We have identified a safety risk in maternity care relating to delays to intrapartum intervention once fetal compromise is suspected.

Intrapartum care covers the start of labour up to the birth of the baby and delivery of the placenta and membranes. Fetal compromise is when there are signs that indicate the baby is not well.

For the wellbeing of the baby and/or mother, clinicians may advise one or more clinical interventions as labour progresses. Intrapartum interventions can range from medications and operations to performing manoeuvres during an emergency. Specific examples include augmentation of labour (artificial stimulation of contractions) and caesarean section (an operation to deliver the baby).

Delays in care once fetal compromise is suspected have the potential to cause harm including stillbirth, hypoxic brain injury and neonatal death.

Trigger for investigation

We started this investigation after reviewing the maternity investigations HSIB has carried out to date at NHS trusts across England, as part of our maternity investigation programme.

Our review indicated that delays to intrapartum intervention once fetal compromise is suspected is a contributing factor to stillbirths, neonatal deaths and babies born with suspected brain injury.

Reasons for delays include issues related to staffing, infrastructure and workload.

Investigation summary

This investigation will:

  • Draw on the field of safety science to understand how staff work within the clinical environment and how they adapt to the challenges posed by the system in which they operate. It seeks to identify factors which modify the impact of issues such as staffing, infrastructure and workload on delays to intrapartum intervention once fetal compromise is suspected.
  • Consider opportunities for building resilience into the delivery of care for labouring mothers.

Definition of labour

We use the definition of labour set out by the Each Baby Counts programme. Each Baby Counts is the Royal College of Obstetricians & Gynaecologists’ national quality improvement programme to reduce the number of babies who die or are left severely disabled as a result of incidents occurring during term labour.

The definition of labour that applies to the Each Baby Counts programme includes:

  • Any labour diagnosed by a health professional, including the latent phase of labour at less than 4 cm cervical dilatation.
  • When the woman called the unit to report any concerns of being in labour, for example (but not limited to) abdominal pains, contractions or suspected ruptured membranes.
  • Induction of labour.
  • When the baby was thought to be alive following suspected or confirmed pre-labour rupture of membranes.

Safety recommendations

As part of our final investigation report we may make safety recommendations to the appropriate national bodies in order to improve the safety of intrapartum care.

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