage, I now speak from the fortunate position of having a beautiful rainbow baby, which is the term used for a baby following miscarriage or baby loss. That is a very different experience from before. I do not know how others have the strength to speak out while they are still on that journey or without their rainbow. I know I would struggle; you are truly inspirational.
It is because of that shared experience that I am especially proud of the teams at Luton and Dunstable University Hospital, who recognise the pain and stress this has caused. I thank the team at Luton and Dunstable for working with me and families to accommodate visitors at scans and appointments as soon as possible. I appreciate that they are under huge stress and pressure during the pandemic, but the difference they make to families is priceless. Thank you to the sonographers, the early pregnancy units, the admin staff, the midwives, the GPs and the consultants who have helped women through this difficult year. You have gone above and beyond—thank you.
To fast-forward to just a few weeks ago, I met some of the brilliant midwife team at the L and D to talk about the changes and the challenges of the future. One is always staffing. They are doing wonders, but to limit the burnout that this pandemic has caused, we need to ensure that we not only retain midwives but recruit adequate numbers. NHS staff have experienced increased stress and pressure, which would test even the toughest of heroes. Hospitals could delay some procedures and surgeries, but as one midwife told me, people do not stop having babies.
We know how important continuity of care is to the health of both mother and baby, so it would be great to get an update from the Minister on where we are on the target to improve continuity of care for women, especially for black and Asian mothers, for whom the maternal health outcomes have been particularly poor. We have heard that stillbirths have doubled for black women, and Asian women are more than 1.6 times as likely to experience stillbirth.
I hope the Minister takes a serious look at the proposals in the report of the Health and Social Care Committee, on which I sit. The Committee heard evidence from a range of parents, grieving families and health experts. I hope the Minister takes a serious look at the recommendations and takes steps to implement them. One of the crucial recommendations is about having adequate levels of staffing. How many midwife vacancies are currently unfilled? How many do we need to train and retain in position to meet future challenges and targets on providing continuity of care to all mothers?
To focus quickly on the pandemic, we know the devastating impact that covid can have on pregnant women. The Royal College of Obstetricians and Gynaecologists released shocking statistics relating to pregnant women and covid. One in 10 pregnant women admitted to hospital with covid symptoms needed intensive care. More than 100 pregnant women have been admitted to hospital with covid-19 in the past two weeks. No pregnant women who have received both doses of the vaccination have been hospitalised since vaccination programmes began. Those are startling statistics.
The Minister joined me to meet my constituent Ernest Boateng who lost his wife Mary more than a year ago, shortly after she contracted covid-19 and gave birth. Ernest has shown amazing strength after losing Mary to look after his two beautiful children. His campaign to see pregnant women prioritised for vaccination is inspirational and one I wholeheartedly support, as do the facts. Yet, throughout this year, and despite protestations from Ernest and MPs such as my hon. Friend Stella Creasy and others, the Government have failed to prioritise pregnant women for vaccination, relying on the Joint Committee on Vaccination and Immunisation recommendations. I feel the figures now show that that should change. I ask the Minister to commit that, should boosters be needed in future, pregnant women will be some of the first to receive them, and that alongside that there will be an education and information programme targeted at pregnant women.
Before we get to that stage, there is the issue about which my hon. Friend Olivia Blake has spoken so passionately from the heart: the ludicrously cruel requirement that women should suffer three losses before support is given specifically for miscarriage and baby loss. Let that sink in. In 2021, we are asking women to go through such a physical, emotional and painful loss three times before they qualify for extra tests, or even early pregnancy support in future pregnancies. How can that be right?
I was lucky to receive extra help and access to some of those tests, but only because a consultant was kind enough to count the losses that I had in the number of babies, rather than pregnancies. I am currently working with a constituent in a similar situation. I am pleased to say that she is now accessing the support she needs, but that should be the norm; it should not be extraordinary. Why are we making women and families go through such pain before they even get a simple blood test? It is cruel beyond belief.
To summarise my points: first, we should make pregnant women a priority for covid-19 vaccines and ensure that they are prioritised for any subsequent boosters. Secondly, we need to recruit, retain and reward midwives to ensure that we have adequate numbers, while being honest about the scale of the challenge ahead of us. That leads on to point three about continuity of care. We need to see continuity of care, prioritising those who are most in need, particularly black mothers, who are four times more likely to die during childbirth.
We must implement the recommendations in the Health and Social Care Committee report. Many of my colleagues on the Committee would have joined today’s debate, but that Committee is sitting at the same time. I pass on their apologies, knowing their strength of feeling and that we are united on those recommendations. Finally, we must end the requirement of three losses before intervention and support is given to women. Pregnancy can be a painful journey for far too many women. Let us listen to women, end that cruel requirement and support women through their joys and their losses, and so improve the statistics on baby loss and miscarriage for good.
It is a pleasure to see you back in your place again, Mr Gray, after the operations you have had. I am very pleased you are back in Westminster Hall. I thank Cherilyn Mackrory for leading the debate. It is a pleasure to follow Sarah Owen and the contributions from other hon. Members.
Very personal stories have been told, some of which have been raised in earlier debates. That does not lessen the pain and heartache that we feel. I imagine the introduction was not easy for the hon. Member for Truro and Falmouth, given the grief and tragedy she has had to deal with after the loss of her little baby last year. As politicians, we often disagree—we can agree to disagree and are given this platform to represent our differing opinions. However, this issue has brought us together and it is heart-warming to discuss a topic that has touched us all in some form and enabled us to come together. My mother had five miscarriages, my sister lost three babies and the young girl who is the PPS in my office had two, so this issue is very real to myself.
Estimates suggest that there are 250,000 miscarriages in the UK every year. One in five pregnancies miscarries and there are 11,000 emergency admissions to hospital for ectopic pregnancies. Those figures sadly represent the mothers, fathers, grannies and grandas who have suffered a heartbreaking loss. I stand here today as someone who has witnessed the effects that this can have on a family. I extend my sympathies to those who have been faced with this in the past and those who unfortunately will be in the future.
The impact of baby loss is difficult enough and I have no hesitation in saying that the covid-19 pandemic has not made these situations any easier. I had multiple constituents contact me regarding hospital appointments and scans. They expressed concern that restrictions only allowed an isolated appointment. A number of MPs—some here and others not—have raised this issue with Ministers and asked them to address it. It has always made me think of those who went through the tragedy of a miscarriage or pregnancy complications and, in some circumstances, went through it all alone. As an example, I remember my mother. We had a shop in Ballywalter. My mother had a miscarriage and the next day she was back in the shop working again. That is how things happened in those days of long ago.
I have heard multiple reports from those in my constituency. One is a student midwife studying in Glasgow. She said that although tests can sometimes not identify any major issue, having efficient staffing levels and more adequate nurses and doctors allows staff to catch issues earlier. When responding, could the Minster give some assurance and encouragement that staffing levels will be sufficient to ensure that there is oversight and that these issues do not happen? An additional step that we as elected representatives can take is to ensure there is sufficient funding to employ more healthcare professionals, if this is what staff are telling us they need—and the staff are telling us that. We need to respond to that.
This is not the responsibility of the Minster but to give the figures, the latest report has shown that the neonatal mortality rate—deaths in the first four weeks of life—is the highest in Northern Ireland, when compared with England, Scotland and Wales. We have an issue back home, which is a devolved matter that the Minister Robin Swann is directly looking at.
When it comes to baby loss, hospitals do not have enough counselling services for parents who have suffered miscarriage, stillbirths and neonatal deaths. There need to be more trained counsellors in our hospitals to act at immediate effect. Baby loss can be prevented through increased research. Again, I urge the Minster and her Department to allocate funds for this.
I am a person of faith, as hon. Members know, and I believe it is important to have church representatives, be they leaders or those with pastoral abilities, to respond to people in hospital when they need it most. Has that been available for those who seek assurance at a particularly difficult time? Life is precious. There is nothing more valuable than the people we have around us and the loss of a wee baby, who has not even had a chance at life, occurs all too often. The Royal College of Midwives stated:
“Maternity and health services cannot do this alone, fantastic as their efforts are.”
We must add more support to our health service on baby loss. I am pleased to see the Minister, and look forward to her response to assure us on this issue.
I very much appreciate the subject of this debate, which is
“the national ambition to reduce baby loss.”
That ambition is shared by so many. I assure those going through the process that they are not alone. It is so important that people realise that they are not alone and that many others out there are trying to help them through those trials. Baby loss has touched the lives of so many, including mine. I am proud to stand here representing those who wish that those babies were with us today—they will not be forgotten. I call on the Minister to commit more time and more financial support to the national ambition to reduce baby loss. If we achieve that, we will have achieved a whole lot.
It is a pleasure to follow Jim Shannon. As many others have done, I thank Cherilyn Mackrory for securing this important debate and for helping to ensure that the issue remains firmly and high up on the political agenda.
Although health in Scotland is a devolved matter, there is no diversion in our collective will across the UK to do all we can to reduce baby loss. In almost every debate on baby loss that I have spoken in—all of them, I think—I have said that in the past, too many women have reported that they felt concerned about their unborn babies because, “Something just doesn’t feel right.” They go on to report that they have been dismissed and have subsequently suffered a stillbirth. I have repeatedly made the fundamental point about stillbirth that women know their own bodies and that clinicians need to listen to them. If that were done routinely, some tragic baby losses could be avoided.
The devastating loss of a baby brings with it not just crushing grief for the bereaved parents and the wider family, but a real social cost. We know that 50% of marriages end in divorce, and that people are eight times more likely to divorce if they suffer the loss of a child in any circumstances. Of course, the cost of divorce to society is well documented, as are the social and personal costs for all those involved. We need to bear those things in mind.
It is truly devastating when the worst happens and a baby is lost. High-quality bereavement care is very important. I am pleased that, alongside the UK Government, the Scottish Government are funding Sands UK—the Stillbirth and Neonatal Death Charity—to develop national bereavement care pathways for different types of baby loss. I also have a sense that the culture in some quarters of dismissing pregnant women who report that something is not quite right is changing, and I really and truly hope that it is. People have talked a lot about figures today, but in recent years there has been some modest improvement in the stillbirth statistics, which is welcome. There is a long way for us to go, however, in understanding more about stillbirth and baby loss.
The Scottish Government have unveiled the women’s health plan to improve women’s health in the round. We have talked about how health inequalities inevitably affect outcome, so looking at women’s health in the round is important. That would, of course, include maternity, neonatal and postnatal care. “The Best Start: A Five Year Forward Plan for Maternity and Neonatal Care” recommends that all women in Scotland receive continuity of maternity and obstetric care. A number of hon. Members have spoken about that, particularly the hon. Member for Truro and Falmouth. That does help to improve outcomes for mother and baby.
Any focus on reducing baby lost must consider pre-eclampsia, which is the most common of the serious complications of pregnancy. If we knew even more about that condition, we could save around 1,000 babies from stillbirth each year. The challenge that pre-eclampsia poses is that in its early stages, it has no symptoms. I declare an interest: my baby son was stillborn on the very day that he was due to be delivered because of an extreme form of pre-eclampsia called HELLP—hemolysis, elevated liver enzymes and low platelets—syndrome. I will not recount the details of baby Kenneth’s death again; I have done it several times in previous debates. Kenneth would be coming up for his 12th birthday, and I am now just getting to the point where I can talk about it without automatically bursting into tears, so I suppose that is progress for me.
As the hon. Member for Truro and Falmouth pointed out, knowing why your baby has died is really important. Many bereaved parents find, just as I did, that the shutters come down when they ask the question why. It is very hard to get answers and they are much more likely to be fobbed off than to be given any explanation. I can testify to the impact of such treatment after your baby is stillborn, and it is beyond what any bereaved parents should have to suffer. If there is anything that can make a stillbirth worse, it is that treatment of being dismissed.
How can we honestly say that practitioners are seeking to improve how they do things and how they improve outcomes if, when mistakes happen—as they inevitably will at times—they too often appear to go unacknowledged? Sadly, I have no reason to believe that that culture has changed. In my case, all the signs of HELLP syndrome were there, but they were missed by a series of clinicians. That very nearly also led to my own death from a ruptured liver.
The Minister knows about the really interesting work going on with regard to pre-eclampsia called placental growth factor testing, which can point us towards improving the early detection and diagnosis of pre-eclampsia and will save babies’ lives. Offering this test to every mother has implications for lab capacity and other resources—resources are always more scarce than we would like—but it compensates by reducing the demand on maternity services in other ways. It offers the potential to reduce admission of expectant mums for suspected pre-eclampsia in lower risk women, as well as reducing unnecessary in-patient monitoring tests. In the next few years, I hope that we will be able to reduce a significant number of stillbirths caused by pre-eclampsia through the use of the PGLF testing for suspected cases.
However, I am deeply concerned—as everyone else will be—that some of the very modest progress made in recent years in tackling baby loss and stillbirth appears to have been reversed since the start of the pandemic. This phenomenon has been noted in a number of countries across the world. St George’s hospital in London highlighted a fourfold increase in stillbirths, and in Scotland, too, there has been an increase since the March 2020 lockdown. Although stillbirth rates were lower than they have historically been, even during the lockdown, it is still very alarming that there has been a rise. To have suffered a stillbirth during the pandemic while separated from the wider support of family and loved ones is truly heartbreaking, and has made it all the worse.
Experts are investigating the increase in stillbirths during lockdown, but we need to know the true cause. Was it because expectant mums were more reluctant to seek help? Was it caused directly by the effects of covid-19 on babies, or is there some other explanation? Regardless of the cause, this is a very worrying development. We are all waiting on the publication of research on that to see what can be learned to inform future care that is better and more responsive to women’s needs during covid, which we must remember is still with us.
I am delighted that we have had this debate today on this very important issue, and hope that wherever reductions in baby loss are made, the whole of the UK will share best practice and each part of the UK will learn from its other constituent parts, because expectant mothers and families awaiting a new arrival should all be entitled to the safest possible delivery of their baby.
It is a pleasure to serve under your chairmanship this morning, Mr Gray. I thank Cherilyn Mackrory for securing today’s debate and the compelling way she spoke both today and in the debate last November. I was not present for that debate, but I read it over the weekend. I never thought that reading Hansard would bring a tear to my eye, but the way that she and many other Members spoke in that debate was incredibly moving and powerful. Today, she said some very important things that we all need to reflect on. She talked about the staff who cared for her during her difficult times, and she used the words “kindness, compassion and professionalism”, which are absolutely the qualities that we need in our NHS workforce in this particularly sensitive area. We should all put on record our thanks to those who do incredible work in incredibly difficult circumstances.
The hon. Member for Truro and Falmouth also mentioned the Select Committee report and noted that progress had been good, but it was from a low base. As a number of Members said, variation still exists across the country. The hon. Member talked about her six priorities. A number of Members talked about some of them, but she set out clearly where we need to do more about staffing the shortfalls. She made an important point about providing not just training, but the back-filling of positions while staff go on training. She also made an important point about parents’ involvement and engagement with such issues, because those who have been through awful experiences have the best input to give us on how to make it a little easier for those who have to face it in the future.
Clinician confidence to report issues was another important point that several Members raised. It is important that clinicians feel able to raise concerns and that they are acted on, which does not always happen. Like most Members, the hon. Member for Truro and Falmouth mentioned continuity of care and the importance of more research. One of the things that parents want to know is why this happened to them.
Each year, 1,200 babies are stillborn, and a third of those die after a full-term pregnancy. We know how important coroners’ inquiries can be in getting to the truth and preventing future deaths, but they are currently unable to investigate stillbirths. Does my hon. Friend think it would be helpful if the Government now responded to the 2019 consultation on extending coronial powers to cover stillbirths, so that some of that important investigative work can contribute to attempts to reduce the number of stillbirths in this country?
My hon. Friend is absolutely right. Her speech gave a very clear example of how that can be of benefit not just to the parents, but to the wider system. Parents will always want to know why this has happened to them. It will not always be possible to give an answer, but if we can do more to look at that, it would be of great benefit.
My hon. Friend Olivia Blake spoke in November’s debate as well as today, and her contribution was incredibly moving. She raised the issue of research and the need for more funding to be brought into this area. Like many Members, she talked about the huge inequalities in perinatal outcomes. She also raised an important point about data collection, which will of course inform policy moving forward. It is not just about collecting data, but about collecting it in a timely manner and accurately.
Peter Gibson mentioned the experience of his constituents Claudia and Andy, and he made a very important point about statutory bereavement leave, which we ought to look at again.
The comments of my hon. Friend Lilian Greenwood about her own trust, the death of baby Winter, and her constituents Jack and Sarah, who had a similar loss with Harriet in 2016, were telling. That really was a case of many of the issues being repeated, and it sounds to me as if the trust has not done enough to learn the lessons. My hon. Friend also made a vital point about parental involvement in the review process. It seems to me that 2016 is an arbitrary date, and I encourage the Minister to engage in a dialogue with parents to make sure that the scope of the review is as wide as it can be.
My hon. Friend Fleur Anderson made an excellent speech, highlighting just how far we still have to go with obstetrics and how inequalities in outcomes still exist. She made the important point that these issues need to be addressed in conjunction with those who have experienced a loss. Parental involvement is a theme that has come through several times today. She also made a very important point about the culture, which is not always the best for raising concerns and learning from past experiences.
My hon. Friend Ian Byrne also mentioned continuity of care and the workforce challenge, something that most Members raised. He said that postcode, ethnicity and income should not be telling factors in outcomes. He also told a very moving story about one of his constituents, who suffered their own loss. Unfortunately, it seems that the failings that were identified there will resonate with many trusts.
My hon. Friend Sarah Owen spoke incredibly movingly today, as she did in the previous debate. She brought home how difficult it is for those who have successful subsequent pregnancies still to have to deal with previous losses, which are still on their minds, as one would expect. Again, continuity of carers and workforce issues were raised. She made a very important point about vaccines and the admissions that we have seen in recent weeks of pregnant women with covid. A very important point was put to the Minister about the priorities for booster jabs, which I hope she will address. The point my hon. Friend made most powerfully was about the three miscarriage rule, and the way she spoke brought home how cruel it is. It really does need revisiting.
Finally, Jim Shannon gave a very heartfelt speech. Again, he raised a number of issues about staffing.
I am nearly out of time, so I will make just a couple of points. A number of Members touched on issues that have arisen during the pandemic. We know that there has been reduced access to face-to-face appointments. Partners have sometimes been excluded, leaving women to receive this terrible news on their own. That has obviously been deeply isolating for mothers, but also for fathers. Virtual appointments just do not allow for the compassion and assurance that is really needed in those difficult moments. Of course, even if the woman has had her partner with her, the wider family has not always been able to comfort them during those difficult times.
We know that, for those who have had a loss, time is of the essence. There is a direct correlation between when someone receives mental health support and how long it is needed. A survey by Sands found that nearly two thirds of bereaved parents who felt they needed psychological support were unable to access it on the NHS. We really need to do much better on that.
Finally, I want to take a few moments to recognise the fantastic work that the more than 60 charities that collaborate together in this area do and the way they support anyone who has been affected by pregnancy loss or the death of a baby. They work very constructively with health professionals to improve services and reduce deaths. I also pay tribute to Donna Ockenden and her team for the work they are undertaking. There is no doubt that the more work they do, the more it becomes apparent that there is an awful lot more to do.
It is now approaching five years since we had the first of what has become an annual debate on baby loss in the House. Those debates have seen the House at its best. Members recall their own experiences, and no one should underestimate how difficult that must be. That plays a vital role in helping to inform policy, but it also says to those who may be going through these awful experiences that they are not alone.
It is a great pleasure to serve under your chairmanship, Mr Gray, and a huge pleasure to respond to my hon. Friend Cherilyn Mackrory. Many tributes have been paid to her bravery, courage and compassion and to how inspirational she is on this issue. I echo all that and thank her for securing this debate today on an incredibly important issue.
This debate has an hour and a half. If we had half a day, it still would not be enough. I have 10 minutes and a huge amount of information to respond to. I will not be able to respond to all the questions and issues raised in those few minutes. Lilian Greenwood and I have a call very soon and we will discuss Nottingham in detail during it.
I want to start by saying that the UK is one of the safest countries in the world to give birth. We are safer than Canada, the United States, France and New Zealand. I could go on listing how safe we are. We have made good progress. I want to start with that context. We have made really good progress in improving maternity safety over the past few years. The original ambition was to halve the 2010 rates of stillbirths, neonatal and maternal deaths, and brain injuries in babies occurring during or soon after birth by 2030. We updated that ambition in 2017 to bring forward that date to 2025 and to include an additional ambition to reduce the rate of pre-term births from 8% to 6%.
In relation to stillbirths, we are making solid progress towards meeting that ambition. Since 2010, the stillbirth rate has fallen from 5.1 stillbirths per 1,000 births to 3.7, which equates to a 25% reduction in the stillbirth rate. That places us firmly ahead of our target to meet the 2020 ambition for a 20% decrease, and that means there are now at least 750 fewer stillbirths each year.
Similar progress has been made on reducing the number of neonatal deaths. According to the ONS, there has been a 29% reduction in the neonatal mortality rate for babies born over 24 weeks of gestational age of viability. I am particularly proud of that progress and acknowledge that progress on reducing the maternal mortality rate, the brain injury rate and the pre-term birth rate has been slower. However, according to a bespoke definition developed by clinicians at the request of the Department of Health and Social Care, the overall rate of brain injuries occurring during or soon after birth has fallen to 4.2% per 1,000 births in 2019 from 4.7% per 1,000 in 2014. Although that progress is slower, we are still seeing a reduction.
Because of that slower reduction, on
Funding for the second phase of the work, beginning later this year, will begin to implement and evaluate this new approach to inform how we can roll it out nationally. On pre-term births, recent ONS provisional data shows the percentage of all pre-term live births decreased for the second year in a row, from 7.8% to 7.5%.
Although we have had a reduction in maternal deaths, there is still more work needed to address the underlying causes of why mothers die in or shortly after childbirth. In the 2016 to 2018 data, 217 women died during or up to six weeks after pregnancy. That represents a 9% reduction in the maternal mortality rate against the 2009 to 2011 baseline, but we obviously need more up-to-date data on that. Some 58% of the deaths were due to indirect causes, such as cardiac disease and neurological conditions. This means that we need to look not only at what maternity services can do during the 40 weeks or less they may care for a woman while she is pregnant, but also at a lifetime approach—supporting women to be in the best health before pregnancy.
To care for pregnant women with acute and chronic medical conditions, NHS England is rolling out maternal medicine networks to ensure that there is timely access at all stages of pregnancy. In the debate today, a number of people have mentioned staffing levels and workforce. We have recently announced £95 million towards increasing the workforce in maternity units—some 1,200 additional midwives and 100 additional consultant obstetricians. The figures have been calculated at trust level on the basis of birth rate, along with the RCOG. We have also given the RCOG £500,000 to develop a workforce tool for planning, so that we have as safe staffing levels as we can have on maternity units, when they are needed.
I am going to go on to the nitty-gritty of the problems that affect some of the outcomes that we are trying to negate during pregnancy. We know that obesity during pregnancy puts women at an increased risk of experiencing miscarriage, difficult deliveries, pre-term births and caesarean sections. I underline the importance of helping people to achieve and maintain a healthy weight in order to improve our nation’s health.
That is why we launched the obesity strategy in July 2020. The strategy sets out a campaign to reduce obesity, including measures to get the nation fit and healthy. We know that obesity has a huge impact on covid-19. According to the RCOG, the overall likelihood of a stillbirth in the UK is less than one in 200 births, but if a woman’s body mass index is over 30, the risk doubles to one in 100. According to Public Health England, 22.1% of women were obese in early pregnancy. If a woman’s BMI is higher than 25, that is associated with a range of additional risks, which I will not list now, but which include miscarriage.
On smoking, some 12.8% of women in the UK were smoking at the start of pregnancy and 10.4% of women were smoking at the time of delivery. With the new emphasis on public health post covid, I requested meetings with Public Health England to discuss how we once again emphasise the negative effects of smoking during pregnancy and the impact of obesity, particularly given the RCOG figures of the doubling of the risk of stillbirth for women with a BMI over 30.
I am sure it is not the Minister’s intention that the tone of the response, particularly in this section, feeds into the guilt that many women experience having suffered miscarriage or stillbirth. It feels as if the onus is being put on the woman—that the reason they have experienced this loss is entirely their fault. Perhaps, if we want to tackle the root causes of obesity and smoking and those reasons for baby loss, we would be tackling the root causes of deprivation, not necessarily focusing on personal responsibility in the way that the Minister has just outlined.
I could not agree more, but we are doing nobody any favours whatsoever if we do not inform women of the impact of smoking and obesity during pregnancy. Before covid—some time ago—Public Health England had a huge emphasis on the negative effects of smoking during pregnancy, and we think we need to focus once more on the fact that 12.8% of women are smoking at the beginning of pregnancy and 10.4% are smoking at the time of delivery, as part of this approach to continuing to reduce the number of stillbirths. To keep that trajectory moving, we have to discuss all the reasons why and all the health implications during pregnancy.
A number of Members mentioned the continuity of care programme. We are committed to reducing inequalities in health outcomes and experience of care. In September 2020, I established the maternity inequalities oversight forum to bring together experts from key stakeholders to consider and address the inequality for women and babies from different ethnic backgrounds and socioeconomic groups.
In response to a direct question from my hon. Friend the Member for Truro and Falmouth, we wanted to see all women placed on the continuity of care pathway by March 2022, but that will not be possible. We are therefore focusing on having 75% of black, black British, Asian and Asian British women on the continuity of care pathway by 2024. We will have 20% of all women on that pathway at the same time. The issue of training on continuity of care was brought up, and that is the important point. We can talk about continuity of care pathways, but it is about having the right training in place and ensuring that those midwives who have those women on that pathway and are caring for them are trained in the particular inequalities that my hon. Friend mentioned. That is why it will take us to 2024, but we will have 75% of those ethnic minority women on that pathway by that date.
A number of Members mentioned covid-19. It has caused a huge amount of disruption to our lives. As Sarah Owen said, women have continued to have babies throughout that time. Maternity and neonatal services have worked hard to enable partners to be present during labour and birth. According to the latest information, all maternity partners are accompanying women to all antenatal scans and appointments in acute settings.
The hon. Member for Luton North also brought up vaccinations. She made the point that the Government need to ensure that all pregnant women are vaccinated. My daughter is 32 weeks pregnant, so no one has been more aware of that than me, but I am afraid that politicians do not make clinical decisions, and the Government are not the JCVI—the Joint Committee on Vaccination and Immunisation is completely independent. The committee decides who is vaccinated.
After constantly asking why pregnant women were not being prioritised and taking a glance at the make-up of the JCVI, however, I was shocked to discover that it is made up of 14 men and three women, so I am unsurprised at the JCVI not emphasising or prioritising pregnant women for vaccination. Again, that is a point I am making in the Department and in particular with the women’s health strategy. Perhaps all scientific committees that make decisions about women’s health should have a gender balance.
I want to reassure the hon. Member for Luton North that I am absolutely on to that and have been all the way through. I might just be beginning to get a bit of insight into why the JCVI has not prioritised pregnant women for vaccination. It is shameful that they were not; they should have been. She highlighted the data herself at the L&D hospital, which is one of my local hospitals, and I hope that the hospital will now begin—despite the constant requests and pressure from Government—to review its policies on pregnant women and vaccination.
I thank the Health and Social Care Committee and its independent expert panel for its inquiry into the safety of maternity services and evaluation of maternity commitments. The Department is considering the recommendations made in the report and will publish a full response in September.
In conclusion, I am absolutely proud of the progress that we are making on stillbirths, neonatal deaths and maternal deaths, but we have to do more. That will involve Public Health England, and that will involve looking at all the reasons why and all the targets that we have to beat so that we can reach those ambitions and reduce those figures.
In the short time left, I thank all Members for their kindness. I have been catapulted into this position quite recently and it was not something that I was expecting to have to advocate on, but I am pleased that I am. I am pleased that I can stand up for parents and families who have had to go through a similar thing. We have had a robust and interesting discussion.
I make a plea for two things. First, our all-party parliamentary group on baby loss is meeting the Minister this afternoon at 3 o’clock, so anybody watching who would like to come along is very welcome. Secondly, I will be applying for another debate from the Backbench Business Committee for Baby Loss Awareness Week this autumn, in October, and if the Committee is listening, please, please, may we have it in the main Chamber? It is important, and that would show the utmost respect to parents who have been through this.
Question put and agreed to.
That this House
has considered progress towards the national ambition to reduce baby loss.