Better Births Four Years On: A Review of Progress 

Since the publication of Better Births in 2016 and of the Report of the Morecambe Bay Investigation in 2015,  the NHS and its partners have come together through the national Maternity Transformation Programme to implement its vision for safer and more personalised care across England and deliver the national ambition to halve the rates of stillbirths, neonatal mortality, maternal mortality and brain injury by 2025. 

As we reach the fourth anniversary, this is an opportune time to take stock of progress, to reflect on successes and remaining challenges, and consider where further action is needed.

The Better Births Four Years On progress report is summarised below. 

Overall good progress against original targets:

• 21% reduction from 2010-2018 in stillbirths - ahead of target for 20% reduction by 2020, but there is still a requirement for a 50% reduction by 2025
• The combined perinatal mortality rate fell by 15.1% over the same period, this is also inline with the 2020 ambition
• 14% reduction in maternal mortality using the triannual rate between 2015-17
• Women continue to feel more confident about their care, with a 2.8% increase in confidence levels since 2013
• 10,000 of women on a Continuity of Carer pathway by March 2019
• 130,000 women had access to digital maternity records by December 2019
• 84% of women thought that if they raised a concern during labour it was taken seriously, this is a 4% increase from 2013
• There has been a reduction of 5.1% in the neonatal mortality rate, which is not meeting target, however there has been an increase in the proportion of babies with a gestational age of less than 23 weeks born alive but who have a very low chance of survival which may affect figures
• Postnatal care plans have been drawn up and the new 6-8 GP check for women will be introduced in the 20/21 GP contract.

Perinatal mental health support has increased:

• Specialist Perinatal Mental Health teams are now in place in every Local Maternity System area
• 40% increase in capacity in specialist mother and baby units
• 700 new specialist staff recruited to community teams nationally.

Areas where requirements not being met or improvement needs to be accelerated:

• More work required on understanding brain injuries; coding and management
• Inequalities and work on black, asian and minority ethnic people's support needs to be increased over the next period
• More work required with women who smoke at time of delivery to reduce national levels to a maximum of 6%
• Specific units must continue to be supported by peers and national teams
• Pre-term birth rates are static at present, and have increased rather than decreased over the last few years; it is hoped that continued work on Saving Babies Lives v2 will change this going forward
• Local Maternity Systems need to continue to offer and promote choice.

Workforce:

• There has been an increase of 15.5% of whole-time equivalent midwives between 2009 and 2019
• Full-time equivalent consultants and obstetrics and gynaecology specialists have increased but junior doctors have reduced.

Other things to note:

• There are more women with higher BMIs (Body Mass Index) presenting at booking, and an increased number of older mothers
• Proportions of pregnancies complicated by the presence of diabetes is increasing; Continuous Glucose Monitoring is being introduced for all Type 1 diabetics in 20/21
• There is the suggestion that a more accurate figure around low gestational deaths may be achieved by combining the stillbirth and neonatal death rate into one indicator
• Maternal deaths are very rare and there can be statistical variation; however work on areas such as cardiac disease and suicide should affect numbers
• Caesarean rates should not be used by themselves but as part of an analysis of other induction factors; birth processes can be useful to understand prevalent trends
• In general the number of medical interventions is increasing
• There is an increase in the recorded number of complications, including postpartum hemorrhage 
• Other areas of continued focus include data management, working with Maternity Voices Partnerships, the Maternity and Neonatal Safety Improvement Programme and the Healthcare Safety Investigation Branch
• New work on Post-natal Physio will be specifically supported from 20/21 onwards.