Clinical care standard takes aim at preventable stillbirths

Around 42 babies are likely to be stillborn this week in Australia.
 
It is a stark figure, even though the country remains one of the safest places in the world to give birth.
 
However, other high-income nations have shown there is room for improvement, particularly during late gestation.
 
In fact, on average eight of those deaths could have been prevented.
 
That is a figure those behind a new Stillbirth Clinical Care Standard, published this week by the Australian Commission on Safety and Quality in Health Care (ACSQHC), want to reduce, including significant geographic and demographic variations.
 
Associate Professor Liz Marles, a former RACGP President and now the ACSQHC’s Clinical Director, believes the care standard will increase support for the role GPs can play.
 
‘It’s a really devastating experience for any woman and it’s also really devastating for their families, and for healthcare providers who might be involved in it,’ she told newsGP.
 
‘We have a long-standing, trusting relationship with our patients so GPs are really important in trying to address … the stillbirths that could be preventable.’
 
One significant historical obstacle has been starting a conversation about stillbirth during prenatal care, an issue that has previously been covered in newsGP.
 
Associate Professor Marles says this is an area she also hopes the care standard can improve.
 
‘It is important to discuss the risk of stillbirth,’ she said. ‘We already talk about risks of miscarriage, we talk about the risks of sudden infant death syndrome [SIDS].
 
‘Having that discussion about the risk of stillbirth and what the woman can do to reduce that risk is a really important part of our pregnancy care … in a way that is empowering for women to be able to do something to minimise the risk.’
 
She also said there is focus on bereavement care in the standard.
 
‘The Commission’s national standard will be the catalyst for real change to reduce the risk of stillbirth and help ease the grief for bereaved women and families
 
‘For the first time, this standard embeds stillbirth guidance into our maternity care that extends across the pregnancy journey.
 
‘This begins when a family is planning for a baby, continues through pregnancy and sadly, in instances where a baby dies before birth, can involve a search for reasons for the death.’
 
David Ellwood, a Professor of Obstetrics and Gynaecology at Griffith University, and a Co-Director of the Centre of Research Excellence in Stillbirth, said the standard defines expected care for women, both during pregnancy and after stillbirth.
 
He believes Australia can learn from initiatives that have taken place in other countries.
 
‘We can do more in Australia to reduce our stillbirth rate, particularly for late-gestation stillbirths, which is almost 50% higher than in countries with the lowest rates worldwide, including the Netherlands, Finland and Denmark,’ he said.
 
According to Professor Ellwood, expanding understanding of the causes behind stillbirth, through clinical conversations, assessments during pregnancy and investigations after stillbirth, would bring ‘immense benefits’.
 
‘While not all stillbirths can be prevented, research shows that in 20–30% of cases, the death may have been avoided had high-quality care been provided,’ he said.
 
‘This highlights the value of investigating why stillbirths are happening, then examining the evidence to improve our health response.’
 
Addressing inequities
Associate Professor Marles says one of the keys lies in addressing an equity gap that particularly affects Aboriginal and Torres Strait Islander women and those living in very remote areas.
 
Women in these groups have a notably higher rate of 11 and 12 deaths for every 1000 births respectively, compared to seven deaths per 1000 births in the broader population.
 
‘The standard has a particular focus on provision of care for those women and the need to make sure that the care that’s offered is culturally appropriate, that it’s provided in a way that those women will trust,’ she said.
 
‘And often that means through GPs, who provide lots of care through Aboriginal medical services or the community-controlled sector.
 
‘For any GP working in the community-controlled sector, this will provide good guidance.’
 
Associate Professor Marles hopes the standard, which is supported by the college and 25 other peak bodies and healthcare organisations, has a significant impact.
 
‘I’d really encourage any GP who’s involved in antenatal care or looking after pregnant women to go and visit the standard see what resources are there and become familiar with them,’ she said.
 
‘[The standard puts] all those resources in one place to equip GPs to provide optimal care.’
 
The Stillbirth Clinical Care Standard is officially released on 4 November and is published on the ACSQHC website.
 
A panel discussion and Q&A is being held for the launch at the National Stillbirth Forum on 4 November from 12 pm–1 pm (AEDT), with registrations available at safetyandquality.tv.
 
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antenatal care clinical care standards stillbirth