29 Mar Stillbirth – the risks for pregnant women
Stillbirth is perhaps the most profoundly upsetting of all all fetal deaths. Research has found that IVF pregnancies don’t lead to significantly more stillbirths than natural pregnancies (but a 2019 study did question this). Can you do anything to reduce the chance of a stillbirth?
A recent study took place in Ghana, a country where 2 to 5 percent of pregnancies end in a stillbirth. (That compares to 0.41 per cent in the UK, or 1 in 250 births.) It found that women who slept on their backs increased the risk of low birth weight and stillbirth. 1 in 4 of these stillbirths might not have happened had the mothers slept in a different position.
A New Zealand study expanded on this. It suggested that women who sleep on their left-hand side suffer fewer stillbirths that those who sleep on their back or right side. Getting up at night reduced the stillbirth risk. But daytime sleeping increased it.
So what’s the general advice for pregnant women? The NHS says sleep on your side after 28 weeks. And that you should attend all ante-natal appointments, eat a balanced diet, keep active, stop smoking, avoid alcohol, and quite a bit more.
Male babies are more prone to stillbirth than females. Eight stillbirths happen each day in the UK. The Royal College of Obstetricians and Gynaecologists has published guidelines on managing fetuses that are smaller than normal, 30 per cent of which end in stillbirth. Better ultrasound monitoring is recommended, alongside anti-platelet drugs, steroids, early admission to hospital and more reliance on c-sections.
The bigger question is: why is the national stillbirth rate so high in the UK? It’s higher than most other high-income countries. Stillbirth rates are going down, but not fast enough. And why is a woman in the East Midlands 30 percent more likely to have a stillborn child that a woman in Cornwall?
Lifestyle plays a part: smoking, drinking, mental health and high BMI. Older mothers have a higher risk. This takes in many fertility patients and explains why induction for women over 40, at 39 weeks, is common. If you had a stillbirth before, you’re four times more likely to have another one. Yet, 60 percent of the time, there’s no clear cause.
The way forward on stillbirth? More studies and better patient management are key. But we need to keep things in perspective. The majority of pregnancies are successful. Aside from medical and lifestyle management of the stillbirth risk, we should also, as a society, focus on helping and caring for anyone unlucky enough to have had one.