Pregnancy / 8 December 2018, 6:00pm / Vicki Flenady, Adrienne Gordon, Caroline Homer, David Ellwood, Jonathan Morris, and Philippa Middleton
Stillbirth is defined as the death of a baby of at least 20 weeks’ gestation or 400 grams in weight. Most stillbirths occur during pregnancy.
Up to 50% of stillbirths happen unexpectedly and a clear cause is never identified. In around one-third, deficiencies in the quality of care in pregnancy and labour are known to play a part.
We can achieve the aim of reducing stillbirths by focusing on five evidence-based practices for women and health providers:
1) Sleep on your side in the last trimester The position pregnant women sleep in has recently emerged as an important risk factor for stillbirth. Women who report going to sleep on their back after 28 weeks of pregnancy have an almost three-fold increased risk of stillbirth.
It’s recommended women after 28 weeks of pregnancy settle to sleep on their side although not all women are aware of this advice.
2) Seek help if fetal movements decrease Women who experience decreased or altered fetal movement should immediately contact their midwife or doctor, as this is a marker for potential problems with the baby, including poor growth, disability and stillbirth.
But women are often not aware of this risk factor and, as such, don’t immediately report decreased fetal movement. A public awareness program on decreased fetal movement was recently launched in Victoria.
We are currently testing a mobile phone app for women to track fetal movement. Our preliminary data shows around 20% of women report concerns about decreased fetal movement during their pregnancy. Of these, around one-third will wait longer than 24 hours to contact their health care provider.
The response by care providers to maternal reporting of decreased fetal movement is often not as good as it should be.
3) Get help to stop smoking Smoking during pregnancy is strongly associated with stillbirth and other serious problems such as fetal growth restriction, premature birth, and SIDS. It impacts on the child’s health throughout his or her life.
One in ten Australian mothers smoke during pregnancy, and rates are higher for women under 20 years (31%), who live remotely (35%) or are Indigenous (42%).
Quitting smoking has massive benefits for women and their babies, but the rate of quitting in pregnancy is low.
4) Attend check-ups to monitor baby’s growth Fetal growth restriction – when the baby isn’t growing well – is a strong marker of potential problems with the baby, including stillbirth, death in the first weeks of life and also chronic diseases later in life.
Good antenatal detection, combined with careful management, improve the baby’s chances of being born healthy.
But Australian midwives and doctors are often poor at detected fetal growth restriction; we only identify around one-third of babies who have it.
We have developed a program to educate midwives and doctors about fetal growth restriction, through improved screening and management of women at risk. So far this has been well-received.
We hope to see similar improvements to that of the UK’s screening and management program, which increased the detection of babies with growth restriction from 34% to 54%.
5) Optimise birth timing, if possible The risk of stillbirth increases as women approach and go past their due date, as the placental function decreases.
The absolute risk of stillbirth from being overdue is very low, affecting about one in 1000 women. But women in higher-risk groups should be more closely monitored for their risk of stillbirth and, if necessary, have their labour induced. This includes women who: