Saving Babies’ Lives

Protecting your baby from smoke is one of the best things you can do to give your child a healthy start in life. The sooner you stop smoking, the better chances you’ll have of a healthier, happier pregnancy and birth.

This element provides a practical approach to reducing smoking in pregnancy by following NICE guidance. Reducing smoking in pregnancy will be achieved by offering carbon monoxide (CO) testing for all women at the antenatal booking appointment, and as appropriate throughout pregnancy, to identify smokers (or those exposed to tobacco smoke) and offer them a referral for support from a trained stop smoking advisor.

Click here to visit the Greater Manchester Make Smoking History website for more information.

The previous version of this element has made a measurable difference to antenatal detection of small for gestational age babies across England. It is however possible that by seeking to capture all babies at risk, interventions may have increased in women who are only marginally at increased risk of fetal growth restriction related stillbirth. This updated element seeks to address this possible increase by focussing more attention on pregnancies at highest risk of fetal growth restriction, including assessing women at booking to determine if a prescription of aspirin is appropriate. The importance of proper training of staff who carry out symphysis fundal height measurements, publication of detection rates and review of missed cases remain significant features of this element.

This updated element encourages awareness amongst pregnant women of the importance of detecting and reporting reduced fetal movement, and ensuring providers have protocols in place, based on best available evidence, to manage care for women who report reduced fetal movement. Induction of labour prior to 39 weeks gestation is only recommended where there is evidence of fetal compromise or other concerns in addition to the history of reduced fetal movement.

Trusts must be able to demonstrate that all qualified staff who care for women in labour are competent to interpret cardiotocographs (CTGs), always use the buddy system and escalate accordingly when concerns arise, or risks develop. This element now includes use of a standardised risk assessment tool at the onset of labour and the appointment of a Fetal Monitoring Lead with the responsibility of improving the standard of fetal monitoring.

This is an additional element to the care bundle developed in response to The Department of Health’s ‘Safer Maternity Care’ report which extended the ‘Maternity Safety Ambition’ to include reducing preterm births from 8% to 6%. This new element focuses on three intervention areas to improve outcomes which are prediction and prevention of preterm birth and better preparation when preterm birth is unavoidable.

The new Element 6 covers the management of pre-existing diabetes in pregnancy for women with Type 1 or Type 2 diabetes, as the most significant modifiable risk factor for poor pregnancy outcomes. It recommends multidisciplinary team pathways and an intensified focus on glucose management within maternity settings, in line with the NHS Long Term Plan and NICE guidance. It includes clear documentation of assessing glucose control digitally; using HbA1c to risk stratify and provide additional support/surveillance (National Diabetes Audit data); and offering consistent access to evidence based Continuous Glucose Monitoring (CGM) technology to improve glucose control (NICE and NHS plan).