Increased risk of newborn death if born out of hours
Latest research suggests that babies born out of hours i.e. at night or at the weekend are at a greater risk of dying than those born within normal working hours.
The study reviewed records of over one million full-term, single baby births in Scotland from 1985 to 2004. It found the risk of death for babies born out of hours was a third higher than for those babies born in the day. Babies born between 0900 and 1700 on Monday to Friday were classified as being within normal working hours, all others as out of hours.
Oxygen starvation
The research team looked at records of 539 neonatal deaths. The deaths occurred at birth or in the first four weeks of life and were not related to congenital abnormalities or prematurity. Around half of the 539 deaths recorded were due to a lack of oxygen. Glasgow and Cambridge universities suggested that night staffing and access to facilities were possible explanations.
The study adjusted for a wide range of factors and excluded babies born via planned caesarean section, who are usually delivered during the day. The team carrying out the research argued that as the risk of death for these babies was so much lower than for those born vaginally, their inclusion could overstate the risks of out of hours birth.
But even with these exclusions, the difference persisted. For mothers giving birth during the normal working hours, the risk of their baby dying was 4.2 per 10,000 and increasing to 5.6 per 10,000 if their baby was born out of hours.
The research found one in every four deaths through oxygen deprivation was directly associated with the risk of being born out of hours. The research team suggested that improving the level of clinical care for women delivering out of normal hours might reduce the overall rates of perinatal death. The research team acknowledged that the costs required to save only a few lives might be seen as out of proportion, but they also noted that they only looked at deaths and a significant amount of money is spent on long-term developmental problems caused by oxygen starvation at birth. They said that any interventions that improved outcomes of babies born out of hours would therefore be likely to have a greater effect than merely reducing the number of newborn or neonatal deaths.
Informed choices and increasing presence of consultants
David Field, professor of neonatal medicine at Leicester University said that it was important that more experienced clinicians were immediately available but he also emphasised that there was increasing momentum towards giving women more choice over where they gave birth, including at home, in hospital or in a midwife-led unit. These facilities will not be the same in terms of ethos, the services they offer or the risks associated with delivery. He said that the different facilities should be transparent about these differences so that women can make a genuine choice of site for delivery in consultation with their midwifery and medical advisers.
Dr Tahir Mahmood, vice president at the Royal College of Obstetricians and Gynaecologists, said all women in labour should be offered one-to-one care by a midwife and an experienced obstetrician. He also thinks that “increasing the presence of consultants in the labour ward around the clock would not only improve training opportunities for the junior doctors but would also improve standards of care for all women in labour.”
Janet Scott, research manager at stillbirth and neonatal death charity Sands commented on the research: “A baby’s life should not rest on whether or not they are born in office hours.”
Boyes Turner’s medical negligence lawyer Nicola Gaukroger said “Whilst this study was based on births in Scotland, the findings no doubt apply to births in England and Wales as well. Many of the cases we deal with relate to oxygen starvation during delivery, resulting in either cerebral palsy or the baby’s death. This study reflects our own observation that birth injuries are often associated with insufficient staffing, and particularly the availability of experienced obstetricians, during the night and at weekends. Whilst ensuring the presence of highly skilled clinicians around the clock would certainly be expensive, the benefit to the families involved is obvious. There are also potential costs savings to the NHS because, as this article points out, a large amount of money is currently spent on dealing with long-term developmental problems caused by birth injuries.”
Consistent with our policy when giving comment and advice on a non-specific basis, we cannot assume legal responsibility for the accuracy of any particular statement. In the case of specific problems we recommend that professional advice be sought.
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