Swabs are used in maternity care for cleansing and to absorb blood and other fluids. They are usually pre-packed in delivery and suture packs. Swabs can be difficult to identify once soaked in blood and are sometimes mistakenly left inside the vagina. Retained swabs following a vaginal birth are a source of maternal morbidity, including pyrexia, infection, pain, secondary post-partum haemorrhage and psychological problems.
Maternity services in England and Wales promote normal birth and it is recognised that there are a number of different birth environments, including the home. However, wherever swabs are used they should be accounted for every time.
All NHS organisations providing maternity services should:
1. have written procedures in place for swab counts at all births (including perineal suturing);
2. audit swab count practices in their maternity services;
3. provide education and training about the counting procedure for all midwifery, obstetric and support staff;
4. ensure that lead professionals (midwives and obstetricians) are aware of their responsibility for documenting the completed swab count in the woman’s health record;
5. in conjunction with their supplies department, risk assess sterile delivery and perineal suture packs and consider using x-ray detectable swabs;
6. ensure staff report incidents of swabs retained after vaginal births and perineal suturing as patient safety incidents;
7. cascade the clinical briefing sheet to relevant staff to raise awareness of the risks of swabs being unintentionally retained following vaginal births and perineal suturing.
Actions should be led by the director of nursing supported by the head of midwifery.