Reducing the rate of stillbirths
In November 2015 the Secretary of State, Jeremy Hunt, announced the government’s ambition to halve the rate of stillbirths in England by 2030. This “ambition” is included in the government’s mandate to NHS England for 2016-2017 and it is part of a wider aim to also halve the number of infant deaths and to address the number of brain injuries occurring during or soon after birth.
This announcement and the mandate has been followed up by the publication of the guidance ‘Saving Babies’ Lives, A care bundle for reducing stillbirth’, published by NHS England on 21 March 2016. This addresses the first part of the ambition relating to reducing the number of stillbirths.
The latest figures from 2014 show that stillbirth rates are currently almost 5 births in every 1000. The guidance identifies 4 key areas to reduce this to 2.3 per 1000 by 2030.
- Reducing smoking in pregnancy – This still remains a problem and the problem varies from location to location throughout England. The guidance’s research has found that just over 1 in 10 women smoke through pregnancy. In the affluent and swinging metropole that is the centre of London, this figure is reduced to 1 in 100. In Blackpool is it 1 in
4. The guidance recommends that all women should be offered a carbon monoxide test at their antenatal book appointment. Smokers and those exposed to smoke should be made fully aware of the risks and/or be referred for support to stop smoking.
- Enhancing detection of growth restriction by monitoring and recording on growth charts – Of all stillbirths, this is the single largest preventable group
- Fetal movement – Reduced fetal movement is something which has come more into the public knowledge thanks to charities such as Kicks Count. Women used to be told that it was normal for babies to move less during the later stages of pregnancy as they had less room to move. This charity was set up to counteract this bad advice and to encourage women to contact their midwives if they had any concerns about the reduction in movement. I follow their facegroup page and if anecdotal evidence is anything to go by, providing women with clear, consistent advice leads to a reduction in avoidable stillbirths.
- Improving fetal monitoring during labour.
Elements 2 and 4 will rely heavily on government investment in training and technology. Jeremy Hunt pledged £4 million investment in improved equipment and training, £500,000 to establish a new safety investigation unit to review and learn from stillbirth and infant deaths and a further £1 million in training packages. It should also be noted that this is “guidance” only, best practices which maternity providers are encouraged to use. It has great support from related charities and professional bodies and it is hoped that the level of investment is sufficient, and remains sufficient, to make a difference.