Yesterday there was a story in NewsGP (the newsletter of the Australian college of GPs) responding to concerns that Australia might be experiencing an spike in Stillbirths in Australia.
The headline read “Significant increase in stillbirth at a UK hospital during pandemic” and the by-line was “But experts say there is little evidence to support the idea it may be happening in Australia.”
The experts were Dr Alex Polyakov, a senior lecturer in the Department of Obstetrics and Gynaecology at the University of Melbourne and a consultant obstetrician, gynaecologist and fertility specialist at the Reproductive Biology Unit at the Royal Women’s Hospital in Melbourne and Dr Wendy Burton, Chair of the RACGP Specific Interests Antenatal and Postnatal Care network. They both agree that they don’t believe Australian hospitals are seeing a similar rise in stillbirths. I hope they are right!
What has led them to this belief? Polyakov’s “anecdotal evidence from working at a tertiary hospital and a fairly busy private practice, we haven’t observed such [a] major increase in stillbirth over the past few months” and Dr Burton going so far as to ask Dr Michael Beckman from Mater Mothers Hospital (MMH) in Brisbane, Australia’s largest maternity hospital, to review their data Dr Beckman reported lower numbers of stillbirths in the period from February to June 2020 at MMH.’
If one concerned Doctor can ask another to have a look at their stillbirth rate in one hospital in Australia then I would call for every maternity hospital (both public and private) as well as every private provider conducting births at home to provide data for this six month time period AND not only that …if we can do that once then I would suggest it can be done regularly and systematically from now on.
Dr Burton agrees “the numbers [from MMH] are small and we need to look at larger population data, not individual hospital event rates’
One of the amazing things about the data that we have had access to during the Covid crisis is that it comes to us daily, we all know how many tests were done just yesterday, how many were positive, how many are in hospital , how many are in intensive care and what age group they are in. This has enabled us to know as much as we can about this virus and as the months have gone by we have learned a great deal about it and thus how to protect ourselves from it in a way that few countries in the world have managed. In contrast we are flying totally blind with respect to stillbirth while, of course, there is some reassurance in one hospital’s data and anecdotal report we really do owe it to our pregnant women to do better than that and find out what is actually happening to our smallest and most vulnerable Australians.
The other thing that is welcome about this story is the concerns Dr Polyakov shares about telehealth:
Dr Polyakov harbours further concerns about the shift away from face-to-face appointments during the pandemic, and its potential effects on pregnancy outcomes.
‘You can only do so much via telehealth,’ he said.
‘For example, you can’t measure blood pressure and you can’t assess fetal movements or fetal heart rate with telehealth, and so this is something that needs to be kept in mind when we change the patterns of antenatal care.’
Dr Polyakov believes the routine schedule of antenatal appointments should ideally be kept at their usual intervals despite the pandemic.
‘And those appointments should really be face-to-face because otherwise there will be some women who will slip through the net and will have adverse events happen to them because they haven’t seen a doctor face-to-face for months,’ he said.
‘So my advice for [clinicians] who participate in shared antenatal care is to make every attempt to stick to the recommended appointment times or schedule, rather than doing it via telehealth or doing it less frequently.
‘My personal feeling is that because antenatal care is designed to minimise stillbirth and various other complications, it really should be done unchanged irrespective of the COVID pandemic.’
Back to the headline of this article, we have “little evidence” that a spike in stillbirth is happening in Australia perhaps because we haven’t really looked. BUT, we do know that women are not seeing their care provider face to face and we know that face to face antenatal care IS designed to minimise stillbirth so it absolutely should be being done unchanged irrespective of the COVID pandemic. Because there is no doubt that antenatal care has changed we really do need to check that if we haven’t inadvertently caused an increase in stillbirth.