In 2013 we recommended ... Last year, we focused on preterm births. While this focus has changed to variation in gestation at term birth this year, our recommendations are still relevant. In 2013 we requested that: 1 All DHBs audit preterm births in their region, particularly births at 34, 35 and 36 weeks. 2 Factors that can be changed may include elective or planned deliveries and the clinical reasons for 3 DHB should cover the subject of preterm births in its next MQSP Annual Report. This should include information about interventions that have occurred as a result of information contained in the NMMG report in relation to late preterm births. What has changed since then? We were impressed by the quality of comments from DHBs on the information we provided about births at 37, 38 or 39 weeks and preterm births. Some noted that they had already focused on preterm births following the publication of the 2013 NMMG Annual Report and that this additional information provided further value for them to consider clinical decision making and rationale for births occurring at these gestations, either by elective caesarean or following induction. The information we received included: Reasons for trends in their region Many DHBs assured the NMMG that increases in their region for early term caesarean sections and inductions of labour are in accordance with best practice guidelines but that it did make them review and consider this from a quality perspective. Demographic changes It was noted by some that increases are due to changes in demographics at birth, eg, older mothers and associated risk, as opposed to obstetric decision-making. This needs to be debated further in relation to evidence. Clinical evidence Some that increased caesarean sections and inductions performed at early term (37–38 weeks’ gestation) may be due to better clinical evidence regarding when these should be done for specific clinical cases. (For example, increased awareness of the importance of antenatal recognition of Small for Gestational Age babies and, for expedited delivery, if there is a risk to the baby.) VBAC Others that this increase has been due to a decrease in Vaginal Birth after Caesarean (VBAC). They believe this is an area where more education and consensus is required between professionals but also in relation to information for women to consider VBAC.
In 2013 we recommended ... Last year, we focused on preterm births. While this focus has changed to variation in gestation at term birth this year, our recommendations are still relevant. In 2013 we requested that: 1 All DHBs audit preterm births in their region, particularly births at 34, 35 and 36 weeks. 2 Factors that can be changed may include elective or planned deliveries and the clinical reasons for 3 DHB should cover the subject of preterm births in its next MQSP Annual Report. This should include information about interventions that have occurred as a result of information contained in the NMMG report in relation to late preterm births. What has changed since then? We were impressed by the quality of comments from DHBs on the information we provided about births at 37, 38 or 39 weeks and preterm births. Some noted that they had already focused on preterm births following the publication of the 2013 NMMG Annual Report and that this additional information provided further value for them to consider clinical decision making and rationale for births occurring at these gestations, either by elective caesarean or following induction. The information we received included: Reasons for trends in their region Many DHBs assured the NMMG that increases in their region for early term caesarean sections and inductions of labour are in accordance with best practice guidelines but that it did make them review and consider this from a quality perspective. Demographic changes It was noted by some that increases are due to changes in demographics at birth, eg, older mothers and associated risk, as opposed to obstetric decision-making. This needs to be debated further in relation to evidence. Clinical evidence Some that increased caesarean sections and inductions performed at early term (37–38 weeks’ gestation) may be due to better clinical evidence regarding when these should be done for specific clinical cases. (For example, increased awareness of the importance of antenatal recognition of Small for Gestational Age babies and, for expedited delivery, if there is a risk to the baby.) VBAC Others that this increase has been due to a decrease in Vaginal Birth after Caesarean (VBAC). They believe this is an area where more education and consensus is required between professionals but also in relation to information for women to consider VBAC.
national-maternity-monitoring-group-annual-report-nov2014-v2.docx