Why do so many babies die – and why aren’t we doing something about it?

Why, asks an article in the Telegraph, do 2,000 babies die needlessly during childbirth every year?

It’s a question that ought to bring us up short. Two thousand deaths is a huge number: compare it to, say, the number of people killed in road accidents in the UK, which is now down to about 1,700 a year.

The article’s writer, Mary Riddell, is talking about needless deaths: in total, there are 3,600 stillbirths a year in the UK, representing one in every 200 births. Some deaths can’t be avoided. So why aren’t we doing more about the ones that can?

It’s curious how complacent we are as a society about the problem of medical negligence. In the US, a study has estimated that medical errors are the third leading cause of death, behind heart disease and cancer. Somewhere between 210,000 and 440,000 patients who go to hospital in the US each year “suffer some type of preventable harm that contributes to their death”. As far as I know, however, no similar study has been carried out in the UK.

Childbirth injuries and deaths can be avoided

We do know that NHS doctors and midwives make mistakes during birth. According to the Telegraph article, compensation claims for childbirth errors have tripled in 10 years. It compares figures for England with those for Sweden:

“In the last five years, Sweden has reduced the number of serious birth injuries from 20 per 100,000 babies to five, compared with the English rate of 30 in every 100,000 babies.”

The Swedish figures show that many injuries and deaths relating to childbirth are avoidable. The Telegraph article goes on to look at a hospital that has got it right: Southmead Hospital in Bristol, which it describes as “probably the safest place in the world to give birth”. Fifteen years ago, Southmead introduced Practical Obstetric Multi-Professional Training, or PROMPT – a method of collaborative working and learning from mistakes. During that time, there has been a 50-70% reduction in common birth injuries.

How the PROMPT approach works

What PROMPT does is to make sure that all members of a team – obstetricians, midwives, anaesthetists – are on the same page when it comes to responding to a medical emergency. A representative group of professionals receive the training together and then take it back and train other staff in their own hospital. It means that if, for example, a baby’s shoulder becomes stuck, everyone knows what to do.

The only extraordinary thing about this is that it’s not already universally applied: you’d hope health professionals would all know exactly how to respond to any likely childbirth emergency. But in the less effective maternity units, that doesn’t seem to be the case – the Kirkup Review into failings at the maternity unit of Furness General Hospital exposed an apparently casual attitude towards safety. In James Titcombe’s account of his son Joshua’s death at Furness, it was striking that none of those involved seemed interested in understanding why he had died or putting measures in place to stop anything similar happening again.

A fundamental change in approach is needed. Everyone makes mistakes, but human error can be minimised if agreed best procedures are in place; and a culture of openness where people are encouraged to own up to, and reflect on, their mistakes enables everyone to learn and improve their practice in future. This is how the aviation industry treats mistakes, and it works well.

The government’s proposed rapid resolution and redress scheme, in which litigation claims could be settled quickly without recourse to the courts may help to end the culture of secrecy and cover-up and bring about a more open approach. The proposals are not without their flaws (safeguards need to be in place to make sure that rapid redress is also accompanied by a desire to learn from mistakes – which isn’t a given), but they are surely a step in the right direction. Certainly many families will be grateful for not having to wait years for compensation while litigation drags on.

It could be that we are finally on the cusp of a change that campaigners have been fighting for over many years. If so, we may look back on those 2,000 baby deaths every year and wonder why we ever tolerated it.

You have a healthy baby – that’s all that matters. Or is it?

Image courtesy of arztsamui at FreeDigitalPhotos.net
Image courtesy of arztsamui at FreeDigitalPhotos.net

I’ve written before about how phrases such as “Your baby’s healthy – that’s the most important thing” or “Time to put it behind you and move on” after a traumatic birth serve to minimise a woman’s feelings of pain or grief.

There’s a good post from an Australian site called BellyBelly that addresses this exact point. The writer, Sam McCulloch, spoke to a group of women about their traumatic birth experiences who said they found the phrase “at least you have a healthy baby” particularly painful – and it was often used by people close to them as well as health professionals.

McCulloch gives a helpful quote from Debby Gould of the birth trauma site BirthTalk:

“Imagine it’s your dream to go to Paris – you go! And you love it! However your plane was hijacked en route – you were terrified and it was the worst twenty hours of your life! Would the fact that you landed safely in Paris cancel the trauma of the flight? Would people say, ‘Well you got to go to Paris, that’s the important thing?’ I think not.”

Actually, I’m not sure that Debby is right about that – human beings are very good at putting a positive spin on someone else’s suffering – but you take her point.

BellyBelly has some good suggestions for things to say to women who have experienced a traumatic birth – some of these are better than others (“You are a strong, amazing woman” might be a bit too much for understated British sensibilities) but the central message is spot on: listen to what the woman is saying, don’t tell her how she should be feeling and don’t try to minimise her pain.

I once interviewed a woman whose baby died at birth. What stays most with me about that interview is that she said she would brace herself whenever someone began a sentence with the words “At least…”. Even when a baby has died, it seems, those around you feel the urge to point out the bright side. But as she said: “There was no silver lining, no reason and no bright side.”

Since then, whenever I talk to someone going through a difficult experience, I’ve tried to avoid using the phrase “At least”. It’s harder than you might think. But it’s something we could all try: the first step to helping someone recover is to stop pretending that their experience doesn’t really matter.