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Improving Mothers’ Care and Saving Lives – Latest Report by MBRRACE-UK

Improving Mothers’ Care and Saving Lives – Latest Report by MBRRACE-UK

MBRRACE-UK is a national programme of work which investigates the causes of maternal deaths, stillbirths, and infant death. The aim is to “provide robust national information to support the delivery of safe, equitable, high quality, patient-centred maternal, newborn and infant health services”.

The latest report relating to mothers’ deaths between 2015-2017 has been published today, and we have set out the key findings and recommendations for women, families, and health professionals below. It is important to remember that having a baby in the UK is still very safe, and that deaths are rare.

“Through its rigorous reviews, the Enquiry recognises the importance of learning from every woman’s death, during and after every pregnancy, not only for staff and health services, but also for the family and friends she leaves behind.” – MBRRACE-UK

Key Points from the MBRRACE-UK Saving Lives, Improving Mothers’ Care 2019:

  • There has been no decrease in maternal death rate in the UK: 209 women died during or up to six weeks after pregnancy, from causes associated with their pregnancy from 2015-2017.
  • Substantial inequalities remain for
    • Black, Asian, and mixed ethnicity women.
    • Older women
    • Women from deprived areas
  • The main cause of death was heart disease.
  • The main cause of death up to a year after birth was related to mental health.
  • Key recommendation: joined-up care needs to improve – transitions between services and care have led to vulnerable women falling through the gap.

Causes of mothers’ deaths:

  • Heart disease remains the leading cause of death, followed by thrombosis and thromboembolism (blot clots); almost quarter of women who died had heart disease (23%).
  • Blood clots; 34 women died due to blood clots (16%).
  • Epilepsy and stroke; 27 women died due to epilepsy and stroke (13%).
  • Sepsis; 1 in 10 women died due to sepsis.
  • Mental health conditions; 1 in 10 women died as a result of suicide. It is the leading cause of death up to a year following birth; and the fifth most common cause during pregnancy and immediately afterwards.
  • Bleeding; 17 women died from bleeding-related causes (8%).
  • Cancer; 8 women died from cancer (4%). Improvements in care have been demonstrated in this latest report.
  • Pre-eclampsia; 5 women died from pre-eclampsia (2%).
  • Other physical conditions; 23 women died from other physical conditions (11%).
  • 7 women died from other causes (3%).

 

Inequalities

The report illustrates that women from older age groups, black, Asian, or mixed ethnic groups or who live in deprived areas have higher maternal death rates, and these differences are significant despite low numbers of deaths.

  • Black women are 5 x more likely to die as a result of complications in their pregnancy than white women.
  • Risk for women of mixed ethnicity is 3 x more than white women.
  • Risk for Asian women is twice as much as white women.

MBRRACE-UK has urged that research and action into why these disparities occur, and management of reducing them, is critical. Due to the physical, mental, and social complexities of why women die in pregnancy, during birth, and afterwards, more information needs to be obtained to begin to address this inequality.

Need for Joined Up Care

The key message from the report is to “mind the gap”: transitions between care/services have revealed weak points where women can fall through gaps in care.

MBRRACE-UK’s key messages for women, families, and health professionals to save mothers’ lives and improve care:

Women – Speak Up

  • Antenatal care is important, and you need to let health professionals know if you feel unable to access care.
  • If you feel concerned about anything, you need to speak to a health professional, especially with any of the following symptoms:
    • You are in severe pain.
    • You have chest pain.
    • You have a low mood or are struggling.
    • You are severely breathless.
    • You are concerned that you have a breast lump.
  • If you are at all concerned with any care you receive during your pregnancy, then please speak up.
  • Keep in touch with your usual care teams; including, your partner, family, GP, and friends.
  • Think about your health before, during, and after your pregnancy.

Family & Friends – Speak Out

  • If know someone who is unable to access maternity care, let someone know.
  • If a woman collapses and she is pregnant, or has recently been pregnant, call the emergency services.

Health Professionals – Mind the Gaps

The number of professionals caring for a woman increases as health and social factors a woman is trying to cope with increases. This can lead to an increased chance that something within her care will collapse. As a professional caring for a woman, it is your responsibility to ensure that her care is co-ordinated and that the woman’s needs are being addressed.

Reg Flags and Risk Factors

Seek medical advice if you feel you have any of these red flag symptoms, or risk factors.

Heart Disease:

Heart disease can occur for the first time during pregnancy, and three-quarters of women that died due to this did not know that they had it beforehand. Know your family history of heart disease and sudden deaths.

Red flags:

  • Severe chest pain spreading to your jaw, arm, or back
  • Persistently racing heart
  • Severe breathlessness, particularly when you are resting or lying flat
  • Fainting whilst exercising

 

Pre-eclampsia:

If you are at high risk of pre-eclampsia, or have more than one moderate risk factor, you need to ensure that a low dose of aspirin (75-150mg) is prescribed to you by your GP or midwife (NICE guidance). Aspirin, in low dose, is the single most important thing to help prevent pre-eclampsia. It should be taken from 12 weeks into your pregnancy until your baby is born.

Two of three deaths due to pre-eclampsia could have been avoided with different care.

Risk Factors

High-Risk

  • Blood pressure problems during previous pregnancy
  • Chronic kidney disease
  • Autoimmune disease; e.g. systemic lupus erythematosus, or antiphospholid syndrome
  • Type 1 or Type 2 Diabetes
  • Chronic blood pressure problems

Moderate-Risk

  • This is your first pregnancy
  • You are expecting twins or triplets
  • You are 40 years or older
  • Your Body Mass Index (BMI) is 35kg/m2
  • You have a family history of pre-eclampsia
  • It has been more than 10 years since your last pregnancy

Breast Cancer

You can still be treated for breast cancer when you are pregnant. It is important to know your body, and to get something abnormal checked. If you do have breast cancer, talk to a specialist about appropriate treatments. Check symptoms of breast cancer.

Pregnancy and Birth

Most women can go full term in their pregnancy and have a natural or induced birth, and options can be discussed with the team caring for you.

If you already have breast cancer and are not pregnant, it is general advised that women with breast cancer should wait two years after treatment has finished before becoming pregnant. This is can be discussed with your healthcare team, and cases can differ.

Breastfeeding

You can breastfeed from your unaffected breast if you are not having chemotherapy treatment. If you do breastfeed, then chemotherapy drugs cannot be taken in the two weeks prior to breastfeeding.

Conclusion

The rate of maternal death has stayed the same, and substantial inequalities remain for Black, Asian, and mixed ethnic women when compared to white women. More work needs to be done to improve the rate of maternal death in the UK in order to achieve the national ambition of halving maternal death by 2025. Research and investigation also need to be carried out to understand the complex nature of inequality between different ethnic groups.

The leading cause of death remains to be heart disease, with maternal suicide as the leading cause of death from pregnancy up to a year after birth.

There is a need for improvements to joined-up care, and better transitions between services for women. Women need to speak up, and families and partners need to speak-out for women.

 

Read the full report.

View the lay summary.

View the infographic.

5 Comments

  1. Darren Earley 3 months ago

    Can you not use the term committed or commit suicide, suicide is not an offence in the UK. Maybe say ended their life or taken their own life etc. instead?

    • Author
      Sara 3 months ago

      Thank you for bringing this to our attention Darren. We have changed the language to mirror that used in the report.

  2. Chris Rudland 3 months ago

    In your Heart Decease Red Flags:

    Please include onset of persistent cough, elevated neck veins and peripheral oedema especially in lower legs and ankles.

    • Author
      Sara 3 months ago

      Hi Chris, we have taken the red flags from the MBRRACE report which is based on confidential enquiries. We have not included the red flags you have listed as they are not mentioned in this report.

      • Chris Rudland 3 months ago

        Thank you, Sara,

        The only reason I mention them is that they are commonly seen in presentations. Especially pregnant and recently pregnant patients, easily confused with normal pregnancy symptoms. Symptoms of heart failure mimic those of normal pregnancy, often resulting in a delay in diagnosis and preventable complications. Echocardiography showing decreased myocardial function is essential for the diagnosis. Medical management is similar to heart failure with a reduced ejection fraction of other etiologies, but adjustments during pregnancy are necessary to ensure fetal safety.

        Thank you for responding.

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