Wide range of practitioners need to go back to basicsBMJ 2011; 343 doi: https://doi.org/10.1136/bmj.d5948 (Published 21 September 2011) Cite this as: BMJ 2011;343:d5948
- Christopher E Lennox, consultant obstetrician and clinical adviser1
Nelson-Piercy and colleagues correctly note an overall rise in indirect causes of maternal deaths since the 1980s, and the encouraging fall in direct causes over the same period, but they do not comment on the decline in indirect deaths in the past decade despite rising levels of obesity and increasing maternal age.1 2 The overall maternal mortality rate in the UK in 2006-8 was the lowest since the 1991-3 triennial report. Although the recent report recommends referring those with potentially serious medical problems to specialist centres, the strongest message is for the early recognition of potential and developing illness through improved “back to basics” clinical skills, followed by appropriate and prompt referral and involvement of relevant experts. Such experts might be general practitioners, obstetricians, or clinicians of another specialty.
Many of the recorded deaths might have been prevented by the early application of basic principles of observation, recognition, management, and referral. A small number of women might benefit from the existence of more fully trained obstetric physicians, but far more women would benefit from the recognition that a wide spectrum of practitioners—both doctors and others, in hospital and community settings—require (re)training in these achievable and probably more effective “basics.”
Cite this as: BMJ 2011;343:d5948
Competing interests: CEL was a member of the writing panel of the Saving mothers’ lives report for 2006-8.2
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