6.-March-2011-Saving-Mothers-Lives-reviewing-maternal-deaths-to-make-motherhood-safer-2006-2008

LewisIntroduction: Aims, objectives and definitionsused in this ReportG LewisNational Perinatal Epidemiology Unit (NPEU), University of Oxford, Oxford, UKCorrespondence: Professor Gwyneth Lewis, National Perinatal Epidemiology Unit (NPEU), University of Oxford, Old Road Campus, OxfordOX3 7LF, UK. Email: gwyneth.lewis@npeu.ox.ac.ukIntroductionThis, the eighth Report of the United Kingdom (UK) Enquiriesinto Maternal Deaths, now known as Saving Mothers’Lives, continues the 56-year unbroken series of reviewsof maternal deaths undertaken to save more mothers’ livesand, more generally, to improve maternity services overall.Although the style and content of the Reports has changedover this time, the essential aims and objectives remain thesame. It is because of the sustained commitment of allhealth professionals who provide maternity and other servicesfor pregnant women in the UK that this Enquiry continuesto be a highly respected and powerful force forimprovements in maternal health, both here in the UK andinternationally. As stated in previous Reports, and equallyvalid today, reading the Report or preparing a statementfor an individual enquiry forms a crucial part of individual,professional, self-reflective learning. As long ago as 1954, itwas recognised that participating in a confidential enquiryhad a ‘powerful secondary effect’ in that ‘each participantin these enquiries, however experienced he or she may be,and whether his or her work is undertaken in a teachinghospital, a local hospital, in the community or the woman’shome must have benefited from their educative effect’. 1Personal experience is therefore recognised as a valuabletool for harnessing beneficial changes in individual practice.Whereas many of the earlier Reports focused mainly onclinical issues, more recent Reports, as with the very earliestones in the 1950s, have also focused on the wider publichealthissues that contribute to poorer health and socialoutcomes. As a result, their findings and recommendationshave played a major part in helping in the development ofbroader policies designed to help reduce health inequalitiesfor the poorest of our families and for the most vulnerableand socially disadvantaged women. Particularly strikinghave been successive Governments’ commitments to reducethe wide variations in maternal mortality rates between themost and least advantaged mothers as identified by theseReports. By acting on similar findings in past Reports, thisEnquiry has also played a major part in defining the philosophyof our maternity services that now expect eachindividual woman and her family to be at the heart ofmaternity services designed to meet her own particularneeds, rather than vice versa.Telling the storyThe methodology used by the Enquiry goes beyond countingnumbers. Its philosophy, and that of those who participatein its process, is to recognise and respect everymaternal death as a young woman who died before hertime, a mother, a member of a family and of her community.It does not demote women to numbers in statisticaltables; it goes beyond counting numbers to listen and tellthe stories of the women who died so as to learn lessonsthat may save the lives of other mothers and babies, as wellas aiming to improve the standard of maternal health overall.Consequently, its methodology and philosophy continueto form a major part of the strategies of the WorldHealth Organization (WHO) and its sister United Nationsorganisations and other donor agencies to reduce maternaldeaths. The WHO maternal mortality review tool kit, andprogramme, Beyond the Numbers, 2 includes advice andpractical steps in choosing and implementing one or moreof five possible approaches to maternal death reviewsadaptable at any level and in any country. Theseapproaches are facility and community death reviews, ConfidentialEnquiries into Maternal Deaths, near-miss reviewsand clinical audit. 3 This work, in modified form, is nowundertaken in more than 54 countries, including many ofthose with the poorest outcomes.Learning lessons for continualimprovementThis Enquiry is the oldest example of the use of the maternalmortality and morbidity surveillance cycle, now internationallyadopted by the WHO programme Beyond theNumbers, which promotes the use of maternal death ormorbidity reviews to make pregnancy safer. 2 The cycle,shown in Figure 1, is an ongoing process of deciding whichdeaths to review and identifying the cases, collecting andassessing the information, using it for recommendations,22 ª 2011 Centre for Maternal and Child Enquiries (CMACE), BJOG 118 (Suppl. 1), 1–203