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My name is Julia; I am a Midwife, a Mummy and am lucky enough to work in the Maternity policy and women’s health team in NHS England. I am pleased to represent them as well as clinical network colleagues and clinicians, charities like Tommy’s, MAMA Academy, Kicks Count and SANDS and organisations like Royal College of Obstetricians and Gynaecologists, Royal College of Midwives, British Maternal Fetal Medicine Society, Public Health England, NHS Digital, The Perinatal Institute and The University of Manchester.
That is a long list! but also an important one. The Saving Babies’ Lives Care Bundle really is a triumph of collaboration. The hard work and dedication of those involved in its development ensured that a pragmatic, best practice solution was created in order to reduce stillbirth rates overall and reduce the variation across regions in England.
We have a lot to do in England. We lose 10 babies every day to stillbirth which is 10 too many. Our stillbirth rates rank us at 24th out of 49 high income neighbouring countries and we are improving only half as fast as the most improved countries. Furthermore, stillbirth rates within England vary considerably from region to region, variations that are not fully explained by the health and characteristics of the local population. Gaps in care are an important contributory factor to around half of term stillbirths and present us with important opportunities for improvement.
The care bundle brings together four elements of maternity care known to impact stillbirth rates:
1. Reducing smoking in pregnancy
2. Risk assessment and surveillance for fetal growth restriction
3. Raising awareness of reduced fetal movement
4. Effective fetal monitoring during labour
These elements were developed using latest evidence and best practice recommendations and agreed upon by subject matter experts. Following the comprehensive development phase, the Saving Babies’ Lives Care Bundle was launched on 21 March 2016 with two inspiring launch events; one in London and another in Leeds with over 300 delegates in attendance. Many midwives, obstetricians, sonographers, commissioners, students, researchers and policy makers made up the audience and had the privilege of hearing from Mel and Chris who told Finley and Henry’s stories. I believe this contributed greatly to what followed. Not only did feedback forms confirm that delegates left with the knowledge, inspiration and intention to make changes to clinical practice, local and national press covered the care bundle. Twitter and facebook activity was instrumental in raising awareness of the problem of stillbirth and the potential of the care bundle amongst those who weren’t able to attend our events in person.
The care bundle is an integral part of the national Maternity Transformation Programme; the programme of work designed to deliver the recommendations of the Better Births report. The care bundle is one of the key elements of the Improving Practice for Safer Care workstream which is which is led by the Department of Health, supported by a number of key organisations, including NHS England. Work continues on the care bundle in the form of an evaluation. In order to ensure that as many stillbirths as possible are prevented, we want to understand the impact that implementation of the care bundle has had on outcomes to date and why it has that impact.
At present 86% of maternity hospitals who responded to our care bundle implementation survey are working to adopt all four elements. The least implemented element is number 3, raising awareness of reduced fetal movement and the most implemented element is number one, reducing smoking in pregnancy. There has been an increase in the levels of implementation across all four elements since the survey began.
I believe the great progress in the implementation of the care bundle has been helped greatly by the collaborative approach to the development and sharing of the document and the communications and engagement activities that have taken place to raise awareness of this important work. Not only does raising awareness of the care bundle shine a spotlight on many babies lost to stillbirth, it also highlights the opportunities women and healthcare professionals have to prevent avoidable stillbirths from happening. For this reason, the care bundle team are grateful for the nomination of the care bundle in the category of most media impact. Thank you Chris!
Significant reduction of stillbirths requires a concerted effort, comprising health professionals, charities, bereaved parents, and the media. Julia and the team at NHS England have, with the Saving Babies’ Lives care bundle, produced an absolutely textbook demonstration of how to unite all those groups to have the most positive effect possible, and have generated excellent media impact to really make a difference.