Mission Possible: Reducing the rate of stillbirth in Australia

What is stillbirth?

It is the term used to describe the loss of a baby more than 20 weeks into a pregnancy. (Miscarriage is used to describe the loss of a baby less than 20 weeks into a pregnancy.)

This traumatic experience affects 2000 expectant parents in Australia annually. Astonishingly, this rate has barely changed in the last two decades, a time during which interventions undertaken in other countries have seen the stillbirth rates in those countries lower.

Recently, an Australian Senate Enquiry recognised the profound impact of stillbirth by committing $7.4 million annually towards stillbirth education. How can we put this funding to good use?

As mentioned, there have been several interventions internationally that have significantly lowered the stillbirth rate.

Education about fetal movements and sleeping position during the antenatal period have been shown to reduce the stillbirth rate by 30% in Norway, New Zealand and the Netherlands.

In the UK, the introduction of customised growth charts has led to a three-fold increase in the detection of small babies, leading to timely investigation and appropriate intervention. Overall, the impact on the stillbirth rate has been profound, with a 20% reduction in stillbirth rate in the NHS hospitals that have instituted the program.

When considering stillbirth, it is important to acknowledge some stillbirths will still happen irrespective of any policies and procedures we have in place. But that shouldn’t stop us from focusing on preventing the preventable.

As mentioned above, here’s what we’ve learned from interventions in other countries:

  1. Early detection and appropriate intervention for small (and large) babies leads to better outcomes, customised growth charts (and subsequent use of ultrasound for growth assessment) should be standard for antenatal care in Australia.
  2. Fetal movements are a sensitive marker of fetal wellbeing. 55% of women who experience a stillbirth also experienced decreased fetal movements prior to the stillbirth.

With these two things in mind, it’s essential that all pregnant women have a designated appointment specifically focused on ‘keeping your baby safe’. This appointment should cover:

  • The importance of safe sleeping positioning (with a focus on settling to sleep on your side as the pregnancy progresses)
  • Getting to know your baby and their movements. Each individual baby will have their own ‘normal’, the important thing is whether their movements are ‘normal’ for them. (For example: is your baby a day or night mover? Does it have powerful movements or frequent smaller movements?) It is important for the expectant mother to know that movements should not change and if they do change, they should seek medical review.

Despite these interventions, stillbirth will still occur and our management of those that are affected by stillbirth needs to change. Our current model of care deserts patients at the time when they need us the most.

Stillbirth education should not be confined to expectant parents only. We also need to educate and provide support to our caregivers so they can help those who are affected by stillbirth in a more sensitive and appropriate way.

I’ve shared further thoughts on that here.

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