Reducing Baby Loss

Nadine Dorries Excerpts

Tuesday 20th July 2021 Westminster Hall

[The Minister for Patient Safety, Suicide Prevention and Mental Health (Ms Nadine Dorries)]

It is a great pleasure to serve under your chairmanship, Mr Gray, and a huge pleasure to respond to my hon. Friend the Member for Truro and Falmouth (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. The hon. Member for Nottingham South (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 4 July I announced £2 million of funding to support a new programme to reduce brain injuries in babies. The first phase of the programme is being led by the Royal College of Obstetricians and Gynaecologists, the RCM and the Healthcare Improvement Studies Institute at the University of Cambridge. It aims to develop clinical consensus on the best practices for monitoring and responding to babies’ wellbeing during labour—the progress of the baby during labour has been mentioned a number of times—and in managing complications with the baby’s positioning, specifically when a baby’s head is impacted in the mother’s pelvis during a caesarean section.

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.

[Sarah Owen]

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.

[Ms Dorries]

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 the hon. Member for Luton North (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.