MNSI National Learning Report. Will recommendations actually be implemented?

Maternity run units (often referred to as “birthing centres”) are those managed solely by midwifery and support staff, albeit in larger hospitals an obstetric managed labour ward is usually next to the midwifery unit to accept transfers in the event of complications.

1. Work demands and capacity to respond

The report notes: “When work demands exceed capacity, staff may be required to make a trade-off between efficiency and thoroughness”. Failures in this area lead to frequent omissions in monitoring fetal and maternal wellbeing during labour.

2. Intermittent auscultation

An astonishing figure was noted in the report that regular listening into the fetal heart (auscultation) in the first and second stages of labour was not carried out in line with national guidance in almost half (49%) of cases analysed – that is a very startling correlation between a clear national requirement (albeit a “complex task that relies on sustained attention” over time) and severe outcomes.

3. How prepared an organisation is for predictable safety-critical scenarios

The report found limited evidence of units being prepared through risk-assessments to identify weaknesses in systems and processes of safety-critical scenarios. They noted in-situ simulations should be used to rehearse such events.

4. Telephone Triage

This was a key area of failures due to the variation of staff and systems in place to give women guidance over the phone, before any admission to hospital. Information was lost if the woman spoke to a number of staff or if staff used different information systems or a mix with handwritten notes. Triage systems need standardised and structured processes to be properly effective.

The key problem is that although the safety recommendations made by MNSI would go to setting up excellent working systems and safe practice in maternity units, they are non-enforceable, the MNSI has no actual power to require any of their recommendations to be implemented.

Many of us who work for families affected by failures in maternity care have heard report after report and inquiry after inquiry list the changes and improvements needed, yet the same failures are repeated time and time again.

To effect true national improvement in maternity care there needs to be a solid investment in well paid clinical staff, excellent and frequent multi-professional training and requirements to implement safety recommendations within 6 months of their announcement.

The issue with MNSI is that the rely on understaffed and underfunded units to implement (sometimes complex) recommended changes of their own volition with no support. Where there is no actual requirement to effect change, only limited attention and resource will go into effecting the safety recommendations made; there is little point in “saying” when no one is following through with concrete responses.