Disparity in maternal deaths because of ethnicity is “unacceptable”
BMJ 2021; 372 doi: https://doi.org/10.1136/bmj.n152 (Published 18 January 2021) Cite this as: BMJ 2021;372:n152
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Dear Editor
An excellent feature on the latest Confidential Enquiry into Maternal Deaths was marred by an inappropriate picture of a baby experiencing unindicated, unnecessary and 'too early' cord interference. Although the image is small, it appears to show either clamping with forceps or cutting with scissors too close to the umbilicus. The cord is full, blue, turgid and probably pulsating as the baby takes its first breaths to enable complete fetal-to-adult style cardiorespiratory transition.
There are virtually no indications to interrupt the newborn's circulation in these vital minutes of the third stage, which is known to be harmful (especially in premature babies with a 30% increase in death and brain damage) (1). Neonatologists must come to the baby to support transition, and can use BASICS equipment (forms of babyside assesssment, stablisation, and immediate cardiorespiratory support) (2) to do so. It is an unjustified harm to routinely separate the mother and baby from its many months of placental life support at such a vital time. NICE recommended against too early clamping in 2014 (CG190) (3), though sadly no audits have been performed to see if even the obligation to record timing is happening. This failure to stop an unjustified intervention, let alone document it, will likely become indefensible in obstetric litigation. The BMJ should avoid publishing such pictures in the future.
References
1. https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD003248.pub4/...
2. Weeks A, Watt P, Yoxall CW et al .Innovation in immediate neonatal care: development of the Bedside Assessment, Stabilisation and Initial Cardiorespiratory Support (BASICS) trolley http://orcid.org/0000-0002-1909-337XA
3. Recommendations 1.14.14 and 1.14.17 https://www.nice.org.uk/guidance/cg190/chapter/Recommendations#third-sta...
Competing interests: Chair of 2014 NICE Intrapartum Guideline Development Group and author of the paper on BASICS trolley (no intellectual property rights)
Re: Disparity in maternal deaths because of ethnicity is “unacceptable”
Dear Editor
Was there any analysis about the ages of the mothers who died in pregnancy - or the number of previous pregnancies? Is there a link between epilepsy and death in pregnancy? Are some races more prone to epilepsy than others? As the abstract mentions epilepsy as an important factor for fatality in pregnancy - how difficult is it to manage epilepsy when pregnant?
There may be reasons other than crude prejudice for the difference in mortality rate between pregnant women of different racial origins.
Competing interests: No competing interests