George Eliot Hospital Saving Babies Lives campaign
In November 2015, the Secretary of State for Health announced a national ambition to halve the rates of stillbirths, neonatal and maternal deaths and intrapartum brain injuries by 2030, with a 20% reduction by 2020. The Second version of the Saving Babies’ Lives Care Bundle (SBLCB) was published in March 2019 and focuses on reducing the stillbirth rate, and reducing the rate of preterm births from 8% to 6% by 2025.
George Eliot Hospital NHS Trust is committed to continually improving care for women and their families and the Saving Babies Lives Care Bundle is a large part of this.
Element 1 – Reducing smoking in pregnancy
Smoking in pregnancy has been identified as the biggest factor influencing poor outcomes. Stopping smoking will help your baby to receive all of the necessary nutrients from the placenta.
Each cigarette deprives your baby of oxygen for up to 20 minutes, so your baby’s heart has to beat harder and faster because of this.
Element 2 – Identifying risk of fetal growth restriction
There is strong evidence to suggest that Fetal Growth Restriction (where your baby is not growing at the rate we would like) is the biggest risk factor for stillbirth. Therefore, early detection of growth restricted babies is vital and has been shown to reduce stillbirth risk significantly because it gives the option to consider timely delivery if your baby is at risk.
Element 3 – Importance of reduced fetal movements
Enquiries into stillbirth have consistently described a relationship between episodes of reduced fetal movements and stillbirth. In all of these case reviews unrecognised or poorly managed episodes of reduced fetal movements have been highlighted as contributory factors to avoidable stillbirths. In addition, a growing number of studies have confirmed a correlation between episodes of reduced fetal movements and stillbirth. This relationship increases in strength when women have multiple episodes of reduced fetal movements in late pregnancy (after 28 weeks’ gestation).
Element 4 – Effective fetal monitoring
Cardiotocography (CTG) monitoring is a well-established method of confirming fetal wellbeing and identification of potential fetal hypoxia. For high risk women in labour where continuous monitoring is recommended, CTG monitoring is the best clinical tool available to carry this out. Continuous CTG monitoring is not recommended for low risk women in labour, the baby’s heart rate is monitored intermittently with a Pinard or Doppler.
Pinard Doppler CTG
Element 5 - Reducing pre-term births
Preterm birth (PTB), defined as delivery at less than 37+0 week’s gestation, is a common complication of pregnancy, comprising around 8% of births in England and Wales. It is the most important single determinant of adverse infant outcome with regards to survival and quality of life. Babies born preterm have high rates of early, late, and post-neonatal mortality and morbidity.
Element 1 – Reducing smoking in pregnancy
You will be offered carbon monoxide screening at your first appointment (Booking Appointment) with the Midwife and throughout your pregnancy.
This involves the midwife asking you to blow into a straw attached to a Smokerlyser, which then analyses the breath and produces a carbon monoxide result.
The range can be from 0 parts per million (ppm) to more than 20ppm.
If you have a result of 4 ppm or more, you will be given advice about checking home gas equipment and referred to the Stop Smoking in Pregnancy Service and / or GEH Risk Perception Team depending on whether you are a smoker or live in a home where others smoke.
You will be given brief advice around the importance of smoking cessation in pregnancy, if you confirm you are a smoker.
Element 2 – Identifying risk of fetal growth restriction
You may require a prescription for aspirin in pregnancy. This is not harmful but must not be taken without medical advice.
If you are identified as a smoker at booking you will be referred to the Stop Smoking in Pregnancy Service and will be given advice around smoking cessation in pregnancy.
It is important you have a correct customised growth chart in your pregnancy records by 20 weeks gestation taking into account your ethnicity, height and weight (& any previous babies you may have had).
Midwives and doctors will measure your abdomen by measuring from the top of your uterus to your Symphysis pubic bone (Symphysis Fundal Height Measurement). This will be done regularly throughout your pregnancy from 28 weeks and this will be plotted onto your personal customised growth chart.
Where growth is identified from your chart as either small or static (your baby’s weight has remained the same) from the Symphysis fundal height measurements you will be referred for ultrasound assessment. We do not want you to worry about this but this helps us to assess your baby’s growth in more detail.
Induction of labour will only be offered to women whose babies are identified as plotting as small (below the 3rd centile) on the chart at around 37 weeks gestation, or if growth is between the 3rd and 10th centile without other risk factors. Induction of labour will not be offered until around 39 week’s gestation as there are risks for the baby of developmental delay.
If you’re carrying twins or triplets an appointment will be made for additional growth scans to monitor your babies’ growth.
Element 3 – Importance of reduced fetal movements
You will be given a ‘Tommy’s Leaflet’ about monitoring your baby’s movements between 12 – 14 weeks of pregnancy. You can also access a copy here - Tommy’s Fetal Movements Leaflet – Tommy’s - Feeling your baby move.pdf.
Your baby’s movements will be discussed with you at every appointment. If your baby is unwell or distressed one of the first signs is baby’s movements will reduce or change. For this reason it is so important that you know what to look out for and you inform the Maternity Assessment Unit (02476 865 246) of a concern as soon as you feel baby’s movements feel reduced or changed.
If you attend with any concerns a management plan will be made regarding your follow up and a tick added to the red star sticker on the front of your pregnancy notes.
Element 4 – Effective fetal monitoring
You will be offered intermittent auscultation (either with a pinard stethoscope or hand held Doppler) or continuous electronic fetal monitoring based on the risk assessment carried out when you attend in labour. This will be discussed with you and documented in your medical notes.
Your risk may change in labour and this will be discussed with you as it may be necessary to re-review the method of listening to your baby’s heart if a concern is identified.
A buddy approach (Fresh Eyes) of reviewing your baby’s heartbeat will be completed. This involves another trained professional other than the midwife providing direct care coming into your room and looking at or listening to your baby’s heartbeat this does not mean that they are concerned about you or your baby.
Any concerns will be raised to the senior midwife in charge and the doctor.
Element 5 - Reducing pre-term births
A risk assessment will be completed at your booking appointment and if appropriate a referral made.
Assessment will be competed regarding administration of aspirin and this will be prescribed if required.
Carbon monoxide screening will be performed throughout your pregnancy and the results documented within your pregnancy notes.
A urine sample to be sent after your booking appointment and results will be followed up by your community midwife / GP. If you have abdominal pain further urine samples may be tested to exclude an infection.
All women with a history of preterm birth will be referred to the preterm prevention clinic for management under the specialist team.
Antenatal steroids may be required and this will be discussed with you.
If you attend hospital with threatened preterm labour you will be offered a magnesium sulphate infusion to help protect your baby’s brain.
