Recently the Lancet published its second stillbirth series. Here is a link to the international stillbirth Alliance (ISA) plain language summary.
As an active stillbirth researcher I have to confess a small degree of disappointment in the apparent focus of this second series. I say “apparent” quite deliberately. There is no doubt that Stillbirth is a global epidemic which impacts greatly on low income countries and disadvantaged women and so the focus of the series and subsequent press releases was quite rightly on this group, but I am not sure how helpful it is to release information in high income countries that 2.3 million babies are stillborn each year across the globe because it then makes our Australian figure of more than 2,000 per year pale into insignificance. Similarly reporting that it would take 160 years for an African woman to have the same chance of life for her unborn baby as a woman in a high income country (such as Australia) currently has, also might lead you to think that stillbirth happens so rarely in this country as to be insignificant compared with the burden in Africa.
So my disappointment lies in the fact stillbirth is portrayed as not really an issue to concern the everyday person in high income countries, but that is absolutely not the case. I have said many times on this blog 6 Australian babies die to stillbirth each and every day. This is a figure that almost always shocks people especially when they realise that it is a figure that far exceeds the number of deaths on the road each day, yet everybody knows the road toll and virtually nobody, least of all the press, know this terrible tragic stillbirth figure.
Don't get me wrong there is a lot of information for those in high income countries in this series. So I would like to point out 3 key points that I got from the new Lancet series that should be of interest to the everyday Australian:
- Stillbirth is costly: Care costs following a stillbirth are up to 70% higher than following a live birth. This does not take into consideration care in a subsequent pregnancy, which should always be considered high risk
- Stillbirth is a hidden tragedy. ‘Disenfranchised grief’ is common, and many suffer ongoing grief and depression suffering in silence because of the stigma associated with this loss.
- Most stillbirths are not inevitable but preventable
- The stillbirth rate is not falling as much as it should be
As was the case for the last series there is an international call to arms which once again I feel some in Australian might be tempted to discount because of its global focus, so I have tried to add in the Australian context using the same headings to show that it is entirely applicable in Australia too. Here it is:
INTENTIONAL LEADERSHIP: Maximise existing leadership; ensure Australian organisations such as ANZSA, Sands, Sids and Kids, StillAware, Pregnancy Loss Australia and the Stillbirth Foundation communicate and collaborate more closely with each other when acting for women and their unborn babies, intentionally involving parents and nurturing champions
INCREASED VOICE, especially among women: Empower women to understand that stillbirth still occurs in Australia at unacceptable rates and that they have every right to demand quality in pregnancy health care which includes information about stillbirth when they are pregnant as well as ways to reduce risk. If a stillbirth occurs, to support all those affected to raise their voices for change; develop culturally appropriate protocols, especially for the aboriginal population, for respectful care after death; to reduce stigma
IMPLEMENTATION of integrated interventions with commensurate investment: Ensure high-quality care for every woman during pregnancy, labour and birth, and after stillbirth; focus on the highest impact interventions, especially antepartum care, increasing awareness of prevention strategies, increase funding and innovation commensurate with the scale of 6 deaths a day; promote these actions within local, state and national processes in support of the Global Strategy for Women’s, Children’s and Adolescents’ Health
INDICATORS TO MEASURE IMPACT & monitor progress: Contribute to the global push to count every pregnancy and every baby, including stillbirths, particularly by improving Civil and Vital Registration Systems; integrate stillbirth-specific components within relevant plans for data improvement, especially to track programmatic coverage and quality, including stillbirth prevention and post-stillbirth support; complete and use perinatal audit tools and a global classification system.
(Note Australia already has a system to count every stillbirth and keeps quality perinatal audit records, reporting these using both the nationally recognised definition of stillbirth (20weeks) and the WHO definition (28 weeks), however some would argue that even so this system has room for improvement and needs to change to a globally consistent classification system)
INVESTIGATION of crucial knowledge gaps: Address gaps in knowledge by setting research priorities regarding stillbirth prevention, awareness and bereavement support, including discovery, translational, and implementation science to drive innovation; develop research capacity. Lobby Government agencies to get stillbirth research into the national research agenda and thereby increase funding opportunities for researchers working in this important area.
Bottom line, Stillbirths occur in epidemic proportions across the globe including in Australia. They are costly in oh so many ways and can often be prevented. More leadership , funding and awareness is needed, so lets hop to it!