Sadly, stillbirths are more common than you may realise. Data shows that 11 babies are stillborn every day in the UK, which is more than 3,600 each year. Approximately one-third of these happen at term, in other words after 37 weeks of pregnancy. These statistics make stillbirth 15 times more common than Sudden Infant Death Syndrome (SIDS), also known as cot death.
What are the causes of stillbirth?
Studies show that stillbirth is associated with four main risk factors:
- Fetal abnormality
- Pre-eclampsia (see: Pregnancy conditions explained: pre-eclampsia)
- Premature birth
- Fetal growth restriction (FGR)
‘Saving Babies Lives’
The Royal College of Obstetricians and Gynaecologists (RCOG) launched the Saving Babies Lives care bundle in March 2016, aiming to reduce the number of stillbirths and early neonatal deaths in the UK.
The care bundle is designed to help NHS maternity services meet the Government’s national targets:
- 20% reduction in stillbirths in the UK by 2020
- Halving the rate of stillbirth in the UK by 2030
It draws on the latest evidence and research to highlight four areas of care that professionals can have a real impact on driving down stillborn rates. These are:
- Reducing smoking in pregnancy
- Risk assessment and observation for fetal growth restriction
- Raising awareness of reduced fetal movement
- Effective fetal monitoring during labour.
The care bundle includes evidence-based risk assessment tools and systems that midwives and doctors can use in clinical practice. These systems provide guidance on antenatal screening and observation of fetal growth in singleton pregnancies (in other words not pregnancies with twins, triplets or more).
Reducing Smoking in Pregnancy
Cigarette smoke contains around 4,000 harmful chemicals as well as tar, and poisonous gases such as Carbon Monoxide. When you smoke these cross the placenta limiting the oxygen supply to your baby. Research shows us that if you smoke when pregnant your baby is three times more likely to be born growth-restricted.
The harmful effects of tobacco are ‘dose-related’ which means the more cigarettes you smoke (or others smoke around you), the more chemicals and less oxygen your unborn baby receives. Oxygen is essential for your baby’s health and development, so limiting the oxygen supply causes your baby’s heart to pump harder than necessary to compensate.
There is strong research evidence which shows if you stop smoking in pregnancy you reduce the likelihood of stillbirth. It also has a positive impact on many other smoking-related pregnancy complications such as:
- Premature birth
- Low birth-weight
- Sudden Infant Death Syndrome (SIDS).
Detection and observation of Fetal Growth Restriction
There is strong evidence to suggest that fetal growth restriction (FGR) is the biggest risk factor for stillbirth. Also, that babies affected by FGR form the largest single group of preventable stillbirths. Independent case reviews found that many of these baby’s deaths were associated with a failure to recognise risk factors and provide the appropriate standard of care required.
Large research studies have found that babies with FGR are seven times more at risk of stillbirth. However, this risk can be greatly reduced through effective antenatal screening using ultrasound scans and Doppler observations, followed by the timely delivery of ‘at risk’ babies.
The Royal College of Obstetricians and Gynaecologists has produced clinical guidelines which recommend regular ultrasound scans in those pregnancies deemed at increased risk of FGR:
Low risk pregnancies
Regularly measuring the fundal height throughout pregnancy, with maternity healthcare professionals plotting these measurements on Symphysis Fundal Height (SFH) charts.
High risk pregnancies
Regular ultrasound scans measuring the fetal growth throughout the third trimester.
You may have concerns about undergoing regular ultrasound scans, however, it is important to point out that these are only recommended where there are factors that place your pregnancy at ‘high-risk’. Maternity healthcare professionals not perform any scans without your informed consent, so it is important that you fully understand the situation and have the necessary information to enable you to make the right decision for you and your baby.
Raising awareness of reduced fetal movement
A number of studies, including the Confidential Enquiries into Stillbirths and Deaths in Infancy reports have consistently found an association between episodes of reduced fetal movements (RFM) and stillbirth. The first ‘MBRRACE-UK’ report (Mothers and Babies: Reducing Risk through Audits and Confidential Enquiries) also highlighted that unrecognised or poorly managed episodes of RFM increase the risk of avoidable stillbirths.
This evidence highlights the importance of you recognising your baby’s normal level and pattern of activity. You should listen to your maternal ‘gut instinct’ and contact your maternity unit if your baby’s movement levels change. If you notice a change at night, never wait until morning to contact your maternity unit – case reviews show that waiting until the morning can sometimes prove disastrous.
Effective fetal monitoring in labour
The way your midwife or doctor monitors your baby’s heart rate in labour will differ depending on whether your pregnancy is considered low-risk or high-risk.
The midwife or doctor will to listen into the fetal heart rate using a Pinard or a small electronic device called a Doppler. The main difference is that the heartbeat can only be heard by the midwife with the Pinard, whereas the Doppler plays the sound so you can both hear it.
Complicated or high-risk pregnancies:
If your pregnancy is classed as high-risk, your baby’s health and wellbeing will need to be monitored more closely. Your baby’s heartbeat will be continuously monitored using a cardiotocograph (CTG). A CTG is an electronic fetal heart rate monitor that records your baby’s heart rate and pattern alongside any uterine ‘tightenings’ or contractions that are present.
CTG monitoring is a well-established method of confirming fetal wellbeing and screening for fetal hypoxia (lack of oxygen). Studies show that it is the best method available to monitor the fetus during a high-risk labour.
What can you do to reduce risk of stillbirth?
There are a number of things you can do as soon as you know you are pregnant, which can help to increase your chances of having a healthy pregnancy and healthy baby. These include:
Attend antenatal appointments
Regular screening and observations taken during your pregnancy help your midwives and doctors effectively monitor both you and your baby’s health and wellbeing. The results of these observations will identify whether your pregnancy is at low-risk or high-risk of complications. This approach enables midwives and doctors to provide the most appropriate treatment and follow-up antenatal care, acting quickly when needed.
Avoid alcohol and drug use
When you drink alcoholic drinks in pregnancy, the alcohol passes directly from your bloodstream into your baby’s bloodstream via the placenta. The baby’s liver is one of the last of the major body organs to develop. This means your baby is unable to process the alcohol in its bloodstream. Therefore, when babies are exposed to too much alcohol it can have a significantly bad effect on their health, growth and development.
Any drugs you use in pregnancy will also pass into your baby’s bloodstream. This can include familiar over-the-counter products and prescriptions, to recreational/illegal drugs. Many over-the-counter or prescription drugs should not be taken in pregnancy, so be sure to read the labels and only use those which are safe.
Studies show that using illegal drugs in pregnancy is associated with an increased risk of:
- Antepartum haemorrhage (heavy bleeding in pregnancy)
- Preterm birth
- Babies who are growth restricted – a known risk factor for stillbirth.
Pregnancy is often seen as a good opportunity for you to make positive lifestyle changes for example:
- Eating more healthily (see: Foundations of a healthy diet part two)
- Exercising more regularly (see our Exercise pages)
- Stopping smoking
Studies also show a link between obesity and an increased risk of stillbirth, so it is important for you to try to eat a more balanced healthy diet and exercise. It is recommended however, that if you were not very active before becoming pregnant, you should speak to your midwife or doctor before starting a new exercise programme during pregnancy.
Support Groups and Organisations
The Stillbirth and Neonatal Death charity provides care and information to those affected by the death of a baby. The charity offers emotional support and information for parents, grandparents, siblings, children, families and friends, healthcare professionals and others.
Find out more: www.uk-sands.org
Telephone: 020 7436 5881
The Babyloss website also provides helpful information and support online for anyone affected by the death of a baby – whether this is before birth, during birth, or shortly afterwards. Babyloss also operate a 24 hour forum where those affected by the death of a baby can share their experiences and receive and offer support through online posts.
Find out more: www.babyloss.com
Tommy’s undertakes research into stillbirth and is dedicated to reducing the numbers of UK babies’ stillborn every year. Their stillbirth research programme focuses on three discrete areas:
- Understanding the causes of stillbirth and developing new diagnostic tools
- Preventing stillbirths by identifying those babies who are at increased risk
- Developing new national guidelines for healthcare professionals.