stillbirth strategy - Homerton University Hospital

Dear Sir/MadamThank you for your Freedom of Information request concerning stillbirth strategy.The Trust can provide the following information:F.O.I. Request Received by bereavement Midwives 31.10.2012Q1-Please provide detail of any strategy, Plan Protocol or performance indicators youhave in place to reduce stillbirth rates. If these include a target rate, please include this.Everything that we practice in midwifery and obstetrics is to ensure the best possibleoutcome for mother and baby and it is difficult to be specific but I will try.We have a robust system of identifying risk at the first booking appointment. The risksare continuously re-evaluated and care plans amended accordingly. This information iswhen appropriate kept in the handheld notes and the electronic systems so is availableto all members of staff caring for the Woman and baby.We have been very fortunate to have had Trust specific reports sent to us by anorganisation known as CMACE (Confidential enquiry into Maternal and Child health)who unfortunately no longer exist. A new organisation known as EMBRACE (Mothersand babies reducing risk through audits and confidential enquiries) will be taking overand we hope that they will be able to provide us with quality information.We have used this data to look at national and local trends and have based much of ourcurrent care and practices on these reports along with NICE guidelines andrecommendations of others. Some initiatives that we have are outlined below (Not anexhaustive list but all measures are in place to ensure that we capture and identify risktherefore reducing our stillbirth rate)-A High risk clinic which is Consultant lead and multi-disciplinary (This would includecaring for women who may have know medical problems such as diabetes which isknown to increase the risk of Stillbirths)-A Clinic for Women who have increased BMI-Weekly meeting on Wednesdays to discuss all cases which give cause for concern.(Perinatal Morbidity meeting)-A dedicated Specialist Midwife who helps with smoking cessation-A dedicated Specialist Midwife for Mental health issues-A dedicated Midwife for Substance Misuse.-A dedicated Midwife for Women who have sickle cell disease.-A dedicated Midwife for Women who are HIV positive.

-All Midwives have mandatory training yearly, which among other things includesupdates from all the specialist midwives.-All Doctors and Midwives are required to do a computer training package known asK2 which refreshes and updates how to assess fetal wellbeing in labour-A Consultant Obstetrician is available for delivery suite 24hrs every day and is if factin attendance from 8am until 8pm Monday to Friday-We have a new system in place known as k2/Athena, which assists us in caring forwomen on delivery suite and in labour-A triage system on delivery suite to ensure that Women receive appropriate care at alltimes.-All midwives have a supervisor of midwives available 24hrs a day.- Ability to refer to Fetal Medicine/ fetal Welfare unitWe have a maternity dashboard, which is updated monthly. This dashboard flags up arisk if we have more than three Stillbirths per monthQ2-Please provide me with protocols or guidance issued to midwives as part of any suchplan to reduce stillbirth rateAs aboveThis would be every protocol and guideline that we have, we are attempting to makeavailable on the hospital website for all to read all our policies in the near future.The Mandatory training for the midwives includes a 1 hour session by the bereavementmidwives and all the other specialist midwives.The CMACE reports were presented a various meetings to raise awareness. I hope thatwe will also be able to do this with the EMBRACE reportsQ3- Please provide me with your guidelines for carrying out perinatal death reviewsOur risk management protocol has a list of triggers for reporting incidents one of thesetriggers is an automatic completion of this form for all StillbirthThe bereavement midwives provide monthly figures to the head of Midwifery, thesupervisors of Midwives, the risk management Midwife and the Obstetric Consultants,which includes brief report, which helps us to identify trends or concerns.All Stillbirths cases are discussed at a multi-disciplinary meeting which is held monthly

( Perinatal Mortality meeting) The areas of concern are acted upon the areas of goodpractice are noted by our risk management midwife and all the findings are storedelectronically and the action points monitored by the risk management team.All the Stillbirths cases are discussed at our MRMR (Maternity risk managementreview) meeting, which is held once a month. This is again a multi- disciplinary meetingand we look for any developing trends any need for changes in protocol increase ineducation etc.Hope this is helpful and answers your queries. We do not have specific protocols for theissues you have raised but are constantly seeking to improve our care and review all ourguidelines every three years updating as appropriate to ensure the health of Mother andBaby are our primary focus.If you have any queries about this response please contact the information governancemanager at foi@homerton.nhs.uk , in the first instance. If, following that, you still haveany concerns, you may contact the Information Commissioner either by letter, FOI/EIRComplaints resolution, Wycliffe House, Water Lane, Wilmslow, Cheshire SM9 5AF, or byemail www.informationcommissioner.gov.uk to take them further.Copyright StatementThe material provided is subject to the HUHFT's copyright unless otherwiseindicated. Unless expressly indicated on the material to the contrary, it may be reproducedfree of charge in any format or medium, provided it is reproduced accurately and not usedin a misleading manner. Where any of the copyright items are being re-published or copiedto others, you must identify the source of the material and acknowledge the copyrightstatus. Permission to reproduce material does not extend to any material accessed throughthe Publication Scheme that is the copyright of third parties. You must obtain authorisationto reproduce such material from the copyright holders concerned.Yours sincerelyJames CookInformation Governance AdministratorMatthew HallInformation Governance Manager