Stillbirth in Australia: Can we reduce the numbers?

A doctor checking a pregnant stomach. RESEARCH SPOTLIGHT

Dr Jane Warland is a registered midwife and senior academic at the School of Nursing and Midwifery at the University of South Australia. Since suffering the unexplained stillbirth of her daughter Emma in 1993, she has been a passionate researcher into preventative and modifiable risk factors for stillbirth as well as promoting awareness of stillbirth.

As news consumers in Australia we are regularly reminded about the number of fatalities on our roads. The national road toll for 2015 revealed that 1209 lives were lost and a lot of publicity is devoted to raising awareness around road safety in an attempt to reduce these statistics.

However there’s another death toll that we don’t hear much about, yet it is nearly double the annual road toll. It is the number of babies stillborn in Australia and in 2013 it was 2191. This means that six Australian babies are stillborn each and every day.

It is important to point out that unlike the road toll which is updated monthly, the release of perinatal data lags behind by two years, so the 2013 Australian Institute of Health and Welfare (AIHW) Australian mothers and babies report was published in December 2015.

One telling comment in this annual report is this: “The stillbirth rate of seven deaths per 1000 births has not changed substantially since 2003.”

Why don’t we know that so many are babies dying and can anything be done to prevent these deaths?

I think there is a lack of awareness of the stillbirth rate in Australia for two main reasons:

  • There is a widespread belief that these babies probably were destined to die anyway because of extreme prematurely, significant maternal illness and/or fetal abnormality incompatible with life. Whilst that is true for some, for more than 30 per cent of these babies, that is actually not the case at all. Those deaths often occur in women with no risk factors, in babies who have a good chances of survival (delivery after the 7th month of pregnancy) and who have no abnormalities.

  • Another reason is that people think that there is little than can be done to prevent stillbirth. Again whilst this is unfortunately true for some babies, many of the babies who die in the last few months of pregnancy actually do give warning signs that they are in trouble by slowing growth and/or movement to conserve energy.

Stillbirth is a heart wrenching experience for the families involved and with many stillbirths being potentially preventable, there is actually great capacity to prevent these deaths but there is a need for further research.

Recently prominent stillbirth researcher from the University of Manchester, Dr Alexander Heazell, was the lead author on a publication reporting a stillbirth research priority setting process in the United Kingdom. It has been known for a while that the UK has the “worst” stillbirth rate in Europe and this has sparked a lot of subsequent activity to try to do something about it.

After following a rigorous process the steering group set the following research priorities for the UK:

  • How can the structure and function of the placenta be assessed during pregnancy to detect potential problems and reduce the risk of stillbirth?

  • Does ultrasound assessment of fetal growth in the third trimester reduce stillbirth?

  • Do modifiable ‘lifestyle’ factors (e.g. diet, vitamin deficiency, sleep position, sleep apnea, lifting and bending) cause or contribute to stillbirth risk?

  • Which investigations identify a fetus at risk of stillbirth after a mother believes she has experienced reduced fetal movements?

  • Can the wider use of existing tests and monitoring procedures, especially in later pregnancy, and the development and implementation of novel tests (biomarkers) in the mother or in early pregnancy, help prevent stillbirth?

  • What causes stillbirth in normally grown babies?

  • What is the most appropriate bereavement and postnatal care for both parents following a stillbirth?

  • Which antenatal care interventions are associated with a reduction in the number of stillbirths?

  • Would more accessible evidence-based information on signs and symptoms of stillbirth risk, designed to empower women to raise concerns with healthcare professionals, reduce the incidence of stillbirth?

  • How can staff support women and their partners in subsequent pregnancies, using a holistic approach to reduce anxiety, stress and any associated increased visits to healthcare settings?

  • Why is the incidence of stillbirth in the UK higher than in other similar high-income countries, and what lessons can we learn from this?

Apart from the last one, these priorities can actually be applied in all high income countries across the globe and therefore there would be no reason why these couldn’t also be adopted in Australia.

In fact, in Australia we have great capacity to lead the world in all kinds of research and we certainly should be leading the world in stillbirth research too. One of the reasons why we aren’t is because there is little political will to increase funding and innovation commensurate with the scale of six deaths a day.

A UK medical journal, The Lancet, recently published a series of papers focused on “ending preventable stillbirth”. One of these papers was a comprehensive literature review which showed that there is a substantial economic and psychological burden of stillbirth on society. In particular the paper pointed out that:

  • A stillbirth needs more resources than a livebirth, both soon after the death and also in the next pregnancy.

  • There are usually indirect and intangible costs of stillbirth which are extensive and usually met by families alone.

  • There are many ongoing negative effects, particularly on parental mental health.

The paper concluded that the value of the baby, as well as the associated costs for parents, families, care providers, communities, and society, should therefore be considered when making investments to prevent stillbirths and thereby reduce the associated morbidity.

Late last year, Australian Prime Minister Malcom Turnbull announced that he was prepared to spend one billion dollars on innovation in Australia, and I would like to ask that surely some of those funds could be directed to stillbirth research to help save babies lives both in Australia and across the globe as a matter of urgency.