A study by the Royal College of Midwives (‘RCM’) has identified significant failings in the provision of postnatal care across the UK. [1]

The study prompted widespread concern that the National Institute of Clinical Excellence (‘NICE’) recommendations for the postnatal period are not being followed. It further identified that 40% of women were discharged before they were ready and that 65% of midwives felt the most significant factor in arranging postnatal visits was organisational pressures, not the patient’s needs.

Premature discharge of newborns and inadequate follow up in the community can increase the risk of missing opportunities to identify and treat neonatal conditions which can result in brain injury.

The NICE guidelines state:

…length of stay in a maternity unit should be discussed between the individual woman and her healthcare professional, taking into account the health and wellbeing of the woman and her baby and the level of support available following discharge“. [2]

The report makes a number of recommendations including increasing the number of midwives to ensure women receive the number of postnatal visits they need and implementation of the NICE guidance to ensure postnatal care of a consistent high quality.

Litigation following failings in postnatal care

I represent clients whose substandard postnatal care has led to severe brain injuries and a wide range of life-changing disabilities.

I have recently secured an admission of liability in a case where a newborn was discharged from hospital shortly after her birth despite clear evidence of lethargy and feeding difficulties. The baby was in fact suffering from infection. The infection subsequently spread to her brain and she has been diagnosed with an extensive and life-limiting brain injury which with competent post natal care and antibiotic treatment was avoidable.

An admission of liability is of course good news, and compensation is central in meeting the complex needs of our clients throughout their lives. But where injuries are preventable, and linked to poor practice and inadequate resources, addressing the problem at the source must be the primary objective for the NHS.

Resources

The number of babies born every year is increasing and the allocation of funds to maternity services fails to reflect the growing demand. Inextricably linked to this, of course, is England’s widely acknowledged shortage of midwives and the financial pressures facing the NHS generally. An additional consideration is the distribution of allocated funds within maternity care.

An RCM ‘Pressure Point’ report into postnatal care funding prompted by the above study found that only a small proportion of maternity care funds are allocated to postnatal care. Taking an average spending per birth, the report shows that £1,015 is spent on antenatal care, £2,203 on intrapartum care and just £331 on postnatal care. [3]

This disparity in funding fails to reflect the risks facing newborns.

Risks of Brain Injury in the Neonatal Period

It is well known that babies are at their most physiologically unstable in the first 6-12 hours of life. It is during this relatively small window that the newborn’s fledgling independent functions can suddenly revert to a dependent fetal state.

It is also during this time that newborns are more likely to present with the first signs of neonatal conditions such as:

  • perinatal infection;
  • jaundice;
  • hypoglycaemia;
  • seizures; and,
  • respiratory disease.

Each of these conditions, among others, endanger the vulnerable newborn brain and render it susceptible to irreversible injury. Close monitoring of temperature, bloods, feeding, response levels and colour are essential during this crucial period to promote early intervention and treatment.

It is concerning therefore to learn in this well-recognised area of risk that most women and babies are discharged within six hours of delivery. [4]

If the monitoring of babies is poor, they are discharged too soon, or their parents are given inadequate support or information, the happy arrival of a new family member can quickly descend into a potentially life changing, or even fatal, injury.

Advice to Parents in relation to newborns

Every parent and baby should be supported during the post natal period and discharge process and the latter should not take place until the passage of an appropriate period of time.

The statistics from the RCM report illustrate that this is not what is happening across the UK.

It is imperative therefore that parents recognise the potential for brain injuries to occur in the early hours and days of their newborn’s life and feel able to speak out and insist that:

  • their baby remain an inpatient for a longer period if they have concerns about their presentation or that they are being discharged too soon;
  • a sufficient number of health visitor and midwife home visits are scheduled for the immediate post discharge period to ensure close monitoring by professionals; and,
  • the warning signs of neonatal conditions and the appropriate response, should they appear, be competently explained and fully understood.

Impact on the NHS

The availability and allocation of resources will always be a thorny issue for the NHS.  But the stark disparity between the funding for postnatal care compared with antenatal and intrapartum care does not reflect the gravity of the risks of brain injury facing newborns and the potentially devastating consequences of failing to act quickly when problems arise.

Cathy Warwick, chief executive of the Royal College of Midwives said:

The impact good postnatal care has on women’s experiences and their long-term health should not be underestimated. Postnatal care should always be based on women’s needs and not on funding or organisational issues. This reinforces the need for more midwives. Numbers have been increasing but not fast enough and England remains seriously short of the numbers needed if care is to be of high quality throughout antenatal, labour and postnatal care. The bottom line is that care must be based on clinical need.”  [5]

Ms Warwick went on to observe that discharging women and babies too early is a false economy for the NHS.

Where avoidable brain injuries arise from untreated neonatal conditions and children develop long-term disabilities, they will require intense lifelong medical intervention from the NHS.  Where such conditions are the result of negligent failings in post-natal care, large awards of compensation are paid from NHS resources to those whose lives have been irreparably damaged.

A Final Thought

If postnatal care continues to be inadequately resourced by the NHS, I anticipate there will be a growing number of medical negligence claims leading to substantial awards of damages.

It must make medical, moral and economic sense to act on the findings of this RCM report, and invest now in improving the quality of this crucial service.