Brr! I'm snuggled by the heater typing! I hope you're somewhere warm and cosy while you're reading all about MBRRACE.
I'd love for you to be able to read the whole MBRRACE report start to finish now, as it's essential knowledge for every midwife....
But as we all know, just because something is essential, it doesn't mean you have time to do it this second! As a midwife, family time, sleeping and eating can be hard enough to fit in.
My 5 Lessons I Learnt From MBRRACE will give you an overview, and also, point 5 is something you really want to hear, trust me…
1. Women from certain ethnic minorities and socioeconomically deprived areas are still at more risk of dying.
We need to try and get these ladies attending all their antenatal appointments and to seek care early in pregnancy. This group is always hard to care for, for so many different reasons, but your efforts to build relationships with the women help so much, and reduce mortality and morbidity.
2. Many more mothers died from their long term medical conditions exacerbated by pregnancy, rather than from childbearing events alone.
These deaths were from conditions like epilepsy (e.g. drowning in baths, or from stopping medication in pregnancy without advice), and asthma (which can become unpredictable in pregnancy; also, the drug labetalol is often prescribed to lower BP in pregnancy, but this isn't great for asthmatic women).
The basic message is, get the consultants and the multidisciplinary team involved early in women with complex needs, and get a plan.
3. Think Sepsis.
Women dying from vaginal/birth canal sepsis has definitely decreased (well done midwives!), but there are still some cases. Also, there are other types of sepsis which we could reduce; it’s a struggle against reduced staffing and resources.
If women keep self-referring to the hospital or GP with any symptoms which could be an infection, this should raise concerns, and we need to take basic obs seriously, respiration rate especially.
If someone has sepsis, they need to be given antibiotics within an hour of being recognised – MBRRACE refers to this as the ‘Golden Hour’.
Senior midwives and doctors need to see anyone with suspected sepsis ASAP. Some sepsis was from really random causes like sinusitis, and additionally in this report many women with sepsis had swine flu (remember the pandemic in 2009?), which brings us to the next point…
4. For every 11 women in the report that died, one of these was from flu. MBRRACE reports that greater uptake of the flu vaccine will save lives.
Respiration rate was one of the basics missed out in many women who came for medical advice when feeling unwell, who then turned out to have flu. It’s thought pregnant women are more at risk of catching flu as their immune system is suppressed so their body can support their baby (though there's more to this flu/vaccine/pregnancy story, which I'll go into in the next post).
5. Maternity mortality has overall reduced! Considering the birth rate is increasing, the health of mothers is reducing, AND the maternity service is so stretched, this is an amazing achievement!
Huge congratulations to everyone who's involved in maternity care.
Also important: MBRRACE is incredible, but that doesn't mean we can just take all the recommendations at face value. There are some controversial parts of this report that I really want to tell you about.
That’s what the next post will be on, so either check back to the blog in a few days or consider subscribing so you don’t miss out 🙂
Now I'd love to hear from you: What’s one positive thing you'll take away from the MBRRACE report which will help your learning about midwifery or enhance your practice?
Stay warm if you're studying hard or commuting, and if you're in the community I hope you have a really good coat and you're offered many cups of tea!