Last summer I applauded the abandonment of the ‘Campaign for Normal Birth’ on the basis that, although motivated by the best of reasons, it was a fundamentally flawed approach that was essentially a throwback to a different century.
The same could be said for stillbirth: until now, parents who lose a baby during labour have no recourse to a coroner’s inquest and have to rely on the hospital itself carrying out an investigation into their baby’s death – or not, as the case may be. The announcement that, from April this year, stillbirths will be investigated by Healthcare Safety Investigation Branch, and that the second reading of MP Tim Loughton's private member’s bill to ensure that all stillbirths are registered was passed, will come as a relief for all those who have been long campaigning for a change in the law.
Stillbirths deserve investigation
There is something particularly distressing about going into labour in the belief you are carrying a healthy baby, only to suffer a stillbirth without knowing what went wrong, and without being reassured that a full investigation would be carried out and reported on. Yet, this is the experience of many parents who find themselves isolated in the face of a hospital unable, or unwilling, to give them any answers. One couple whose case received particular media attention by dint of the fact that they were both doctors themselves, went to great lengths to try and uncover why their baby was stillborn. The hospital eventually admitted that staff error was the cause. Their story is repeated up and down the country with the net result that parents feel they cannot trust what they are being told by medical staff.
UK stillbirth rates are unacceptably high
The stillbirth rate in this country is more than twice as high as that of either Iceland or Denmark; there are around 11 stillbirths a day in the UK; and stillbirth is more common than cot death, and yet it has taken years of campaigning for recognition that every stillbirth needs proper, independent investigation. The death of a seemingly healthy baby during labour should ring alarm bells and for it not to do so seems perversely contrary to the Royal College of Obstetricians & Gynaecologists (RCOG) ‘Every Baby Counts’ report. A number of studies, both here and in Norway, have shown that straightforward changes to ante-natal care could spot early indicators of potential problems, such as babies growing too slowly or a reduction in foetal movement.
Impartial investigation from April
The Campaign for Safer Births, established by parents who have suffered stillbirths, has campaigned tirelessly for all stillbirths to be investigated. Their voice is being heard: at the end of last year Jeremy Hunt announced that all stillborn and neo-natal deaths will be properly investigated by the Healthcare Safety Investigation Branch from April 2018, meaning that each death will be examined by an impartial team of investigators. In addition, Mr. Hunt has also given his backing to the campaign to change the law so that stillbirths are examined by a coroner. This will address the current anomaly whereby babies who die after showing brief signs of life are investigated by the coroner, whereas those born with no sign of life are not. Some commentators have also suggested that some babies who live only briefly may well be classified as stillborn in order to avoid an inquest. Jeremy Hunt announced, at the same time, that the government’s target date for halving the number of stillbirths and neo-natal deaths is being brought forward by five years to 2025.
Hospitals must learn lessons
Judging by the studies that have been undertaken into stillbirth, it is apparent that many of the preventive measures are straightforward, requiring a different approach rather than major investment. Alerting pregnant women to signs they should look out for; being clear about specific risk factors; introducing different checks into ante-natal care; and more careful monitoring during labour will all help to reduce the danger of stillbirth. This bank of knowledge will only increase as independent investigations highlight what went wrong and what preventative measures could be taken.
It will also, hopefully, encourage more transparency by hospitals and a greater willingness to admit when mistakes are made. Maternity-related errors account for the majority of negligence-related payments against hospitals so any improvement in outcome will avoid the need for costly litigation. Nonetheless, the elephant in the room, that of staff shortages, shows no sign of departing and unless, and until, there are enough midwives to cope with our increasing birth rate, the tragedy of stillbirth will remain.