Back home in Scotland I was a pupil at George Heriot’s School. When Heriot died in 1624 he wanted his fortune spent on a hospital or charitable school for the free education “puir faitherless bairns” of Edinburgh. I was one of thousands of kids to pass through its halls. What it gifted me was a deep sense of community. With the work ethic my parents instilled in me, I grew up wanting to give back.
In Scotland I trained in paediatrics and I came to Australia inspired by The Flying Doctors TV show. I spent my first months in the country on a neonatal training rotation, working for NETS (Neonatal and Paediatric Emergency Transport Service) and experiencing being a flying doctor myself. But it was after that, when I joined King George V hospital in Sydney, and saw how their research was integrated into clinical practice that I was inspired to stay and work here.
When Emma McLeod founded The Stillbirth Foundation, my PhD project, The Sydney Stillbirth Study, was one of the first projects funded.
Emma was smart and passionate and she had a very clear purpose: to use her experience as a parent of a stillborn child combined with her sharp intellect and business know-how to drive change and fund research into stillbirth prevention.
Then as now, stillbirth was common in society yet seldom discussed. Much of the public health funding in newborn care went to new treatments or equipment to support the babies who survived to reach intensive care. Yet no one was tackling this huge unknown area that affected so many.
I knew more research had to be done to improve understanding of stillbirth. But I encountered resistance early on. You’re not an obstetrician, people told me. Stillbirth is just natural selection… Stillborn babies are simply not meant to be.
That attitude angered and inspired me. For me, a newborn was a newborn and I could see babies born still, and babies born sick or early, shared so many risk factors. Our study committed to digging deeper for detail to tease out new truths.
Several ‘gatekeepers’ made progressing the Sydney Stillbirth Study harder than anticipated. Some hospitals were concerned about the team approaching women who had experienced stillbirth in case we uncovered clinical management issues. One ethics committee held us up three years. Other hospitals were concerned about the healthy women. No pregnant woman wants to talk about stillbirth, they told us. Yet when we asked the women themselves, 86% consented to help.
The stories of those brave women and their families will stay with me forever. Each was unique yet we heard many of the same things – about clinical management, failure to follow-up after a loss and poor communication. These ‘avoidable factors’ in clinical care are often fixable and its one reason around 20-30% of stillbirth deaths in Australia are preventable.
The Sydney Stillbirth Study assessed risk factors for stillbirth through detailed interviews. The project looked at many risk factors including country-of-birth, maternal diabetes and high blood pressure, maternal age, undetected infections in the placenta, fetal growth restriction and maternal perception of reduced fetal movements. The big breakthrough, even though midwives had been advocating it for decades, was about sleep position – with a clear association found between sleeping on the back and stillbirth.
We published the Sydney Stillbirth Study in 2015. Since then, the rate of late-pregnancy stillbirth has been falling.
There are many factors behind this improvement. Most recently, the National Safer Baby Bundle is focused on implementing research into practice to reduce the stillbirth rate beyond 28-weeks of pregnancy. The bundle includes a collection of interventions designed to reduce late pregnancy stillbirth: smoking cessation, side sleep position, awareness and management of decreased fetal movements, improved detection of fetal growth restriction and better decision making around timing of birth.
The Safer Baby Bundle aims to reduce stillbirth in late pregnancy by 20%. It is key that such programs also include information for the community and I am delighted to be working with RedNose, SANDS and the Stillbirth Foundation on a public awareness campaign to complement the Safer Baby Bundle Program.
In terms of new research into stillbirth, Australia is a real leader in studying blood tests to establish if the placenta is functioning as it should late in pregnancy with groups in Melbourne, Newcastle and Brisbane all working in this area. This research will help understand more clearly which babies might benefit from earlier delivery or more intensive surveillance.
I strongly believe that the more open we all become in talking about stillbirth, the more we implement what we already know and the more we strive to understand, the more we will improve and the more “puir bairns” we’ll save.
Adrienne Gordon is a senior specialist Neonatologist in RPA Newborn Care and a Clinical Professor at the University of Sydney. She is a chief investigator on the Stillbirth Centre for Research Excellence, a key member of the Safer Baby Bundle initiative aiming to reduce late pregnancy stillbirth in Australia by 20%, and a board member of the International Stillbirth Alliance.