Pregnant women are dying needlessly because of “basic failures” in NHS care, leading obstetricians and midwives say in a letter to The Times today.
According to a recent report, most women who die of pre-eclampsia, a blood flow problem that is the most common complication of pregnancy, should have been saved — a situation that the letter condemns as shocking.
Staff shortages and fragmented shift patterns are blamed for the deaths, as well as an inability by doctors and nurses to spot the symptoms.
Twenty-two women died from the condition between 2006 and 2008 — of whom 20 received sub-standard care, according to the Centre for Maternal and Child Enquiries.
For 14 of these women, care was so bad that death could have been prevented by better treatment, says the letter, whose signatories include James Walker, a professor at the University of Leeds and vice-president of the Royal College of Obstetricians and Gynaecologists.
The experts say that the figures “highlight basic failures in management and organisation of care in the community and in hospital” with implications for thousands of women.
The deaths are the “the tip of an iceberg of many more tragedies: deaths of babies, ‘near misses’ and serious ill-health caused by pre-eclampsia,” say the signatories, who also include Chris Redman, Professor of Obstetric Medicine at the University of Oxford, Professor Catherine Nelson-Piercy, consultant obstetrician at St Thomas’ Hospital, London, and Helen Crafter, senior lecturer in midwifery at Thames Valley University.
Doctors must get better at spotting the symptoms, the letter says, otherwise “unnecessary maternal and baby deaths and adverse health outcomes will continue”.
The cause of pre-eclampsia is still poorly understood but guidelines on screening for it have been in place for six years. “There is no excuse for the basic errors of failure of detection and lack of adequate control of blood pressure,” the experts say.
Up to a third of women with high blood pressure caused by preeclampsia are not being treated, research suggests. While most suffer no serious problem, some have strokes and the number dying of complications has increased over the past decade.
Philippa Brice, a trustee of the charity Action on Pre-eclampsia, said that she nearly died herself when a doctor missed the signs of the condition, and her son had to be delivered weighing only 1lb 7oz.
“Fortunately, I survived — but without my GP’s action and proper care from the hospital, it could have been very different,” she said. “Nine years on, I am horrified that women are still dying when there are clear guidelines for recognising and treating this common disorder of pregnancy.”
Maternity units, already understaffed, are likely to come under further pressure as hospitals cut budgets. On Saturday, midwives joined the march against government cuts in London, saying that vacancies were not being filled. Mervi Jokinen, of the Royal College of Midwives, said: “We are concerned that posts will be reduced in the future when we are barely coping now.”
She added that poor communication and referrals were hampering efforts to improve care: “You’re not going to pick up high blood pressure if you don’t have any contact with the woman.”
A spokesman for the Royal College of Obstetricians said that GPs, midwives and specialists needed to work together better.
“Every maternal death is a tragedy and we must do what we can to ensure that good-quality care is provided on the NHS,” he said.
“As well as following clinical guidelines, there is the need to ensure that at-risk women are carefully monitored throughout their pregnancy so that quick action can be taken for women with pre-eclampsia.”
Every Woman is entitled to understand what happened in her pregnancy when pre eclampsia strikes. I hope to be able to support that process.