Association for Improvements in the Maternity Services (AIMS) critique of 'The London Project : a confidential
enquiry into a series of term babies born in an unexpectedly poor condition' by the Centre for Maternal
and Child Enquiries (CMACE Report)

Edwards, N; Davies, SE

Abstract

The AIMS critique of the CMACE Report includes the following concerns:
why the report was requested by King’s College Hospital
the selection of cases that were sent to be reviewed
the methods used to review them
the validity of the conclusions that were drawn
The AIMS critique concludes that the CMACE Report:
Reported on the excellent reputation of Kings, but failed to include the excellent
reputation of the Albany Midwifery Practice, and omitted any details about King’s
community midwifery which also achieves excellent outcomes. It is possible that CMACE
was not actually given access to previous reports about the Albany Midwifery Practice.
Failed to consider the possibility that the 'cluster' of cases presented by King's could have
been a chance event, and that the selection of data (including the time frame) may have
contributed to the construction of such a 'cluster'.
Failed to use the recommended term, Neonatal Encephalopathy (NE), which describes
symptoms and instead uses Hypoxic Ischaemic Encephalopathy (HIE) which implies
cause.
Selected groups of babies with and without a problem who were cared for by the Albany
Midwifery Practice and a group of babies who had a problem who were cared for by
King’s community midwives, but failed to include any babies cared for by the hospital.
Used Confidential Enquiry methodology designed to look for trends in large groups of
cases in order to help to identify practice changes to improve outcomes. This
methodology was not appropriate for the comparison of small groups of cases.
Misunderstood women’s right to be supported to make their own decisions and not be
pressured into having to accept care dictated by protocol and guidelines. The report
contradicts itself saying that the midwives were not directive enough, yet is critical saying
that “the choices the woman makes will to some extent reflect the preferences of her
midwife”; it seemed that the report had clear medical views about what women should
and should not be ‘directed’ to do.
Assumed that the Albany Practice midwives needed further education that could be
provided by them working in the hospital environment and failed to consider that King’s
staff could gain from what the Albany Practice midwives could teach them,
Made unsubstantiated assumptions that outcomes could be improved by adherence to
hospital protocols and guidelines, and included a suggestion of a homebirth risk
assessment tool. However there is no evidence that place of birth was an issue in any of
the cases considered.

Citation

and Child Enquiries (CMACE Report)

• Other Type: Other
• Publication Date: Mar 1, 2010
• Deposit Date: Jun 12, 2019
• Publicly Available Date: Jun 12, 2019
• Related Public URLs: http://www.aims.org.uk/