StaRs: Time to prioritise, but not to panic
The BBC’s Today programme headline “Health Service “ignores stillbirth”” highlights a series published by the Lancet (a UK medical journal). It gives rise to the question of why 1,200 of the 4,000 babies who are stillborn in the UK are normally formed babies of mothers who have low risk pregnancies and are born at over 37 weeks gestation (and therefore have a good chance of survival).
The obstetrician, Professor Gordon Smith, interviewed by Radio 4 quoted an interesting statistic relating to Sudden Infant Death Syndrome (SIDS) explaining that there had been a four-fold reduction when simple measures to do with sleeping environment were introduced.
The question must be whether equally simple measures, in particular education of staff and, importantly, listening to the concerns of expectant mothers could herald a parallel success story in relation to stillbirths?
The third article in the Lancet series “Stillbirth: What difference can we make and at what cost?” states in its introduction “Basic and comprehensive emergency obstetric care were identified as key effective interventions to reduce intrapartum stillbirths.” Also, right at the end of the article is another interesting observation “Our findings underscore the need for the development of models that include potential interventions to address morbidity and incorporate dimensions of interest to long-term outcomes – eg. post-asphyxial encephalopathy.” It continues “…the global burden of stillbirths is not intransigent to change” which is heartening to read, and very importantly “In countries with the highest burden of stillbirths, a large proportion of which are intrapartum stillbirths, interventions can substantially reduce stillbirths and could also improve maternal and neonatal outcomes.”
As a lawyer who deals with cases involving stillbirth and also those involving the effects of post-asphyxial encephalopathy, specifically cerebral palsy, I recognise that this a very important area to tackle, and, given the financial constraints faced by the NHS at the moment, one policy makers cannot afford to get wrong.
The identification of, and reduction in, the number of stillbirths should herald antenatal treatment that is acutely risk focused. This would not only save the indescribable pain and trauma of a stillbirth but would also have the collateral benefit of saving the health service significant amounts of money by reducing the number of avoidable cases of cerebral palsy. If these cases are litigated they equate to high damages awards that are met by the National Health Services Litigation Authority (NHSLA) but that is not the whole story: where there is no litigation a child with cerebral palsy who becomes an adult with cerebral palsy will require lifelong healthcare if they are to have any quality of life which they absolutely deserve and the cost of providing that will fall to the NHS. Investment in research and action to prevent stillbirths could have far reaching positive impact and cannot come soon enough.
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