Let’s bring childbirth into the 21st century
The Covid app was an impressive achievement by the digital teams of the NHS, who have not always been known for responding quickly.
It was in many ways transformational for our population. It quite literally enabled us all to get on with our lives because we could prove our vaccination status.
I thought it would be fairly easy, in comparison, to create a new app to record data around the arrival of a new baby, yet in this digital age, the plastic red book is what every parent still receives after their baby is born.
I still have three red books as mementoes of my three children in which facts such as birth weight, circumference of the head and percentile length are recorded. One or two immunisation records appear in pencil.
Yet there is no record of the 48-hour labour with my first born, nor the post-natal depression I experienced, nor the extraordinary speed of my second baby arriving at home on the dining room floor, nor the “born in the bath” third arrival.
In all the trauma and exhilaration of the moment, I can still recall those events, but there is no official record that could be useful for my children’s own lives, nor is there any anonymised information fed into the NHS to help in designing better services for the future.
The government’s Best start for life: the vision for the 1,001 critical days has set out six key areas that will put babies and families at the centre of all services.
A digital version of the red book is action No 3, and in the view of many, it is the lynchpin that will truly transform support for every baby to have the best start in life.
Throughout the research phase of the start for life project, parents and carers told us that they need to be able to find information quickly and to share it with early years professionals. With subsequent pregnancies they should be able to refer back to details such as the birth experience, how their first child slept, when they were weaned, and how they were potty trained.
In today’s red books, information is still added by hand by a midwife, health visitor or GP, and parents are urged to bring the book to their baby’s health checks and vaccination appointments.
Of course, when you are trying to get out the door after a sleepless night with a baby who just filled the second nappy in an hour and a toddler who hasn’t finished their breakfast, the last thing on your mind will be remembering to go and find the red book.
Consequently, health data recorded rarely gives a complete picture and many parents and carers lose them during those challenging early years.
Midwives, health visitors, and of course GPs, keep their own records, but in the majority of cases these are paper records kept in filing cabinets and not shared among different early years professionals.
In the research phase, we heard from so many parents who were tired of having to tell their story again and again to different professionals — if you’ve had a stillbirth or your partner has left you, then constantly having to repeat the details to strangers is hardly enjoyable.
Likewise, we heard from dozens of early years professionals who wish they could provide more joined up support for parents by being better briefed on their health and family situation prior to meeting them.
We also heard from two foster carers who told us that between them they had fostered 40 babies, and only two of those babies arrived with the paper red book.
As a result they had no way of knowing whether the baby was suffering from foetal alcohol syndrome, potential addictions or had been potentially abused before arriving in their care.
A digital version of the red book would help parents and carers advocate for their baby’s needs, and also enable early years professionals to offer more joined up, more empathetic support.
Crucially, digitisation would solve a major challenge within the NHS which is the currently scrappy recording of such anonymised statistics as number of live births, initiation of breastfeeding, A&E admissions, and prevalence of mental health problems around childbirth.
In launching a joined up start for life offer for every family that puts the baby at the centre and focuses on continual improvement, this type of information will be invaluable.
I want to see a digital version of the red book offered to every parent during the second or third trimester of pregnancy, and I believe allocating an NHS number to the unborn baby before he/she is born would enable important maternity notes during the latter part of pregnancy to be linked to outcomes for the baby.
Once the baby is born, the digital record will then be available to facilitate joined up services, and it will ultimately become that baby’s new lifelong health record, something that NHS professionals have longed to put in place for decades.
There are about 700,000 babies born in England each year, and a digital red book for that number would be entirely feasible in scope, with a huge long-term benefit for the population as a whole.
The start for life vision commits to a digital version of the red book being introduced for every baby born in England from April 2023. I am working closely with ministers and the digital team in the NHS to prioritise its development and to ensure that we see the benefits of technology in giving every baby the best start for life.
As we find ourselves in a new chapter of living with Covid, it is vital that we now tackle some of the other priorities that can really transform the lives of families across the country.
There is nothing that will contribute more to levelling up than investing in the lifelong emotional wellbeing of our children, and the very best time to start that is in the 1,001 critical days — the period between conception and the age of two.
