Working together to reduce stillbirth

Stillbirth and neonatal death have long been taboo subjects for conversation in society – nobody likes to think about babies dying, never mind talk about it.

Perhaps this unwillingness by many to acknowledge that these tragic pregnancy outcomes do happen is one of the reasons why stillbirth rates have not fallen significantly in the last 20 years.

Statistics show 17 babies continue to be lost either before, during or just after birth every day in the UK – that’s over 6500 each year – one of the highest rates in the developed world. One in every 200 babies delivered in the UK is stillborn. One in every 350 babies born in the UK dies in the first four weeks of life. The figures are shocking and speak for themselves.

But times are changing. Baby loss is being taken incredibly seriously by a lot of people who will hopefully be able to do something about it. Reducing stillbirth is being brought to the top of more agendas, and the stagnant figures which have frustrated those working in the field for so long might be on the decline in the not too distant future.

One of the initiatives aiming to make a difference is the Each Baby Counts project, set up by the Royal College of Obstetricians and Gynaecologists.

The RCOG have committed to reducing avoidable incidents during labour at term resulting in stillbirth, early neonatal death or severe brain injury by 50 per cent by 2020.

From this month, the Each Baby Counts project team will collate data from local investigations of such serious events in the hope of identifying themes which may help shape changes in practice around the country.

I was quite disturbed to read in the launch material for the project that around 500 babies a year in the UK die or are left severely disabled because something ‘goes wrong’ during labour. The RCOG states that they do not accept that all of these incidents are ‘unavoidable tragedies’, nor should any of us.

A major programme of work is also being carried out by NHS England, with the involvement of the Strategic Clinical Networks, called Saving Babies’ Lives. The programme has developed a ‘care bundle’ for tackling stillbirth with four elements that, if implemented as a package of care to all pregnant women, has huge potential to significantly reduce stillbirth rates.

A combined approach of smoking cessation interventions, fetal movement monitoring, better CTG interpretation, and improved detection of growth restricted babies has been decided upon as the potential solution that has evaded us for so long and will be taken forward throughout this year.

Two key factors with all of the above proposed plans, and what will hopefully make them successful in finally reducing stillbirth after two decades of little progress, are teamwork and training. Only a real commitment from the whole multidisciplinary team involved in caring for women and their babies will allow the full benefit of the interventions to be realised. A commitment to learn from situations that could have been managed better, a commitment to continuous improvement of clinical skills, and a commitment to support colleagues to provide the best possible care for the best possible outcomes.

Another crucial element is communication (and I’m starting to sound like the 6Cs now). Communication between colleagues is vital to protect everyone from some of the ‘avoidable incidents’ that may not have happened if someone had mentioned their concerns to another. Equally, communication between health professional and expectant mother is vital to build a relationship of trust, to detect suspicious signs early, to ensure pregnant women know what to look out for and that they will be listened to when they tell their midwife. Continuity of care may be the most important element of all.

NHS England, the Royal Colleges, maternity professionals, and committed pregnancy charities like Tommy’s and MAMA Academy, are working together like never before to make the devastating loss of a baby something that fewer families have to go through. I for one look forward to the day when those tragic figures make for more heartening reading.

Jenny Hicken

Jenny Hicken is a Network Delivery Facilitator in the Northern England Clinical Networks, and is part of the Mental Health and Dementia Network team.

She is currently working on projects addressing the wellbeing of vulnerable groups, and represents the Network team on the North East and North Cumbria ICS Zero Suicide Ambition Steering Group. She also keeps a hand in with the Maternity Network team, with whom she has worked closely on a number of pieces of work.

Jenny lives in Newcastle upon Tyne with her husband and two young sons, and has worked in the NHS since 2009.