More NHS screening targets being missed
Sarmad Gassoub | 04.02.2019
25.06.2018 Sarmad Gassoub
A new study carried out by the University College London performed between 2005 and 2014 analysed data of 5 million births.
Overall, this revealed that 70% of births took place outside regular working hours – most likely after midnight.
In fact, it was revealed that 4:00 a.m. is the time most babies are born spontaneously in England, with the majority arriving between 1:00 a.m. and 7:00 a.m.
In contrast, planned C-section births tend to happen on weekdays.
Only 28% of spontaneous births took place between 9:00 a.m. and 17:00 p.m. on weekdays. This poses management difficulties to NHS obstetricians and midwives already working under huge strain in labour wards across the country because they are comparatively poorly staffed outside of working hours, often when they are most needed.
The pattern is seen in other jurisdictions. This isn’t just a problem experienced by the NHS. A study conducted in the 1990’s at Stanford University in California revealed that babies born at night were 12-16% more likely to die within their first 28 days of life. Similar results were seen during a Swedish study in 2003 and a German study.
The timing is thought to be due to an evolutionary pattern in humans giving birth at night when predators were at rest – thereby affording some protection.
However with respect to managing births, particularly higher risk births, steps can be taken to plan deliveries so that they occur at times when senior obstetric staff are going to be available to assist. However in practice (and so counter intuitively) induction still appears to be timed so that babies are most frequently born around midnight. Unfortunately, given the paucity of senior obstetric staff in maternity wards around that time, this maximises the possibility of complications being dealt with less effectively.
Despite changing patterns of birth since the 1950’s (with a greater number of C-sections and induced births than ever before), 66% of women in England and Wales commence labour spontaneously with spontaneous birth accounting for 50% of outcomes.
In contrast, 22% of women are induced for labour and 12% requiring surgery (either elective or emergency caesarean).
In order to try and better match resourcing levels to need so that care is provided by more experienced staff at the time it is most pressingly required, some have recommended changes to current practice.
According to the BBC, Sean O’Sullivan, at the Royal College of Midwives has suggested maternity services should organise their staffing rotas to match patterns of birth in their local areas.
Notwithstanding the logistical challenges, doing so would certainly help to reduce the likelihood of adverse events resulting in what would otherwise be avoidable birth brain injury. This is particularly so in circumstances where for example urgent delivery of the baby within minutes is needed if catastrophic damage is to be prevented (for example cord prolapse, massive placental abruption, and rupture of the uterus).
In many of these cases, swift and decisive action by an experienced obstetric team will avoid a hypoxic brain insult or an insult in labour due to chronic partial hypoxia for example.
Sadly and too often, I have worked with the parents of severely brain injured babies who were tragically delivered too late, when the warning signs were there to be seen and acted upon by those who might have been able to understand them.