Persistently high rate of stillbirths mystifies doctors
Ten babies are stillborn every day in England, Wales and Northern Ireland causing lasting distress to the bereaved parents and mystifying doctors, a report released yesterday said.
The rate of stillbirths has remained stubbornly high for 15 years, despite improvement in every other area of infant health, but the causes are little understood.
The report is the latest from the Confidential Enquiry into Maternal and Child Health (CEMACH) examining perinatal mortality in 2005 - deaths of all babies from 28 weeks of gestation to four weeks of age.
It found wide variations among NHS trusts in the number of babies dying in the womb or in the first weeks of life, which it described as an “area of concern”. Of the unidentified trusts surveyed, 15 had death rates significantly above the average.
Levels of deprivation and ethnic mix are known to play a role in the death rates along with quality of care. Mothers in deprived areas, and those who are black or Asian, were twice as likely to have a baby who died.
Overall there were 3,600 stillbirths in the year, one in 200 pregnancies. There has been no improvement in the stillbirth rate since the early 1990s, in sharp contrast to the survival rate for premature babies. In the past decade the proportion of premature babies born at 25-weeks’ gestation who lived for more than four weeks has risen from below 60 per cent to 77 per cent.
Richard Congdon, chief executive of CEMACH, said: “The rapid improvement in recent years in the survival prospects of babies who have been born very prematurely is highly welcome, but unfortunately there seem to be deep-seated reasons why we are not seeing the same improvement in the number of stillbirths. We believe this needs attention.”
Women over 40 have the highest stillbirth rate at 7.2 per 1000 live births, a third higher than the average. As the age of motherhood is rising with more women giving birth in their forties, the report warns that the rate of stillbirths and perinatal mortality could rise.
Half of stillbirths are recorded as “unexplained” making it difficult for doctors and managers to change the care provided.
The report pointed out that there had been a “long period of steady progress” since the 1950s in reducing the stillbirth rate, which ended in the early 1990s. Since 1992, the stillbirth rate has remained largely unchanged while the perinatal mortality rate - deaths in the first four weeks of life - had fallen “significantly”.
Jim Dorman, vice-president of the Royal College of Obstetricians and Gynaecologists, said: “These results show that the occurrence of stillbirth is still a major and tragic problem in this country. Advances in technology mean that neonatal mortality [deaths in the first week] through to premature births have fallen but stillbirths present us with a challenge.”
He added: “We need to know what stillbirths happen. The best way forward is to identify the patterns and associations behind stillbirth so that we can discover the most promising areas for further research into its prevention.”
A spokeswoman for the Stillbirth and Neonatal Deaths charity, said the causes of still births were not properly investigated by obstetricians. Fewer post-mortem examinations were being performed since the Alder Hey hospital scandal in the late 1990s in which babies’ organs were retained without their parents’ knowledge.
There was a possible link between the baby’s weight and the risk of stillbirth but the topic needed more research, the spokeswoman said. If a baby was not developing properly in the womb, as shown by its failure to put on weight, it was possible for doctors to intervene to help prevent a tragedy. “You can monitor the mother, give her steroid drugs, or induce the birth when she is near to full term. There are things you can do to mitigate the outcome,” she said.
Carolyn Bray, 31: ‘The silence was deafening’
When Carolyn Bray’s daughter, Rebecca, was born she looked in every respect like a normal, healthy baby - with one difference. She did not cry. “The silence was deafening,” Ms Bray said. She had been told that her baby was dead hours earlier, when midwives placing a foetal monitor had been unable to detect a heartbeat. Some women at that point opt for a Caesarean to get the process over. But Ms Bray chose to deliver Rebecca normally. “A small part of me said they had got to be wrong and I wanted to go through with the birth. It is part of the grieving process and I was proud I did.”
The cause of Rebecca’s death was placental abruption, when the placenta becomes detached from the womb. “Coming away from the hospital with nothing but a few photos and a lock of hair was tough. I sobbed and sobbed,” she said. Rebecca died five years ago and Ms Bray, now 31, and her husband Grev, 37, have two other children. But they still mark Rebecca’s anniversary each year.
The Stillbirth and Neonatal Deaths charity helpline number is 020 7436 588
Independent News and Media Limited