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Hi, I'm Ellie and my goal is to help you become a fantastic midwife. I qualified as a midwife in the UK and have worked in both the UK and New Zealand. Now I'm a midwifery writer and support giver.
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A Simple Summary of MBRRACE – and some thoughts on the maternal mortality stats linked to race
I'm sitting here with my purple mug of long cold tea, trying to get into words what the National Perinatal Epidemiology Unit (NPEU) is and how MBRRACE works.
I've noticed a few students worry that they don't understand, and I've struggled to find a post explaining, so here's my take. If you read towards the end, you'll also find a summary of the 2019 findings and my comments on something quite hard to talk about, which is race and how it impacts maternal mortality.
Everyone's talking about MBRRACE right now because of the report published in Dec 2019. It was actually blocked from being published for a while, as the government did their general election period 'purdah' thing - the idea was to stop the report influencing votes given that no party would have had time to change manifestos based on the findings, but it's questionable whether this repression was ethical.
MBRRACE is the bit of the NPEU that do Confidential Enquiries; it stands for 'Mothers and Babies: Reducing Risk through Audits and Confidential Enquiries'. Since the UK started to run Confidential Enquiries into Maternal Death in 1952, the maternal mortality rate has dropped from 90/100,000 to 10/100,000.
That's a lot of Mums who got to see their kids grow up, thanks to lessons learned.
The MBRRACE-UK team is based at Oxford and Leicester Universities. It's made up of midwives, obstetricians, anaesthetists, pathologists and others and they receive every set of notes for every mother who died so they can share lessons with maternity care providers. This is what the Confidential Enquiry process is.
The 'Saving Lives, Improving Mothers' Care' report is out annually, but as (thankfully) only 200ish women die from maternity causes each year, MBRRACE has to wait for three years to get enough data to assess.
This means MBRRACE publishes on different topics each year.
This is the bit students find confusing, it's kind of like one of those magic tricks with the three cups and the ball but the reports go like this:
2014 (covers deaths from 2009-2012): Topic cycle A which covers sepsis, haemorrhage, amniotic fluid embolism and more
2015 (covers deaths from 2011-2013): Topic cycle B which covers psychiatric causes, thrombosis, homicide and more
2016: (covers deaths from 2012-2014): Topic cycle C which covers deaths from cardiac causes, deaths from pre-eclampsia, and more
2017: (covers deaths from 2013-2015): Back to Topic Cycle A again, i.e. sepsis, haemorrhage, amniotic fluid embolism and more
And then the cycle continues.
It's like if a TV show covered the whole week's news but did it in three different themed episodes spaced out across 7 days.
There'd be a bit of a delay while the episode got made, but every day and every topic would eventually get covered.
The 'Saving Mothers Lives' reports give details about the death rate as a whole, particular lessons learned from expert opinion, and also 'maternity morbidity' themes are chosen and addressed.
This year it was breast cancer, which is fascinating, lots on chemotherapy and how to breastfeed around the treatment, it can't just be me who has limited information on the topic.
On to the actual findings. I might need coffee. Or wine...
The main learning points were about clinicians getting better at multi-professional teamwork and liaison, and that the maternal mortality rate has stayed about the same, which is not great because, in 29% of mortality cases, care could have been improved.
The leading cause of death is still cardiac disease so we all have to be on the look out for high resps, sinus tachycardia and breathlessness, and other signs that are not normal in pregnancy, and we need to ask for help from specialists fast.
There's lots on pre-eclampsia, particularly on taking aspirin throughout pregnancy if you're in a high-risk group. This is a new recommendation.
And then there's there are the stats around mortality and race.
If you're an Asian mother, you have a 3x increased risk of dying during childbearing; if you're black you have a 5x increased risk.
These risks are not linked to being from deprived areas (though that in itself is another issue).
I'm reading a lot of Reni Eddo-Lodge and Roxane Gay and reflecting on this inequality and I think this quote summarises things well.
"When I talk about white privilege, I don't mean that white people have it easy, that they've never struggled, or that they've never lived in poverty. But white privilege is the fact that if you're white, your race will almost certainly positively impact your life's trajectory in some way. And you probably won't even notice it."
- Reni Eddo-Lodge, Why I'm No Longer Talking to White People About Race
And I'm also thinking about some of the online events regarding race and midwifery that happened last year.
You might not have heard but a particular midwife was found to be trolling black women (amongst others), saying things like 'she brings every argument back to race'. The mainstream media reported on the online abuse but didn't really mention racism.
In our cultural climate, it can feel we should ignore it, these attacks were linked to Instagram communities where the currency is beautiful bowls of porridge and fruit, handbags and holidays.
Saying that social media doesn't matter, there are bigger things to worry about, is seductive.
But social media is where we talk and reflect, and this is how racism plays out, in a country where black women have a five fold increased risk of dying as they have their babies.
For what it's worth, I think the comments towards black women are part of the culture and we all have the roots of that behaviour inside us because that's the water we're swimming in.
But when that kind of racism happens, we have to notice what's going on. We can and have to talk about it and strive to do better.
This is what I'm trying, anyway. I hope this helps with understanding what the reports are about, and how we can help.
I'd love to hear your thoughts on all this.
Leave me a comment, what's your key takeaway from MBRRACE 2019?
I'd recommend a hot cup of tea to help the learning!
Much Love, Ellie xxx
The Secret Community For Midwives In The Making Reading List
Aspiring MidwivesBlogStudent Midwives
I first became obsessed with midwifery when I was a teenager, and I found out Waterstones had midwifery books. And I could 'browse' them for free.
I'd turn up most weekends in the bookshop cafe, order the cheapest coffee on the menu and then take Mayes or Myles Midwifery from the shelf, remove my bookmark, and start where I'd left off. I made notes.
Should We Apply #MeToo to Birth – Webinar with Milli Hill
Here's my debate with birth activist Milli Hill about whether #MeToo should apply to birth.
It's up now! You can stop asking me for the replay! 😉
Thanks for all the questions, there were some brave ones.
Not to detract from the seriousness but Milli is hysterical - love the story about talking about birth rights on a train, Milli reports it 'was like that Peter Kay stand up about garlic bread.'
People just didn't get the concept. Birth? And rights? We don't need that in the UK, do we?
Answers to this question and much more can be found in Milli's new book, 'Give Birth Like A Feminist', out 22nd August.
Leave me a comment - I bet you have an opinion! Should We Apply #MeToo to Birth?
Thanks to Milli Hill and to you for listening. Much love and respect to birth workers leading the way x
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