Recognising and responding to deterioration of a baby during labour: surveys of maternity professionals

Contributors

• Jan W van der Scheer
• Margaret Blott
• Mary Dixon-Woods
• Annabelle Olsson
• Jordan Moxey
• Sarah Kelly
• Matthew Woodward
• Giulia Maistrello
• Wendy Randall
• Sarah Blackwell
• Chloe Hughes
• Caroline Walker
• Louise Dewick
• Rachna Bahl
• Tim J Draycott
• Jenni Burt
• See full list of contributors

Why it matters

Recognising and responding to signs that a baby is struggling during labour remains a challenge in maternity care. Variations in how clinical signs are interpreted and inconsistencies in practice can lead to delays in response and, in some cases, avoidable harm.

A consistent approach that considers multiple risk factors along with fetal heart rate patterns can help maternity professionals to pick up problems sooner and act on any concerns. Clear and respectful communication with those in labour and their birth partners is just as important, to make sure that their concerns are acknowledged and keep them actively involved in decision-making.

Standardised practices work best when they are developed with input from those who will use them, rather than being imposed. For example, bringing healthcare professionals into the process early and throughout development helps ensure that new approaches are practical, effective, and widely accepted.

That’s why, as part of the Avoiding Brain Injury in Childbirth (ABC) programme commissioned by the Department of Health and Social Care, we conducted two national surveys. These surveys gathered insights from maternity professionals to help shape a practical, evidence-based approach that can be implemented across different maternity settings.

What we found

The two surveys gave us useful insights to help us improve and refine the standardised approach and how it can be put into practice.

Suggestions for how to implement a standardised approach: To help with implementation, participants recommended highlighting the evidence base, keeping a role for clinical judgement and local adaptions where needed, and making sure that the approach is practical and highly usable.

Broad agreement on the need for a standardised approach: More than 90% of participants agreed that a systematic approach to monitoring babies during labour was needed, and one which considered a set of risk factors other than just fetal heart rate.

Clearer definitions: Many professionals felt that some clinical terms—like ‘delay in progress of labour’ and ‘rise in fetal heart rate baseline’—needed clearer definitions to ensure consistency in practice.

Different views on when action is needed: Participants had different opinions on the type of changes in certain risk factors that should be considered serious enough to require action (such as calling an obstetrician).

Inconsistent use of guidelines: Less than half of participants said they relied on national fetal monitoring guidelines, and many preferred to use local approaches instead.

Strong appetite for practical tools and training: Participants highlighted the need for a clear, structured process for identifying and responding to deterioration during labour (82%), effective teamwork (78%), dealing with disagreements (76%), and guidance on communicating concerns with women and their birth partners (75%).

Next Steps

From these findings, we have identified a need for:

• Making clinical definitions and action thresholds clearer, to help address differences in views and make it easier to use a standardised approach.
• Working closely with maternity professionals, women, and their families to develop clinical practice tools, training, and implementation strategies for putting a standardised approach in practice.
• Use a de-implementation approach to encourage a shift away from local methods towards a standardised evidence-based approach.
• Invest in training and other forms of support that build confidence in decision-making, teamwork, and communication with those in labour and their birth partners.

Work is underway to take these recommendations forward, such as in the latest national guidance, in co-design of clinical practice tools, and in patient and public involvement to help develop an improvement programme

With thanks to other contributors

Thiscovery Authorship Group: André Sartori, Andy Paterson, Luke A. Steer, Ruth Cousens.

ABC Contributor Group: Bethan Everson, Daniel Wolstenholme, Neil A. Muchatuta, Philippa Storer.