Stillbirth is the devastating and tragic loss of a baby
from 20 weeks’ gestation or 400 grams of body weight
(where gestation is unknown).
There were 4,263 stillbirths recorded in Australia in 2015 and 2016. That’s 1 in every 135 pregnancies with 60% of stillbirths occurring between 20-26 weeks.AIHW: Stillbirths and neonatal deaths in Australia 2015 and 2016
Indigenous women are 50% more likely to have a stillborn baby (9.4 deaths per 1,000 births) than their non-Indigenous counterparts (6.6/1,000).AIHW: Stillbirths and neonatal deaths in Australia 2015 and 2016
What causes stillbirth?
According to the Australian Institute of Health and Welfare (AIHW) the major causes of stillbirth in Australia are congenital abnormality, ‘unexplained death’, premature birth, perinatal conditions, and maternal conditions.
However, there is still a lot unknown about the causes of stillbirth and around 20% of stillbirths remain unexplained. A lack of adequate research and investigation into stillbirths around the country may also result in possible missed diagnoses and may hinder prevention messaging.
Congenital abnormalities refer to conditions that affect the development of the baby’s physical structure or function while it is in the uterus. These abnormalities may involve problems with chromosomes or vital organs such as the brain, kidney or heart that lead to the death of the baby during pregnancy.
The birth of a preterm baby can result in the baby being too immature to survive and result in a stillbirth. Underlying reasons for premature birth are not well understood but can include infection or maternal medical conditions necessitating an early delivery.
Specific perinatal conditions most commonly are those that are associated with the placenta. The placenta may not nourish the baby sufficiently, leading to the baby being small in size and/or distressed. Sometimes the placenta detaches from the wall of the uterus – placental abruption – leading to stillbirth.
Maternal conditions are the fourth leading known cause of stillbirth and include underlying medical conditions of the mother such as diabetes, high blood pressure, autoimmune diseases and connective tissue disorders.
Other causes of stillbirth include:
- Perinatal infection – primary or secondary infection in the baby or in the placenta;
- Hypertension – pre-existing and pregnancy related hypertensive (high blood pressure) disorder; and
- Hypoxia – acute or chronic hypoxia (oxygen deprivation) of normally formed babies.
Defined by the AIHW, certain maternal characteristics may increase the risk of stillbirth.
It is important to note that certain maternal characteristics are often unavoidable, and it is not implied that these characteristics are the cause of perinatal deaths.
Risk factors include:
- Maternal age – stillbirths are higher in women <20 and >40 years of age;
- Smoking during pregnancy;
- Previous stillbirth – women who have had one stillborn baby are three times more likely to have another;
- Pre-existing diabetes;
- High blood pressure (hypertension);
- A body mass index (BMI) >30.
While this is not an exhaustive list of risk factors, it is important if you are pregnant that you are aware of your individual risk profile and that you discuss any concerns with your doctor, midwife or obstetrician to ensure any risks are carefully monitored during pregnancy.
Prevention - what do we know?
No one wants to contemplate their pregnancy not resulting in a healthy, live birth – yet six babies are stillborn each day in Australia.
While this is a daunting statistic, arming expectant parents with evidence-based information about modifiable risk factors and increasing public awareness of stillbirth in Australia, we hope to lower the rate of stillbirth by 20% within the next five years.
Based on the success of the Saving Babies’ Lives Care Bundle in the UK, the University of Queensland’s Centre of Research Excellence in Stillbirth has created the Safer Baby Bundle, which includes five interventions that may lower the risk of stillbirth.
Smoking in pregnancy is one of the major contributors to stillbirth. Every puff of a cigarette has an immediate negative effect on your baby. Carbon monoxide replaces some of the oxygen in the blood, and nicotine also reduces the flow of blood through the umbilical cord. Quitting at any time during pregnancy reduces the harm to your baby. However, planning to quit as early as you can means a better start in life for your baby. Ask your healthcare professional about advice and support on how to stop smoking and available services to support quitting – or seek help directly from Quitline.
Monitoring for fetal growth restriction
Your healthcare professional should be regularly measuring your baby’s growth during your pregnancy, to check that your baby is growing at a healthy rate. They can measure your baby’s rate of growth every time you visit, using a tape measure to monitor the baby’s symphyseal fundal height (SFH). A small baby can still be growing at a healthy rate, or a large baby can be growing slowly. Improved detection and management of growth restriction during pregnancy is a key safer baby strategy to prevent stillbirth.
Getting to know the pattern of your baby’s movements is important – it is a way your baby can tell you that they are well. There is no set number of normal movements. You should get to know your baby’s movements and what is normal for them. You will start to feel your baby move between weeks 16 and 24 of pregnancy, regardless of where your placenta lies, and you should feel your baby’s movements right up until they are born, even during labour. If you are concerned about a change in your baby’s movements, contact your midwife or doctor immediately.
Sleep on your side from 28 weeks
Research shows that going-to-sleep on your side from 28 weeks of pregnancy can halve your risk of stillbirth, compared to going-to-sleep on your back. After 28 weeks of pregnancy, lying on your back presses on major blood vessels which can reduce blood flow to your uterus and the oxygen supply to your baby. You can go to sleep on either the left or the right side – either side is fine. It is normal to change position during sleep and many pregnant women wake up on their back. That’s ok! The important thing is to start every sleep lying on your side (both for daytime naps and at night). If you wake up on your back, roll over on your side.
The Stillbirth Foundation, with the support of Holly and Joshua Ryan, in honour of their precious baby Bluey, born sleeping in January 2018, created this in 2019.
Optimal timing of birth
For all pregnancies, there’s an optimal time for your baby to be born. If your pregnancy is healthy and progressing without any issues, then waiting for labour to begin on its own is the ideal plan. However, if a planned birth (most commonly via caesarean section) is needed, then that is ideally as close to 40 weeks as possible. If there are health concerns that might increase your risk of stillbirth, your health care professional will discuss with you how the timing of birth might reduce your risks, with your pregnancy continuing as long as it is safe for you and your baby.
Staying healthy during pregnancy is one of the most important preventative measures you can take to avoid possible complications for your baby. This includes taking folic acid prior to conception, managing weight and avoiding alcohol, smoking, and drugs during pregnancy.
It is also important to attend all antenatal appointments, screenings and ultrasounds to monitor the growth and development of your baby.
And most importantly, if you feel that anything is different about your baby’s normal patterns of movement or if you are worried about anything to do with your pregnancy, please speak up and seek advice. You are your baby’s best advocate.
Want to learn more about the Safer Baby Bundle?
Follow the link below to the Safer Baby website. And you can read more about one of the co-architects of the Bundle, David Ellwood, below.