Summary of the AIMS Critique

Summary of the 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

Full Text of the AIMS Critique

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.

Full Text of the AIMS Critique