All Categories - Stellar Research

Celebrating international midwives day

5/4/2018

“I’m sorry there is no heartbeat” These are words no midwife wants to utter yet most midwives do have to say them at some stage in their career. The time when I said them is burned in my mind in a similar… yet different… way as when I heard them before my own baby Emma was stillborn.
The woman, who was having her first baby, had arrived for admission to birth suite. I introduced myself and led her into the assessment room chatting as we went, neither of us had any clue about the tragedy which was about to unfold. I lay her down on the delivery bed to do an abdominal palpation and, still happily chatting, felt for the baby’s position. My hand touched the baby’s foot and a cold chill went down my spine as I realised that there was no reaction to my touch. My heart in my mouth I reached for the hand held Doppler and placed it directly over the anterior shoulder but there was no sound. Still a little disbelieving I checked the battery, which was full. I quietly said “I’m sorry there is no heartbeat, I’mgoing to arrange for you to have an urgent ultrasound but to be honest things don’t look good” it was time for the woman to be disbelieving, she later told me that she thought I was an “incompetent idiot” as she had felt her baby moving only a few hours earlier. Her beautiful baby girl was born still just a few hours later, not a mark on her perfect little body.
Since that day I have cared for many other families as they have met their stillborn baby. Just as is the case with live birth, every single birth and every single circumstance was different. But unlike the many hundreds of live births that I have attended I still remember each and every one of the stillborn babies names, the bereaved parents names and the circumstances of the birth and very few of the baby’s and parents whose baby was born alive and well. Why? Well I think it is because when birth and death collide it is always memorable AND I think that it is the most enormous privilege to provide care to parents when they are at their most vulnerable and sad. I often say to my students that a key role for the midwife is one of advocacy and it is never more important to advocate for the woman and her family than when the baby is stillborn.
So on this International day of the midwife as we celebrate the role of the midwife which is usually “being with” families at one of the most joyful times in their life, we should also remember the more than 7,000 babies across the world who will be stillborn today, their parents and their midwives who are “being with” them at one of the saddest times of their life.

January 11th, 2018

1/11/2018

Today I watched this news story from the UK.
In brief it covers the intrapartum (in labor) stillbirth of Harriet Hawkins. By the sound of it this little girl died while her mother was in prolonged dysfunctional labor. A report that the parents managed to instigate found what seems to be appalling negligence: “13 different identifiable delivery and service problems”!
I say “managed to instigate” because in spite of the fact that Harriet entered labor alive and that her stillbirth has been described as “almost certainly preventable” and in spite of the hospital investigating and admitting fault there can be no coroner’s inquest!
As I have said before on this blog, far from assigning blame that many people think is the Coroners role, the Coroner actually has a strong role in serving the public in helping to prevent preventable deaths. BUT the coroner has no jurisdiction over stillbirths because the baby is not considered a “legal entity” until the baby has been born shown signs of life. Also contrary to public opinion the Coroner’s inquest is MUCH more than an autopsy as an inquest examines the circumstances surrounding the death specifically looking for what could have been done differently and then handing down recommendations that are MUCH more powerful than recommendations made by a single institution like a hospital committee.
While it is apparent that Jack and Sarah Hawkins successfully fought to get their baby’s death investigated it is also apparent that they have the wherewithal and intestinal fortitude to persist where others with less determination may well have given up or even not tried. This is NOT acceptable. Babies like Harriet deserve to have their deaths investigated just like any other person who dies suddenly and expectantly ESPECIALLY when the death is at the hands of care providers.
So what is needed? It is high time that the Coroners jurisdiction is extended to include stillborn babies. This is needed so that parents who have just experienced the tragedy of stillbirth don’t have to expend energy, that many simply don’t have, to gain justice for their baby. If you agree please sign the Army against stillbirth petition.

Come on Aussie come on come on

11/29/2017

Today I was delighted to see this story out of the UK
Coroners to investigate stillborn deaths
The argument put forward in this article is so compelling I think it’s worth highlighting some main points from it with a little of my own commentary:
Today, the Health Secretary announced “a new maternity strategy to reduce the number of stillbirths”. This strategy centres on the investigation of still birth deaths by the new Healthcare Safety Investigations Branch but it also included a planned change in the law to allow coroners to investigate full term still birth deaths. Currently there is no requirement for a doctor to refer a still birth death to the local coroner.
This echoes the current state of affairs not only in the UK but in most high income countries across the globe including Australia, the stillborn baby is not considered a legal entity.
A recent report by MBRACE-UK included the finding that in 8 out of 10 deaths different care might have saved the baby’s life.
We currently don’t have a similar report in Australia BUT if we did, I suspect that we would also find similar concerning rates.
Recently the Chief Coroner voiced concerns about the inadequacy of the law in England and Wales on referrals of still born deaths to coroners. There is no legal requirement for doctors to refer the death of a still born baby to the local coroner which is a lost opportunity to improve the safety of maternity care.
The situation in Australia is even worse, the Coroner has no jurisdiction for investigating stillbirth meaning that even if they wanted to the current law prevents anyone referring a stillborn death to the coroner.
This means that coroners are not routinely investigating still birth deaths and so the reasons why babies die in unexplained circumstances are not being discovered and lessons are not being learnt. Not only does an inquest bring to light the causes of deaths but it also requires coroners to make a formal Report to Prevent Future Deaths where concerns are identified. Such a report is public and sent to those with the power to make changes highlighting the practical steps that need to be taken with the intention of improving public health, welfare and safety.
These are PRECISELY the reasons why the Coroner needs to have jurisdiction over stillborn deaths in Australia too!!!
The Chief Coroner reported that discussion had commenced on considering whether stillbirths/near term deaths should be reportable cases but that any changes would be likely to require primary legislation. Today’s announcement in the House of Commons promises that these changes will be made after further consultation with the Ministry of Justice. The Health Secretary suggested in his response to questions from the House that this consultation might include considering whether or not “specialist” coroners will be needed in order to properly investigate these types of death.
Stillaware is calling for a similar change in legislation in Australia BUT we are apparently a LOOOOONG way behind the UK. So Come on Aussie come on lets also begin the process that will inevitably lead to saving more babies lives in Australia and not be left behind by countries like the UK!

Credit where credit is due

11/20/2017

Today something really rather remarkable happened. The first, I hope, of many timed international releases of a stillbirth public awareness campaign. This one is the Sleep On Side campaign which tells women about the risk of going to sleep on their back in late pregnancy. #SleepOnSide is timed to coincide with the lifting of a publication embargo on the latest case-control study that demonstrates (once again) that going to sleep on your back in late pregnancy is risky. The study lead by my mate Prof Alex Heazell is published in the British Journal of Obstetrics and Gynaecology (BJOG) it’s the fourth well conducted case controlled study to find a link between stillbirth and maternal going to sleep position.
The accompanying campaign consists of a short youtube video TOTALLY brilliant in its simple yet memorable message.
Three organisations have formed an International Stillbirth Awareness Collaborative (ISAC) to make this happen Stillaware, Tommy’s (UK) and Star Legacy Foundation (US).
In Australia, Stillaware are the only organisation solely dedicated to raising awareness of stillbirth, Tommy’s in the UK have a multifunction of raising funds for stillbirth research and also raising awareness and education, as do the Star Legacy foundation in the US.
Today represents the culmination of a LOT of behind the scenes work, meetings and most importantly passion to see a timed release of this very important public awareness message aimed at informing pregnant women of a modifiable risk (something they can act to change) and thereby reduce stillbirths.
I have to give an enormous shout out to Claire Foord CEO and Founder of Stillaware without who this timed international release most certainly would not have occurred. Her amazing artistic talents vision and her passion, to make this happen… actually did make it happen. I look forward to continuing to work with this amazing passionate woman and also the ISAC.

From care to cure.

11/6/2017

Last week I had an absolutely fantastic week with Prof Ingela Radestad from Sweden. I first met her in 2010 at the Sydney ISA/ISPID conference. Last week I discovered that she and I share many life experiences in common, we are both midwives, we have both lost a daughter to stillbirth, we have both come uncomfortably close to losing a grandchild to stillbirth, we began academic life committed to making a difference to bereavement care for families but in more recent years we have both come to the realisation that while bereavement care is, and always will be, vitally important that preventing stillbirth from happening in the first place is really what we should focus on.
How do we prevent stillbirth?
I think we need a three pronged attack. We need:

Public awareness that stillbirth happens
Pregnant woman awareness of warning signs to look out for and ways to protect herself and her baby during pregnancy
Care providers improved awareness of risk factors and what to look out for, taking care to listen to women and appropriately respond to their concerns

The organisation that is working hard to raise awareness and prevent stillbirth in Australia is Still Aware. This organisation was founded by a bereaved mother Claire Foord. I attended the Australian College of Midwives conference in Adelaide last week and was very privileged to hear Claire speak about stillbirth awareness to an audience of nearly 400 midwives. Her message was incredibly simple yet very powerful.

6 babies die in Australia every single day (Stillbirth happens)
Many pregnant women do not know the warning signs to look for and are unaware of simple measures they can take to keep their unborn baby safe. (She is working to address that by distributing information about how women can keep their unborn baby safe to maternity hospitals across Australia free of charge)
Care providers need to tell women about stillbirth and ways to keep their baby safe (she is regularly holding care provider education sessions to address knowledge gaps, not in stillbirth management but stillbirth prevention)

One of the midwives attending the conference congratulated Claire on Still Aware's simple yet understandable messaging. I also would like to congratulate Still Aware for the good work they are doing raising awareness of stillbirth in this country. It is my hope that as a result we will soon see a downward trend in stillbirth rates in Australia. Meanwhile, I would urge other stakeholders to join Still Aware, fund Still Aware and work with Still Aware so we can achieve what we all want and that is an end to preventable stillbirth in this country.

Army against Stillbirth

9/6/2017

Today I joined the army against stillbirth. Why?…because I want change!...

I silently stood with a few other militia :) outside the Minister of Health’s office in Adelaide holding a placard which said:

Why was this an important placard for me to hold? Because my baby Emma was stillborn 24 years ago and frankly I am APPALLED that we were losing 6 Australian babies a day to stillbirth then and we are STILL losing that same number to stillbirth today.

What is the army all about?
StillAware have produced a document calling for “change to stop preventable stillbirth” which was recently sent to each health Minister. We are going to meet in a silent rally on the 6th of each month until the 3 actions we are calling for have been addressed. The three actions are :

1. Mandated policy
2. Coronial Jurisdiction
3. Access to information for all...

The mandated policy requested is that maternity health care providers are required to undertake mandated professional development in ways to prevent stillbirth and that they be required to have discussions throughout pregnancy to inform pregnant women in their care about how to reduce their risk.
We are asking for coronial jurisdiction to be extended to include stillbirth so that maternity care-providers are held accountable and the public can be assured that when a preventable stillbirth occurs that it has been properly investigated and recommendations made to prevent such deaths from occurring in the future.
Finally we are asking for funds to raise public awareness. Currently there is silence and taboo around the word stillbirth (the reason why we stood silently today) But we need to break that silence and really the only way to do that is to make the public aware that 6 babies die each and every day and that that is simply NOT OK.

So wherever you are in Australia I invite you to join the army when it next is due to ‘fight’…the 6th of October. Whoever you are and whatever your connection to stillbirth is (parent, grandparent, or extended family member of victim) friend, near miss parent, health care provider or just a concerned person. Because as this placard so beautifully says:

Things my mother thinks......

8/24/2017

Today I came across this
The Pregnancy Diaries: Things My Mother Did That We Now Know Not To
Although there is “pregnancy” in the title the “things my mother did that we now know not to,” are all related to caring for the new baby.
I did think that this might be about busting some pregnancy ‘old wives tales” and as it actually wasn’t I thought maybe I’ll blog about it instead?!
Baby’s move less close to term as they are running out of room
This is not true, in fact the unborn baby should continue to move strongly, often, and to the same kind of pattern all through the last 3 months of the pregnancy.
If a baby is not moving drink a cold drink to wake it up
This is not true. There is no possible way that drinking cold water can possibly ‘wake’ an unborn baby as both the stomach and uterus are at body temperature and are at least 10cm away from each other! Even if it was possible that this strategy could make the baby move it is completely impossible that it could make a sick baby well!
If you put your hands above your head it will strangle the baby
Lifting your hands above your head does not strangle the baby with its umbilical cord.
It’s safe to lie on your back in pregnancy if it doesn’t make you feel dizzy
The thing about this ‘old wives tale’ is that it disregards what this position might be doing to the baby! Just because you don’t feel dizzy doesn’t mean that your baby isn’t feeling the effects of you lying on your back. When you lie on your back, the weight of your uterus presses on the major vein that returns blood from your lower body to your heart and the one that supplies blood to the placenta and baby! It is therefore best to avoid lying in this position during the day and also not settling to sleep in this position at night.

Any wives tales I’ve forgotten??

Offspring

8/18/2017

I LOVE Offspring, it’s one of my favourite shows. It’s an Australian comedy-drama which follows the life and loves of a 30 something obstetrician (Nina Proudman) and her impossibly zany family.
As a midwife I cannot help but critique the maternity ward scenes. While it depicts exactly the same team working day and night! It is usually impressively accurate in the maternity management side of things. Certainly when the lead character suddenly lost her partner, the love of her life, Patrick the grief depicted was profound and very true to life. So when I heard that Offspring was tackling the topic of stillbirth I was really looking forward to how they might do it.
This link provides a really good summary of the episode

While there were some inaccuracies and outdated practices depicted in the baseline story the impact of the stillbirth on Nina was incredibly well done and as a maternity care provider who has been in that situation more than once myself I actually don’t think it could have been better done. As the show is actually about Nina and not meant to be about current evidence based practice I think the writers can be forgiven and actually congratulated for being prepared to acknowledge that stillbirth happens and that it is devastating to everyone (including care providers) when it does. So my absolute congratulations to the writers of the show for the episode.

The dangers of listening to your baby's heart

8/7/2017

I have often spoken on this blog about the dangers of hand held doppler devices in the hands of lay people. On the weekend a pregnant mum I know sent me this screen shot from a popular App that she subscribes to.

I concerned (not because her battery was flat :)) but because of the flippant and completely careless way this piece of medical equipment is spoken about, as if there is no downside to a lay person attempting to use a device they are not trained to use. Imagine if you were to read in a do it yourself gardening book “ if a large tree is blocking your view just pick up a chainsaw at the local hardware store and cut the tree down” many people might get away with doing this without injury but it doesn’t mean it isn’t stupid dangerous advice. The thing that alarms me the most about this app is the statement “hearing the heartbeat lets you know that your baby’s developing and growing” this is simply NOT TRUE. All that the presence of a heart beat tells the mother, or anyone else for that matter, is simply that there is a heart beat! Babies who are not developing or growing very well at all can still have a heartbeat. So MUCH better careful advice would be “on days you are worried call your maternity care provider and express your concerns, if you don’t feel reassured by what they say immediately seek a second opinion.”

Similarly the statement that there are "perks" to an amnio- centesis left me gob smacked. If a maternity care provider orders an amniocentesis this is for very serious concerns about the mother or baby and no-one should EVER imply that this procedure should be done to get a good long look at the baby.

Whoa Nelly!

7/7/2017

Anyone who knows me well would know I would be the first to say anything that reduces the stillbirth rate is a good thing BUT I do think that excitement about technology and innovation ALWAYS needs to be tempered with caution especially when lives are at stake.
A good example of this occurred today. The Australian newspaper reported that the Australian Stillbirth Foundation had teamed with a San Francisco 'start up' Bloomlife to provide some funding for the development of a wearable device to help provide a “early warning for mothers to seek urgent attention if there is a reduction in their baby’s movement” and that this would be done by taking “research out of the lab.”
While at face value this is probably a good thing I hope the promised “early warning” has been thoroughly thought through and to be frank I have my doubts. Certainly there is never anything wrong with an aide BUT technology must never… EVER be relied on at the expense of a mothers skills and intuition and here is why:
Getting to know your baby and your baby’s movements is complex. A well baby moves frequently, strongly and to a pattern, therefore if the device is going to be at all helpful it needs to somehow recognise these 3 elements that make up fetal well being. I’m not saying it cant or it wont but its going to need to be a very smart device indeed if it can actually learn each individual baby’s pattern of movement, note any changes in strength and also learn the individual baby’s pattern of behaviour such as if the baby is a morning or an evening person, always moves at mum’s bedtime, if he or she always responds to music, touch etc etc and if any of those elements change that the mum can also be warned.
If, as I suspect this device, is set to detect less than a certain number of movements in a set time period (say 10 in 2 hours) and warns the mum that her baby hasn’t done this then that doesn’t allow AT ALL for the baby individuality such as one who is constantly moving and the baby who NEVER moves that much. Such that for the mum of the baby who is a constant mover to be warned the movement would have to fall to a dangerously low amount for that baby and likewise the mum whose baby is a slug and never moves that much will be constantly receiving warnings.
So while this innovation is pretty exciting and points us all towards understanding that fetal movements are important in pregnancy I, for one, am dubious that such a device could, or indeed, should replace the vigilant pregnant mum. So I’m still for promoting that the mum get to know her baby and immediately report changes in her baby’s behaviour (not only frequency but also strength and pattern). IF technology can assist with this then all the better but ONLY if it is understood that all mums, irrespective of technology, are in the best position to know their unborn baby best.