A report produced by the Centre for Maternal and Child Enquiries (CMACE) last month has identified continuing high levels of substandard treatment in a number of key areas within antenatal and post natal care. The report investigates the causes for maternal deaths between 2006-2008. These include thromboembolism, pre-eclampsia, haemorrhages and infection. The findings have led to ten recommendations for better treatment for pregnant women in an attempt to reduce maternal and infant mortality.
The findings identify substandard care in 56% of deaths caused by thromboembolism and in 66% of deaths caused by haemorrhages (although the overall figure for deaths in this area was slightly reduced). 54% of deaths in early pregnancy involved inadequate care to include the failure to identify and treat ectopic pregnancies. A similar trend occurred in deaths caused by pre-eclampsia with 20 out of the 22 deaths during this period reported as involving deficient levels of care. Similarly 86% of deaths arising from anaesthetic or perioperative care and 69% of maternal deaths caused by sepsis were reported to involve substandard care.
The recommendations made by CMACE include further training for midwifes in serious obstetric conditions and potential emergencies. The report advocates multi-disciplinary care for those women with potentially serious medical conditions and urgent referral for specialist care.
These findings further compound the continued concern that NHS maternity services are already overstretched putting pregnant women and infants in danger. They highlight the difficulties for the midwifery, obstetric and anaesthetic workforces who are already fully committed with their workloads should complications arise on the maternity ward.
With rising birth rates (up by 19% since 2000) and the increase of multiple births from assisted pregnancies, obesity and older mothers, there is an increasing need for sufficient numbers of midwifes, adequate guidelines and training to reduce avoidable deaths.