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Routine scans for mums-to-be at 36 weeks could save lives18th April 2019 Clinical Negligence
Routine scans for mums-to-be at 36 weeks could save lives
Yesterday we heard the news that routine scans for mums-to-be at 36 weeks would avoid 4,000 emergency caesareans and eight baby deaths a year by helping to detect if a baby is in the breech position.
The BBC reported that as well as having crucial patient safety benefits, researchers from the University of Cambridge also found that providing the routine scans could provide financial gains for the NHS
The safest and most ideal position for a baby to be born is head down and facing the mother’s back. This is called the occipito-anterior position and it allows the baby to move through the mother’s pelvis with the greatest ease. A baby that is the breech position is the opposite way round and has its feet or bottom down meaning its head would be delivered last if the birth was to go ahead in this position.
All births are unpredictable to a greater or lesser extent but if breech births, which are known to cause problematic deliveries, can be identified early the risk of harm coming to affected babies will be greatly reduced.
Although many babies end up being born in the breech position and arrive safely, it is not an issue that can be taken lightly. Sometimes a breech birth goes ahead because this is the mother’s choice. However it also regularly happens because it is not known beforehand that the baby is in this position and it is these cases that are more problematic. This is because it is impossible to plan how this complicated birth will be managed and things can start to go wrong. Breech births pose a greater risk of injury being caused to the baby because they can lead to it getting stuck which can cause oxygen deprivation. The result of this can be that the baby suffers brain damage leading to cerebral palsy or even death and these are injuries that the specialist medical negligence team at JMW regularly deals with.
I think that offering women routine scans at 36 weeks would have a positive impact on the management of breech deliveries. It would mean an early plan being put in place and consideration of the mode of delivery, including potentially a planned caesarean section, and the risks and benefits being fully explained to families.
It would also mean that the plan can be fully communicated to staff before the start of labour rather than being done on an emergency basis if the breech presentation is only identified at a late stage. Babies who are born in an emergency situation always face additional risks and although any birth can end up this way anything that can be done to minimise the number should be welcomed.
We also know from the cerebral palsy, stillbirth and neonatal death cases we deal with at JMW that recognition of a baby being in distress is not always adequate in maternity units. Although we feel that is a completely unacceptable position that should be addressed, by introducing these routine 36 week scans the risk factors for a birth getting to that stage may be reduced.