Enough is enough – new maternity report suggests care getting worse not better | Bolt Burdon Kemp Enough is enough – new maternity report suggests care getting worse not better | Bolt Burdon Kemp

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Enough is enough – new maternity report suggests care getting worse not better

The UK’s maternal death rate has soared according to a new report showing maternity services are getting worse, not better. How much longer can we accept these failings in women’s health care?

Despite increased awareness, several Government inquiries and multiple maternity scandals across the country, the NHS has yet to get a grip on maternal health, according to figures in the 2024 MBRRACE UK report, which analysed cases between 2020 and 2022.

There was a significant increase in the overall maternal death rate in the UK between 2017-19 and 2020- 22, the report found. This increase remained statistically significant when deaths due to COVID-19 were excluded, which suggests a concerning trend independent of the pandemic.

As solicitors who campaign for improved maternal care, we read this report with a sinking feeling. This is the 11th MBRRACE UK annual report but there is still very little change in the inequality in mortality between mothers from a black or Asian ethnic background compared to white women, as well as those from the most and least deprived areas.

Why is there still such a stark difference? Why are lessons still not being learnt?

The MBRRACE report scrutinises the care given to expectant or new mothers who died during a period in time – this time between 2020 and 2022 when 625 women died. In a bid to improve maternity safety and care, the report identifies learnings from mistakes, making recommendations based on the experiences studied.

Overall, the report opens with the headline that “by global standards” the UK remains a safe place to give birth. However the key statistics below paint a shuddering alternative reality instead in that for some women, outcomes are getting worse and not better:

The report found that:

  • 275 women died during pregnancy or up to six weeks after pregnancy in 2020-2022.
  • 56 women per 100,000 died during pregnancy or up to six weeks after pregnancy.
  • Women aged 35 or older had three-fold higher rates of maternal death compared to women aged 20-24.
  • Inequalities in maternal mortality rates remain with a nearly three-fold difference in rates amongst women from Black ethnic backgrounds and an almost two-fold difference amongst women from Asian ethnic backgrounds compared to White women.
  • 9% of the women who died during or up to six weeks after pregnancy in the UK in 2020-22 were at severe and multiple disadvantage.
  • Women living in the most deprived areas continue to have maternal mortality rates twice that of women living in the least deprived areas, emphasising the need for a continued focus on action to address these disparities.
  • Thrombosis and thromboembolism were the leading cause of maternal death in the UK followed by COVID-19 and cardiac disease during the time period. Together, these three causes represented 43% of maternal deaths during or up to six weeks after pregnancy.
  • Deaths from mental health-related causes continue to account for a large proportion (34%) of deaths occurring between six weeks and a year after the end of pregnancy with deaths due to substance misuse and other psychiatric causes the leading cause of deaths in this period.

The chapters this year raised new pertinent issues contributing to maternal mortality including shining the light on thrombosis and thromboembolism, malignancy, ectopic pregnancies and migrant women with language difficulties, and the lessons identified to improve outcomes in these areas.

The increased figures from years gone by should ring alarm bells far and wide and warn of an overstretched and under funded healthcare system with seemingly not much notice taken to make the necessary changes which would see improving figures for birthing women in the UK.

National recommendations to improve maternity care

The report called for the following recommendations to be enacted:

  1. Improving rapid access pathways for women known to be at risk of thrombosis to access treatment when they need it, especially in the first trimester.
  2. Produce a clearer VTE risk assessment tool which is clear, accurate and includes postnatal factors which could arise.
  3. Revise and implement guidance for cancer diagnosis and management in pregnant women to include clear recommendations on the use and safety of diagnostic imaging tools ie. scans in pregnant women with a history of or with newly diagnosed cancer.
  4. Update end of life care guidance for the appropriate service delivery to pregnant or recently pregnant women.
  5. Review ambulance risk assessment algorithms for pregnant women.
  6. Ensure language needs are recorded in the maternity record including the need for interpretation services to ensure consideration at all interactions including emergency situations.

Conclusions reached

The mortality rate for 2020-2022 being significantly higher than in 2017-2019 is extremely concerning.

What was clear from the information reviewed was that the service-related changes required by the COVID-19 pandemic had a real and devastating impact on the care received by expectant or new mothers.

However, the statistics are still alarmingly high taking COVID out of the equation and shouldn’t be used as a veiled excuse for this period in time.

Some reasons set out surround the increasing complexity of the maternity population including women having babies later on in life, increased obesity in the population and those with multiple adversities including mental health conditions and social complexities.

What is clear is that addressing the stubborn inequalities which remain is ever important if the NHS is to improve outcomes and prevent maternal deaths.

Our thoughts

It is so disheartening to see these figures, especially when looking back at our review of the 2021 MBRRACE report when we were full of hope for increasingly better statistics.

If anything, with the huge amount of work and awareness being put into these issues by those campaigning and striving for better outcomes, including the Race Equality Taskforce, several government inquiries and multiple maternity scandals nationally, more now than ever is being done to catapult these issues into the light and yet with a huge sigh, the figures sadly speak for themselves.

Enough is surely enough, how much longer can we stand back and just accept these worsening figures year on year, losing loved ones unnecessarily and this now just becoming the accepted state of maternity care for our first world nation.

Each of these statistics relate to a mother lost before her time, a family without a wife, mother, sister, daughter. It is important to remember those families trying to come to terms with navigating life without their loved one, let’s not let this be in vain. We must avoid this happening again and again.

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