Agenda item

To receive an overview of perinatal and infant mortality in Blackpool and the challenges caused by the pandemic.

Ms Pauline Tschobotko, Deputy Director of Operations, Blackpool Teaching Hospitals NHS Foundation Trust (BTH), presented an overview of perinatal and infant mortality in Blackpool including the challenges caused by the Covid-19 pandemic.

Ms Nicola Parry, Head of Midwifery, BTH, informed Members that Blackpool faced significant challenges and was listed as having some of the most deprived areas in the country. This had necessitated close multi-agency working between partner organisations to improve the lives of children, place families at the centre of care work and minimise instance of infant mortality across Blackpool.

Ms Liz Petch, Public Health Consultant, Blackpool Council, provided detailed figures on the levels of perinatal and infant mortality rates within Blackpool. Members were informed that the infant mortality rate was 6.4 per 1,000 between 2015 and 2017t compared with 3.9 per 1,000 across England and 4.3 per 1,000 in the North-West region. It was added however that although infant mortality rates as a proportion of the population in Blackpool were high, the actual numbers of infant deaths were low due to Blackpool’s small population size. Ms Petch also added that most infant mortality cases had links to the baby’s weight.

Ms Parry informed Members that BTH was good at identifying instances of low birth weight, however additional work was need to track other factors such as parental health and baby brain development. As part of this work a pre-term clinic had been established to monitor prenatal development through to a child’s birth.

Although smoking during pregnancy, by both the mother and father, was a risk factor and an ongoing issue, Members were informed that instances were recorded as falling in Blackpool.

Ms Sarah Keighley, Health Visiting Team Leader, BTH, spoke to the Committee regarding the work of Health Visitors (HV) in addressing infant mortality. She stated that high levels of deprivation in Blackpool meant that many children were born into adverse circumstances that increased risk factors related to mortality. The HV team had therefore worked with Better Start to support parents and help them learn how to better engage with their baby. This included helping them understand how adverse circumstances affected a child’s development and how they could be addressed.

The Committee was also advised of the impact of the Covid-19 pandemic on the work of partners to address perinatal and infant mortality. Ms Keighley explained that while face to face contacts had been reduced during the first national lockdown they had increased since the summer. Ms Parry added that BTH’s Families Division had ensured that face-to-face contact had continued for all mothers at thirty-two weeks, which had continued into the ante-natal period.

Members of the Committee queried how a low baby birth rate was determined and asked for more details on the impact of drugs and alcohol during the perinatal period. Ms Parry replied that the median weight for a baby was based on the mother’s size, height and weight. This would produce an individual median weight for each baby, with any falling below this being considered low weight. Ms Petch added that while there was strong evidence of the damage caused by smoking in the perinatal period on a baby there was less evidence for alcohol and drug abuse and more research was need into the specific impact of both alcohol and drugs.

Members also asked if there were any details regarding poor nutrition and its impact during the perinatal and antenatal periods. Ms Parry responded that there was limited understanding of the impact of poor nutrition on infant mortality, but that a link was recognised between nutrition and the mother’s health, with some having either high body mass indexes or babies with low birth weight. Ms Petch added that the benefits of breastfeeding to ensure good baby nutrition was promoted as part of engagement with new mothers.

The Committee noted that Blackpool had an induced birth rate of 38.5% and queried how this compared nationally and if a link existed between this and infant mortality. Ms Parry replied that no national number existed for rates of induced births, however the Blackpool figure was comparable to those in Lancashire and South Cumbria. She added that inducted births were undertaken based on the individual need of a mother and that there was no known link between induced births and infant mortality, but this was monitored as a precaution. The majority of babies delivered by induced births were described as healthy.

Members asked if data existed for the levels of home births in Blackpool and what support existed for those who wished to give birth in this way. Ms Parry replied that around 4% of births in Blackpool took place at home. This compared with a rate of 2% nationally. In the case of each birth, engagement took place with families to determine their wants and needs so that appropriate advice and support could be provided to ensure mother and baby’s health and safety.

The Committee queried what would happen if a family refused to engage with the support offered. Ms Keighley replied that people had a right to refuse the support offered and it was difficult when they did so. Therefore it was important that the widest range of support possible was offered and that the offer was sustained throughout the perinatal and antenatal period.

The impact on services and learning from the Covid-19 pandemic was also queried by the Committee. Ms Tschobotko, answered that there had been lots of learning for services during the pandemic. One of the most significant had been the increase in digital forms of communication, compared with 2019. This had included ensuring contact with service users addressed their needs and that their experience was positive despite not being face-to-face. Overall she felt that partners had shown great resilience in their response to the pandemic.

Ms Tschobotko also added that the physical effect of Covid-19 on children had been minimal, however the mental health impact of the isolation many experienced during lockdown was greater. The Committee requested that more information be provided on the impact of the Covid-19 lockdown on mental health and requested that a report be provided to a future meeting.