Centre for Maternal and Child Enquiries. 2011. (accessed 7 September 2015)

Cross-Sudworth F, Williams A, Herron-Marx S Maternity services in multi-cultural Britain: using Q methodology to explore the views of first– and second-generation women of Pakistani origin. Midwifery. 2011; 27:(4)458-68

Department of Health. The NHS Outcomes Framework 2013/14. 2012. (accessed 7 September 2015)

Flenady V, Middleton P, Smith GC Stillbirths: the way forward in high-income countries. Lancet. 2011; 377:(9778)1703-17

Gardosi J, Madurasinghe V, Williams M, Malik A, Francis A Maternal and fetal risk factors for stillbirth: population based study. BMJ. 2013; 346

Henderson J, Gao H, Redshaw M Experiencing maternity care: the care received and perceptions of women from different ethnic groups. BMC Pregnancy Childbirth. 2013; 13

Jonkers M, Richters A, Zwart J, Öry F, van Roosmalen J Severe maternal morbidity among immigrant women in the Netherlands: patients' perspectives. Reprod Health Matters. 2011; 19:(37)144-53

Lewis G The Eighth Report of the Confidential Enquiries into Maternal Deaths in the United Kingdom. Saving Mothers' Lives: Reviewing maternal deaths to make motherhood safer: 2006–2008. 2011; 118:1-203

Mumtaz Z, O'Brien B, Higginbottom G Navigating maternity health care: a survey of the Canadian prairie newcomer experience. BMC Pregnancy Childbirth. 2014; 14

Pregnancy and complex social factors: A model for service provision for pregnant women with complex social factors.London: NICE; 2010

2010. (accessed 7 September 2015)

Puthussery S, Twamley K, Harding S, Mirsky J, Baron M, Macfarlane A ‘They're more like ordinary stroppy British women’: attitudes and expectations of maternity care professionals to UK-born ethnic minority women. J Health Serv Res Policy. 2008; 13:(4)195-201

Puthussery S, Twamley K, Macfarlane A, Harding S, Baron M You need that loving tender care': maternity care experiences and expectations of ethnic minority women born in the United Kingdom. J Health Serv Res Policy. 2010; 15:(3)156-62

Raleigh VS, Hussey D, Seccombe I, Hallt K Ethnic and social inequalities in women's experience of maternity care in England: results of a national survey. J R Soc Med. 2010; 103:(5)188-98

Royal College of Obstetricians and Gynaecologists. Late Intrauterine Fetal Death and Stillbirth (Green-Top Guideline No. 55). 2010. (accessed 7 September 2015)

Taylor B, Newall D Maternity, mortality and migration: the impact of new communities.Birmingham: Heart of Birmingham PCT and West Midlands Strategic Migration Partnership; 2008

West Midlands Perinatal Institute. Confidential enquiry in to stillbirths with fetal growth restriction. 2007. (accessed 7 September 2015)

West Midlands Perinatal Institute. Confidential enquiry into intrapartum related deaths. NHS West Midlands Investing for Health Reducing Perinatal & Infant Mortality (2c). 2010. (accessed 7 September 2015)

West Midlands Perinatal Institute. Perinatal Mortality, Social Deprivation and Community Midwifery 2008-9 Available at: West Midlands Perinatal Institute (2011) Perinatal mortality, social deprivation and community midwifery 2008-9. 2011. (accessed 7 September 2015)

Childbearing among UK born and non-UK born women living in the UK. 2012. (accessed 7 September 2015)

Perinatal deaths of migrant mothers: Adverse outcomes from unrecognised risks and substandard care factors

02 October 2015
Volume 23 · Issue 10


Migrant mothers have a high rate of perinatal mortality. We set out to investigate the reasons through a confidential enquiry of babies born to mothers who were themselves born outside of the UK. The cohort consisted of 36 perinatal deaths from three large hospitals in the West Midlands, including 30 stillbirths and six early neonatal deaths from 34 weeks' gestation, with 18 normally formed babies and 18 with congenital anomalies. The case notes were anonymised and reviewed by independent multi-professional panels to assess standard care factors and avoidability of outcome. Of the normally formed babies, nine (50%) deaths were considered potentially avoidable. The majority of cases had one or more medical (78%) or social (81%) risk factors, most of which were not identified by care providers during pregnancy. Key substandard care themes included poor translation services, inadequate information-sharing with mothers and within the multi-disciplinary team, inappropriate management planning as well as an ad hoc approach to social care and support. In addition, the majority of the perinatal deaths had not been reviewed in the Trust where they had occurred. We conclude that many migrant mothers have medical and social risks that are currently not recognised or acted on, which can result in perinatal deaths that are potentially avoidable. Good risk assessment and communication with the mother as well as within the multidisciplinary team underpins high-quality and safe delivery of maternity care.

Stillbirth rates in the UK have consistently been among the highest in Europe (Flenady et al, 2011). One contributory factor may be the heterogeneity of the UK population, including the raised perinatal mortality rate of migrant mothers, of whom the overall proportion of births in the UK is increasing. One in four (24%) babies born in 2011 was to non-UK-born women, and this trend looks likely to continue (Zumpe et al, 2012).

In a recent study of stillbirths (excluding congenital anomalies) in the West Midlands, mothers born outside the UK had a stillbirth rate of 5.2 per 1000 births, compared to mothers born in the UK who had a rate of 3.4 per 1000 births (Gardosi et al, 2013). This difference also applied within individual ethnic origin categories: migrant mothers from Pakistan had a higher stillbirth rate (6.9/1000) than Pakistani mothers born in the UK (4.1/1000).

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