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Effective clinical monitoring during skin-to-skin contact straight after birth is key to reducing the risk of sudden unexpected postnatal collapse (SUPC) in babies, according to a maternity safety report.
The report, from the Healthcare Safety Investigation Branch (HSIB), focuses on the importance of monitoring to ensure babies are as safe as possible during crucial skin-to-skin contact following birth.
“Close and ongoing observation and careful positioning of the baby and partner while in skin-to-skin contact is critical”
HSIB said it had worked with Unicef, which administers the UK Baby Friendly Initiative standards, to ensure that the report was a “key learning document”.
The report comes after the HSIB identified six out of a total of 335 reviewed cases, where positioning of the baby during skin-to-skin may have contributed to SUPC.
The six cases of SUPC – a rare but potentially fatal collapse in babies that appear otherwise healthy – were drawn from an overall 12 cases reviewed between April 2018 and August 2019.
In the cases HSIB looked at, contributing factors included persistent pulmonary hypertension, sepsis, stroke and respiratory issues due to opiates given to mothers in the antenatal or intrapartum period.
In three of the 12 cases, the babies died and the nine surviving babies received treatment in the neonatal intensive care unit, noted the HSIB.
It said the “overarching theme” was that effective monitoring during skin-to-skin straight after birth was key, along with continued vigilance and prompt removal of the baby if there were any concerns.
With these in place, a baby born well and with a good Apgar score – to assess wellbeing immediately after birth, then five and 10 minutes later – could benefit from skin to skin contact with their parent.
Continued observation of the Apgar score could also be done with little or no interruption to the skin to skin, the report added.
Monitoring was “especially important” when there were additional SUPC risk factors, for example, antenatal or intrapartum use of opiates, sedation and increased maternal body mass index.
“Skin-to-skin is really important for the mother baby bond, helping the baby to adjust to life outside the womb”
The report also warned that a lack of communication with parents and poor positioning of the baby could also contribute to this increase in risk.
It said staff should always speak to parents about correct positioning, the difference pain relief or other drugs given to the mother could make, and how they could recognise changes in the baby.
The report highlighted that HSIB maternity investigations also pointed to a number of systemic risk factors that may also reduce staff ability to ensure effective clinical monitoring.
These factors included a high number of tasks done straight after the baby’s birth, leaving the maternity suite to find equipment, the physical environment and any overall staffing issues.
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Sandy Lewis, HSIB programme director of maternity investigations, said: “Whilst occurrence of SUPC during skin to skin is rare, the impact can be sudden and devastating.”
Ms Lewis highlighted that a key part of the HSIB’s remit as a national body was to ensure that any learning could be shared widely across the NHS.
“We felt it was important to produce this learning report to highlight that minimal interventions can make all the difference in reducing the risk of harm,” she said.
“Skin-to-skin is really important for the mother baby bond, helping the baby to adjust to life outside the womb and supporting breastfeeding,” she noted.
Sue Ashmore, director of the Unicef UK Baby Friendly Initiative, said: “The impact of SUPC for the families involved can be devastating and lifelong, so we must do everything we can to learn from this investigation.
“Close and ongoing observation and careful positioning of the baby and mother or partner while in skin-to-skin contact is critical for the baby’s short- and long-term health and wellbeing.
“Any concerns, including and particularly those raised by the parents, should be responded to immediately,” she noted.
“This report reinforces the need to listen carefully to any concerns raised by the mother and her partner”
She added: “Working together we can ensure that all babies are kept safe, while still enabling babies, their mothers and families to benefit from the many advantages of skin-to-skin contact.”
Professor Tim Draycott, consultant obstetrician and vice president of the Royal College of Obstetricians and Gynaecologists, welcomed what he called an “invaluable learning report” from the HSIB
“While there were a small number of infants with sudden unexpected postnatal collapse, each case is significant and has a devastating impact on the families involved,” he said.
“This report reinforces the importance of regular observations of the baby and mother, careful positioning of the baby during skin-to-skin contact and the need to listen carefully to any concerns raised by the mother and her partner.”
He added that he also welcomed changes made to guidance from the Unicef UK Baby Friendly Initiative as well as the development of information posters in several trusts to support safe positioning.