New program aims to prevent stillbirths

Evelyn Lewin

12/06/2019 2:56:50 PM

The Victorian Government wants to reduce the rate of stillbirths in the state by 20%.

Hand on pregnant woman's stomach
Community awareness of stillbirth risk factors remains low.

Around 500 babies are stillborn every year in Victoria, a rate that has stayed largely the same for the past two decades.
While the causes of stillbirth are sometimes unknown, in some cases it can be prevented.
As part of an effort to reduce the number of stillbirths, Victoria’s Health Minister Jenny Mikakos has launched the Safer Baby Collaborative in partnership with the Institute for Healthcare Improvement.
‘Losing a baby to stillbirth is such a heartbreaking and traumatic time for too many hopeful parents,’ Minister Mikakos said.
‘Equally tragic is that our stillbirth rate has remained the same for the past two decades. We must do things differently to prevent stillbirths and save lives.’
The program aims to reduce the rate of stillbirths in Victoria by 20% by 2022. It is designed to provide support and resources to 20 participating maternity services from five different angles, including:

  • increasing public awareness of the importance of fetal movements
  • improving diagnosis and management of fetal growth restriction
  • improving rates of smoking cessation in pregnancy
  • raising awareness of safe maternal sleep positions
  • promoting appropriate timing of birth and mitigating unintended consequences or harm.
GPs are ideally placed to help discuss a number of these issues with patients, both in preconception counselling and throughout a woman’s pregnancy.
The issue is how to convey such messages.
‘My view is that it’s good to raise awareness. But how to do it in a sensitive and sensible way that informs and empowers, without creating fear and alarm, that’s the difficult part,’ Dr Wendy Burton, Chair of the RACGP Specific Interests Antenatal and Postnatal Care network, told newsGP.
Awareness is needed, with Victoria’s Royal Women’s Hospital reporting that 60% of Australian women incorrectly believe it is normal for a baby’s movement to decrease towards the end of pregnancy, with around half of women waiting more than 24 hours to seek help.
In order to know whether fetal movements have changed, Dr Burton advises pregnant women to become familiar with the pattern of their baby’s movements in the last half of pregnancy.
If they notice any changes, Dr Burton said they should be encouraged to seek attention that day (either from their doctor, midwife, or by proceeding to hospital). She said such changes should then warrant monitoring.
Counting movements can be key, with research from 2011 published in PLoS One finding that maternal ability to detect clinically important changes in fetal activity ‘seemed to be improved by fetal movement counting; there was an increased identification of fetal growth restriction and improved perinatal outcome, without inducing more consultations or obstetric interventions’.
Dr Burton said the position in which a woman sleeps should also be discussed, with pregnant women being advised not to sleep on their backs in later pregnancy.
In fact, the Stillbirth Centre of Research Excellence reports that one in 10 stillbirths occurring after 28 weeks’ gestation could be avoided if women did not go to sleep on their back during this time.
Dr Burton said women should also be advised not to worry if they wake up on their backs, and that if they find themselves in that position, they should ‘just roll over onto their sides and go back to sleep’.
Naturally, smoking cessation should occur as part of preconception counselling (when possible), and again encouraged during pregnancy, for a number of reasons, including reducing the risk of stillbirth.

Research published in BMC Public Health in 2015 found that smoking ‘greatly increases’ the risk of stillbirth.
‘Every opportunity must be utilised to record smoking status during pregnancy, to give advice and support, including necessary facilities to help women stop smoking,’ the researchers stated.
The Safer Baby Collaborative builds on Safer Care Victoria’s Movements Matter campaign, launched last October, which encouraged women to become familiar with their baby’s usual movements and to immediately speak up if they notice a change.
According to the Royal Women’s Hospital, one in 137 Australian women experience a stillbirth after 20 weeks of pregnancy, and Australia is ranked 15th globally in its rate of stillbirth.
Minister Mikakos hopes to change such figures.
‘When we’re all working together, we can help prevent stillbirths,’ she said.

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