Health charities welcome improvements in reducing stillbirths but say consistent approach is needed



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30 July 2018

Smoking in Pregnancy Challenge Group news release

Health charities welcome improvements in reducing stillbirths but say consistent approach is needed

The Smoking in Pregnancy Challenge Group [1] a coalition of health organisations, today welcome news from NHS England [2] that progress has been made to reduce the number of stillbirths through implementing evidence-based practice in maternity units.

However, as NHS England notes, there is still work to be done to ensure a consistent approach around the country including providing effective support to help women quit smoking during pregnancy.

The latest Government data shows that while a number of NHS Clinical Commissioning Groups are bringing rates of maternal smoking down rapidly, rates in some are stalling. As a result the overall national rate has been stuck at just under 11% for the last three years, [3] a long way off the Government’s ambition of less than 6% by 2022 [4].

Professor Linda Bauld, University of Stirling and Deputy Director of the UK Centre for Tobacco and Alcohol Studies and Co-Chair of the Smoking in Pregnancy Challenge Group:

“Too many places are still not implementing best practice for supporting women to quit smoking. This has a real cost in babies’ lives. It’s good to see this NHS initiative is having an impact but eight years after national guidance was issued there is no excuse for variation in practice.”

Francine Bates, Chief Executive of The Lullaby Trust and Co-Chair of the Smoking in Pregnancy Challenge Group:

“Our recent analysis shows that the Government is likely to miss their target to reduce rates of smoking in pregnant women, risking hundreds of babies’ lives. More needs to be done to ensure those women most in need get support to quit.”

On 3rd July the Smoking in Pregnancy Challenge Group published a new report [5] with recommendations for Government action to speed up the rate of progress.

The report includes a new analysis [6] estimating the positive impact of achieving the Government’s stated ambition. It estimates that in 2022 this would mean that around 30,000 fewer women would be smoking in pregnancy. Leading to:

  • 45 – 73 fewer babies stillborn
  • 11 – 25 fewer neonatal deaths
  • 7 – 11 fewer sudden infant deaths
  • 482 – 796 fewer preterm babies and
  • 1455 – 2407 fewer babies born at a low birth weight.

Last week Public Health England published a new analysis of maternity data showing that women from the most deprived postcodes and in the youngest age group are most likely to smoke before and during pregnancy [7]. The Challenge Group report sets out specific recommendations to intensify the support for this group.

ENDS

Notes and Links: 

The Smoking in Pregnancy Challenge Group was established in 2012 in response to a challenge from the then Public Health Minister to produce recommendations on how the smoking in pregnancy ambition contained in the Government’s tobacco strategy could be realised.

The Group is a partnership between professional organisations, the voluntary sector and academia. It presented its report and recommendations to the Public Health Minister in June 2013 and continues to meet annually to review progress.

The Smoking in Pregnancy Challenge Group is jointly chaired by Francine Bates, Chief Executive of The Lullaby Trust, and Professor Linda Bauld of UKCTAS and the University of Sterling.

Members of the Challenge Group are available for interview. For more information contact ASH on 020 7404 0242 or out of hours Hazel Cheeseman on 07754 358 593.

References:

[1] For more information about the Smoking in Pregnancy Challenge Group see: http://smokefreeaction.org.uk/smokefree-nhs/smoking-in-pregnancy-challenge-group/

[2] Full NHS England press release:

NHS ACTION PLAN CAN PREVENT OVER 600 STILLBIRTHS A YEAR SAYS NHS ENGLAND

Evaluation shows clinical improvements across 19 sites led to maternity staff helping to save more than 160 babies’ lives.

An estimated 600 stillbirths annually could be prevented if maternity units adopt national best practice says NHS England.

Clinical improvements such as better monitoring of a baby’s growth and movement in pregnancy, as well as better monitoring in labour, means that maternity staff have helped save more than 160 babies’ lives across 19 maternity units, according to an independent evaluation due to be published on Monday (30 July).

The detailed report shows that stillbirths fell by a fifth at the maternity units where national guidance, known as the Saving Babies Lives Care Bundle, had been implemented. The best practice guidance is now being introduced across the country and has the potential if these findings were replicated, to prevent an estimated 600 stillbirths.

The Saving Babies Lives Care Bundle is part of ambitious plans by NHS England to make maternity care safer and more personal.

Dr Matthew Jolly, National Clinical Director for Maternity and Women’s Health at NHS England, said: “These findings show significant progress in the reduction of stillbirth rates. This is thanks to the dedicated maternity staff who have developed and implemented the clinical measures we recommend as national best practice. We know more can be done to avoid the tragedy of stillbirth and as we develop the 10 year plan for the NHS, we want to build on the progress we’ve made to make maternity services in England among the safest in the world.”

Matt Hancock, Secretary of State for Health and Social Care, said: “There is nothing more devastating than losing a child so this improvement is welcome and testament to the incredible NHS maternity staff who do everything they can to improve care; saving many babies’ lives as a result.

“We still have more to do but these results demonstrate really positive progress towards our ambition to halve the rates of stillbirth, neonatal death and maternal death by 2025.”

Prof Alexander Heazell, Professor of Obstetrics, University of Manchester, said: “This large scale evaluation of the NHS England Saving Babies Lives Care Bundle shows that the interventions to reduce cigarette smoking, detect small for gestational age babies, inform women about reduced fetal movements and improve monitoring of babies during labour, have been increasingly implemented in the early adopter maternity units. Over the same time period stillbirths have fallen by 20%, meaning 161 fewer stillbirths in the participating units.

“This is an encouraging step towards achieving the UK government’s ambition of halving stillbirths by 2025. Importantly, this project has also highlighted areas which need further work – to reduce preterm birth and ensure that intervention is focussed on women and babies who require it. This project shows the importance of continually developing and evaluating the care we give to women and babies.”

Jane Brewin, CEO at Tommy’s Centre for Stillbirth Research, said: “Tommy’s is proud to have been involved in devising the programme which has been implemented in 20 NHS Maternity Units and has resulted in a significant reduction in stillbirth.  When all Maternity Units adopt this programme, fewer families will have to experience the tragedy of stillbirth which destroys so many family’s hopes and dreams. We are finally making progress towards making this country the safest place to give birth in the world and that’s something really worth striving for.”

There are currently around 665,000 babies born in England each year, but despite falling to its lowest rate in 20 years, there are around 3,000 stillbirths, with one in every 200 babies stillborn.

Key successes identified in the report include:

*   Increase in the detection of small babies – there was a 59% increase detection attributed to better monitoring and scanning in pregnancy

*   Better awareness of a baby’s movement in pregnancy – with a high number of women attending hospital due to reduced movement.

*   Carbon monoxide testing for smoking in pregnancy was almost universal – Smoking is strongly associated with stillbirth. A 1% increase in smoking rates increases the chances of stillbirth by 1.7%. Alongside carbon monoxide monitoring there has been a decline in the number of women smoking, at time of booking.

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For further information please contact the NHS England media team on nhsengland.media@nhs.net or 01138 250958/9”

[3] NHS Digital, Smoking at Time of Delivery, July 2018, https://bit.ly/2viGdRV

[4] Department of Health, Towards a Smokfree Generation; Tobacco Control Plan for England, 2017 https://bit.ly/2uDYNGe

[5] Smoking in Pregnancy Challenge Group. http://smokefreeaction.org.uk/download/1071/

[6] Lullaby Trust, the full analysis and methodology can be found here: http://smokefreeaction.org.uk/download/1086/

[7] Public Health England, Health of women before and during pregnancy: health behaviours, risk factors and inequalities, July 2018 https://bit.ly/2mRHSdy