Coronavirus: Majority of pregnant women who died were ethnic minority background, report finds
A majority of pregnant women who died from coronavirus during the peak of the pandemic were from an ethnic minority background, it has emerged.
A new study of more than a dozen women who died between March and May this year also heavily criticised the reorganisation of NHS services which it said contributed to poor care and the deaths of some of the women.
This included one woman who was twice denied an intensive care bed because there were none available, as well as women treated by inexperienced staff who had been redeployed by hospitals and who made mistakes in their treatment of the women.
The report, by experts at the National Perinatal Epidemiology Unit, based at the University of Oxford, also criticised mental health services after four women died by suicide. The report said women were “bounced” between services which had stopped face to face assessments during the crisis.
Two of these women were pregnant at the time they killed themselves.
Other services failed to take action when two women reported domestic violence. Both were subsequently killed by their partners.
The report looked at 16 women’s deaths in total. Eight women died from Covid-19, seven of whom had an ethnic minority background. Two women with Covid-19 died from unrelated causes, four died by suicide and two were victims of homicide.
In the report, published on Thursday, the authors concluded improvements in care could have been made in 13 of the deaths they examined. In six cases, improvements in care could have meant they survived.
The authors warned that while some issues were linked to the way services were organised because of the pandemic, they added “most represented what should be basic care for severely ill pregnant or postpartum women.”
In one case a woman was denied intensive care twice because no beds were available. She presented at A&E after suffering with Covid-19 at home for a week but was not recognised as being seriously ill. She was reviewed by a junior obstetrician 11 hours later.
She had a caesarean birth but again no intensive care beds were available, and she was put on a general ward. She deteriorated and was eventually transferred to intensive care where she died a few days later.
The reviewers said: “This woman was cared for in five different areas and there was no consistency in who was caring for her. Obstetric input was limited and a senior obstetrician was only involved at the time of her caesarean.”
Despite the need for intensive care the authors noted: “No consideration appears to have been made of the possibility of transfer to another facility to obtain an appropriate level of care when this care could not be provided in the location in which women were situated.”
The report said the redeployment of staff varied between hospitals with some redeploying junior staff, leaving senior doctors to care for women, while in other hospitals the consultants were moved to care for coronavirus patients leaving junior staff unsupported which the report said “exacerbated problems” with a lack of senior medical input to the care of women.
It added: “The majority of these women received critical care in temporarily repurposed settings such as operating theatres or recovery areas. It was evident that some staff who had been redeployed from their very different usual roles were unfamiliar with the critical care equipment, including ventilatory support, they had to use and monitor, and had no experience of caring for pregnant or postpartum women.
“Some were operating in these roles after very minimal training and inevitably errors occurred.”
In mental health services the report said it was clear “changes to service provision as a direct consequence of the pandemic meant that women were not able to access appropriate mental health care,” adding patients were “being bounced between different mental health services” with no one recognising the patterns that women were in need of help.
In one case a woman who had recently given birth contacted a mental health crisis team and was said “not to be suicidal”. She was referred to a perinatal mental health team. The next day she had several consultations with both teams but was never seen face to face. She died by suicide the next day.
The report said: “This woman had clear risk factors for postpartum psychosis. She should have had a face-to-face assessment the same day yet both crisis and perinatal mental health teams seem to have viewed it as the other’s responsibility. Earlier face to face, or at the very least video consultation may have enabled the diagnosis of psychosis and prevented this woman’s death.”
In another case a woman with a history of mental health problems had repeated referrals not accepted or cancelled due to Covid-19 restrictions. She received a letter saying she would not been seen because of Covid-19 and only people acute mental illness would be seen. The woman died by suicide two weeks later.
For two women who were killed by their partners, services failed to consider they needed protection. In one case after an attempt on her life one woman was told to lock herself and her children in the home and to get help from her family.
The report said: “Neither she nor her children were removed to a place of protection. She was killed the following day.
“Both these women needed safeguarding. Whilst the first woman had multiple problems and had disengaged with services, all conversations were around protection of the child rather than the woman herself.”
Chief Midwifery Officer for England, Jacqueline Dunkley-Bent, said: “Despite the challenges of giving patients care during a new pandemic, the NHS safely delivered more than 160,000 babies, while mental health services for new mums and pregnant women have been maintained, with a 30 per cent increase in women accessing this support in April, and when evidence of heightened risk for women from black, Asian and ethnic minority backgrounds giving birth during the pandemic became clear, the NHS stepped up extra support.
“While the overwhelming majority of women receive safe care for them and their baby, midwives will always seek to learn lessons and make care even safer, and my thoughts and condolences are with the families involved in this report.”
In response to the report, both the Royal College of Midwives and Royal College of Obstetricians and Gynaecologists said women needed to have better advice, and more support from the wider team in hospitals.
Dr Edward Morris, president of the RCOG said recommendations from the report had already been included in guidance to doctors.
He added: “Future pandemic planning should ensure that the care of pregnant women is not compromised by redeployment of maternity staff and that access to face-to-face antenatal and postnatal care for women who need support with their mental health is prioritised.”
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