Baby heart monitor training made mandatory in Scotland

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Regular training in properly monitoring baby heart rates during labour is to be made “mandatory” for obstetricians and midwives in Scotland.

The chief medical officer and chief nursing officer have written to every health board in Scotland to make the training compulsory.

It follows a high-profile campaign by the families of babies who died at Crosshouse Hospital in Kilmarnock.

A review highlighted staff shortages and a low uptake of training.

It called for NHS Scotland to develop and agree mandatory skills and competencies and review training across the country.

Experts say the proper monitoring of a baby’s heartbeat during childbirth could mean the difference between life and death.

A study by the Royal College of Gynaecologists found that in 70% of stillbirths and neonatal deaths in the UK, different care could have led to a different outcome.

The Scottish government instigated the review of maternity care at Crosshouse after a BBC investigation.

June and Fraser Morton’s son Lucas died in Crosshouse hospital November 2015 after a series of failings by hospital staff, who had failed to diagnose pre-eclampsia and did not properly monitor the baby’s heartbeat during childbirth.

They also failed to alert senior members of staff despite being unable to hear the baby’s heartbeat for 35 minutes.

The health board ultimately apologised for Lucas’s “very tragic and unnecessary death”.

“Unnecessary” or “avoidable” deaths are referred to as those where harm was caused to a healthy baby during childbirth – usually resulting in them being deprived of oxygen.

‘Save lives’

Scotland’s Chief Medical Officer Catherine Calderwood and Prof Fiona McQueen, the chief nursing officer, have now written to health boards asking them to put in place mandatory training in foetal heart monitoring and obstetric emergencies for all obstetricians and midwives in Scotland.

Dr Calderwood told BBC Scotland: “We have been very concerned about the number of stillbirths for some years and we have reduced those numbers by over 20% in the past five years.

“We know there is more to be done and when we look at the figures we know that the baby heart rate monitoring has a significant impact on numbers of babies born with difficulties after birth and also with numbers of stillbirths.”

She said the mandatory training would be in “interpreting” baby heart rate monitoring correctly in labour.

Dr Calderwood said midwives and obstetricians must know how to interpret the data, escalate if there is a problem and what action to take so that lives could be saved.

The chief medical officer wrote to Mr Morton to notify him of the change and thanked him.

He told BBC Scotland: “I was more than a wee bit emotional when I read this.

“Many people played their part in achieving this.

“This will undoubtedly save lives and prevent some horrific injuries to both mothers and babies.”

Each Baby Counts

A project by the Royal College of Gynaecologists (RCOG) aims to halve the number of “avoidable” stillbirths in the UK by 2020.

The Each Baby Counts project looks at more than 1,000 stillbirths, neonatal deaths and brain injuries that occur on UK maternity units each year.

It has found problems with accurate assessment of foetal wellbeing during labour and consistent issues with staff understanding and processing of complex situations, including interpreting baby heart-rate patterns (on traces from CTG machines).

Prof Alan Cameron principal investigator for the (RCOG) Each Baby Counts project told BBC Scotland: “Going through labour is the most hazardous journey in a person’s life.

“We should be making sure every possible thing is done to ensure it is as safe as possible.

“Foetal monitoring is the gold standard way of checking on a baby’s progress during labour.”

He said a large percentage of hospital births required continuous foetal monitoring.

“Ensuring mandatory training for staff in how to do this is very welcome,” he said.

Prof Cameron added: “In Each Baby Counts we found about 70% of cases could have had a different outcome with different care.

“In a large proportion – at least 50% – foetal heart rate monitoring was a major contributory factor.

“It is not going to solve every case but it is certainly a very important factor.”

The rate of stillbirths in Scotland has been falling in recent years. There were 225 stillbirths last year.

Health Secretary Jeane Freeman said: “Families going through the heartbreak of losing a child deserve to know that all is being done to ensure the best possible care.

“Progress has been made on all of the recommendations from the review of Mr Morton’s case, including all midwives and obstetricians having to go through clinical training in foetal heart monitoring each year.”

She added: “The chief medical officer wrote to health boards last month to remind them of the training requirements.

“Boards will monitor clinical training and are due to report in December 2019 and again in 2020.”

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