The Health and Social Care Secretary has announced that the majority of pregnant women will receive care from the same midwives throughout their pregnancy, labour and birth by 2021. The first step towards achieving this will see 20% of women benefiting from a ‘continuity of carer’ model by March 2019. To help achieve this, the NHS plans to train more than 3,000 extra midwives over 4 years. There will be 650 more midwives in training next year, and planned increases of 1,000 in the subsequent years.
Maternal or fetal complications, following the insertion of a balloon catheter to induce labour, are rare. Pain or discomfort was most common affecting around 1 in 400 women. Balloon displacement, bleeding or abnormal fetal heart rate affected less than 1 in 1,000.
The catheter is a device inserted through the cervix, where inflated balloons on the end of a tube put pressure on the cervix helping it to “ripen” and start contractions. Prostaglandin drugs are the current recommended induction method, but uterine (womb) overstimulation, where contractions become too frequent or long, is a recognised side effect.
Individual trials have indicated that catheter induction could be a safer alternative. This review is the first to gather the available evidence from 26 studies including 8,292 women that have reported the adverse event rate for catheters.
It supports balloon catheters as an induction method for low-risk pregnancies that could allow women to stay at home, benefiting the mother and saving NHS resources.
“This review provides encouraging evidence for the safety of balloon catheter cervical ripening in an outpatient setting. Adopting this technique for low-risk pregnancies could significantly improve women’s birth experience as well as economically benefiting the NHS. Is it time we reconsidered our induction methods?”
Sally Collins, Consultant Obstetrician & Subspecialist in Maternal & Fetal Medicine, Oxford University Hospitals NHS Foundation Trust; Associate Professor, Nuffield Department of Women’s & Reproductive Health, University of Oxford; Lecturer in Medical Sciences, St Anne’s College, University of Oxford
Diederen M, Gommers J, Wilkinson C, et al. Safety of the balloon catheter for cervical ripening in outpatient care: complications during the period from insertion to expulsion of a balloon catheter in the process of labour induction: a systematic review. BJOG. 2017. [Epub ahead of print].
The National Institute for Health and Care Excellence (NICE) is producing guidance on using biomarker tests (Actim Partus, PartoSure and the Rapid fFN 10Q Cassette Kit) in the NHS in England. The diagnostics advisory committee has considered the evidence base and the views of clinical and patient experts.
The advisory committee is interested in receiving comments on the following:
Has all of the relevant evidence been taken into account?
Are the summaries of clinical and cost effectiveness reasonable interpretations of the evidence?
Are the provisional recommendations sound, and a suitable basis for guidance to the NHS?
The consultation will close on 3rd April. More details available from NICE here
Public Health England has produced Best start in life: return on investment tool. This tool aims to help local commissioners provide cost-effective interventions for children aged up to 5 years old and pregnant women. It pulls together evidence on the effectiveness and associated costs for a number of interventions aimed at providing children with the best start in life. It is accompanied by a report providing details on how the tool was constructed.
This report from Save the Children looks at the scale and impact of the marketing activities of six global formula milk companies that together own more than 50% of the market in breast-milk substitutes. It sets out recommendations for change, with the aim of benefiting millions of children and mothers’ health.
To download the summary report, full report, and to see responses to Save the Children from major formula milk companies click here