ONE of Britain’s leading maternity experts has revealed how you can reduce your risk of deadly issues during or after pregnancy – after the UK saw a tragic surge in deaths.
The UK saw levels of maternity deaths return to a near 20-year high in 2020 to 2022, sparking concerns about the “very worrying trend”.
Research led by Professor Marian Knight, of the University of Oxford, showed 13.41 women per 100,000 died during or six months after pregnancy in those two years.
It was up 53 per cent on the 8.79 recorded in the previous three years and the highest since 2003 to 2005.
It comes after a landmark inquiry found good pregnancy care for women in the UK “is the exception rather than the rule”.
The damning report into NHS maternity services – known as the Birth Trauma Inquiry– detailed harrowing stories of mothers being left to lie in their own blood and urine or denied basic needs such as pain relief earlier this week.
NHS England chief executive Amanda Pritchard said the care received by the more than 1,300 women who gave evidence to the inquiry as “simply not good enough”, while Health Secretary Victoria Atkins said she was “determined” to improve the care mums receive.
Professor Knight said the “concerning” rise maternity deaths has been fuelled by a number of factors, not just the pressures being faced by the NHS on maternity wards.
An increase in the age women are having children means they are more likely to have long-term health conditions that can make death in pregnancy more likely, like high blood pressure.
And there has been a surge in the number of mental health issues faced by women in pregnancy — particularly during the Covid pandemic — leading to a tragic uptick in suicide numbers.
She told The Sun: “We can’t just solve this in maternity services.
“There’s a lot we can do in maternity services and some of the work that we did that we released towards the end of last year clearly showed some evidence of maternity services under pressure, adversely impacting on the care women received.
“But we’ve also got to recognise that the care they receive elsewhere, you know, before pregnancy, very importantly as well as after pregnancy, and perhaps in different areas of the health and care system.
“You know, we mustn’t forget the importance of maternal mental health.
“So making sure that we’ve got good mental health services as well as good maternity services will have an impact on these figures.”
THREE FATAL CONDITIONS TO BLAME
The number of women dying during and immediately after pregnancy in the UK had been on the decline during the 2000s and remained relatively stable until around 2018.
But the most recent data shows there has been an increase in mortality since, particularly over the most recent three years during the Covid pandemic.
The leading causes of death from 2020 to 2023 in pregnant and recently pregnant women were thrombosis and thromboembolism.
Both are caused by a blood clot in the veins, which can be more likely during pregnancy because women’s blood clots more easily during labour and delivery.
People tend to dismiss symptoms as being due to pregnancy when they really are quite concerning
Professor Marian Knight,
The second most common cause of death was Covid, followed by heart disease and mental health-related causes.
Professor Knight said: “We definitely did see increasing concerns about women’s mental health and and and sadly, a number of women who died by suicide in in 2020, and at at that time services you know mental health services almost completely stopped.
“You know there were no face-to-face consultations, and I think there were very definitely women who had mental distress at the time.
“I mean I don’t want people to think that perinatal mental health is only important during the pandemic.
“We know that, you know, between 10 and 20 per cent of women giving birth can have a perinatal mental health problem, whether it be anxiety, depression, post-traumatic stress disorder.
“So it’s a really important thing to be aware of — for women to be aware of when they’ve got concerning symptoms, but also for families to recognise when women simply aren’t themselves.
“And I always say, anybody that’s expressing thoughts around suicide, it’s really important that they get help.”
The study was published as part of the Mothers and Babies: Reducing Risk through Audits and Confidential Enquiries across the UK (MBRRACE-UK) programme.
STRANGE PREGNANCY SYMPTOMS TO KNOW
If you’re concerned about your health risks in pregnancy, it’s important to pay attention to any strange symptoms, Professor Knight said.
She said: “People tend to dismiss symptoms as being due to pregnancy when they really are quite concerning.
“So breathlessness is an example. We all know that when we’re heavily pregnant and we’re climbing the stairs, we might get a bit out of breath.
“But as a pregnant woman, if you’re sitting still or lying down, you shouldn’t be breathless.
“Breathlessness in those kind of situations is definitely a concerning symptom that we would typically recognise as due to heart problems if you weren’t pregnant.”
She added: “So you know, chest pain that goes down your left arm. That might be a symptom of a heart attack that’s concerning in pregnancy.
“Don’t dismiss it as just being due to pregnancy.”
If you are worried, do talk to a midwife, talk to your GP or your obstetrician and don’t feel you can’t speak out. If women feel they’re not being heard, then you can seek a second opinion.
Prof Knight
Heart disease affects around 7.6million people in Britain, including 3.4million women.
Heart or circulatory diseases cause nearly a quarter of all deaths in the UK — more than 170,000 a year.
Risk factors include having high blood pressure, cholesterol, diabetes, smoking, not exercising and being obese.
Alongside breathlessness chest pain, the condition can cause pain in the neck, jaw, throat, upper chest or back in women.
It may also cause nausea, vomiting and tiredness that won’t go away or feels excessive.
Professor Knight said: “If you are worried, do talk to a midwife, talk to your GP or your obstetrician and don’t feel you can’t speak out.
“If women feel they’re not being heard, then you can seek a second opinion. Take someone with you who can help advocate for you.
“Don’t worry about concerning symptoms without asking for advice. It doesn’t do any harm asking for advice.
“Women shouldn’t be reticent about seeking advice if they’re unsure about the significance of any symptoms that they’re feeling.”
Birth Trauma Inquiry conclusions
It received more than 1,300 “harrowing” submissions from people who had experienced traumatic birth, included accounts of stillbirths, babies born with cerebral palsy caused by oxygen deprivation, and life-changing injuries to women as the result of severe tearing.
“In many of these cases, the trauma was caused by mistakes and failures made before and during labour,” the authors wrote.
“Frequently, these errors were covered up by hospitals who frustrated parents’ efforts to find answers.
“There were also many stories of care that lacked compassion, including women not being listened to when they felt something was wrong, being mocked or shouted at and being denied basic needs such as pain relief.”
They called for the introduction of a base standard in maternity services across the UK.
“Currently there are several strategy documents relating to maternity but no single overarching document,” the All-Party Parliamentary Group on Birth Trauma wrote.
It called on the government to publish a National Maternity Improvement Strategy, led by a new Maternity Commissioner which would outline how to:
- Recruit, train and retain more midwives, obstetricians and anaesthetists to ensure safe levels of staffing in maternity services and provide mandatory training on trauma-informed care.
- Provide universal access to specialist maternal mental health services across the UK to end the postcode lottery.
- Offer a separate 6-week check post-delivery with a GP for all mothers which includes separate questions for the mother’s physical and mental health to the baby.
- Roll out and implement the OASI (obstetric and anal sphincter injury) care bundle to all hospital trusts to reduce risk of injuries in childbirth.
- Oversee the national rollout of standardised post birth services, such as Birth Reflections, to give all mothers a safe space to speak about their experiences in childbirth.
- Ensure better education for women on birth choices. All NHS Trusts should offer antenatal classes. Risks should be discussed during both antenatal classes and at the 34-week antenatal
check with a midwife to ensure informed consent. - Respect mothers’ choices about giving birth and access to pain relief and keep mothers together with their baby as much as possible.
- Provide support for fathers and ensure nominated birth partner is continuously informed and updated during labour and post-delivery.
- Provide better continuity of care and digitise mother’s health records to improve communication between primary and secondary health care pathways.
- Extend the time limit for medical negligence litigation relating to childbirth from three years to five years.
- Commit to tackling inequalities in maternity care among ethnic minorities, particularly Black and Asian women.
- NIHR to commission research on the economic impact of birth trauma and injuries, including factors such as women delaying returning to work.
Source: Birth Trauma Inquiry Report