tag:theconversation.com,2011:/africa/topics/stillbirths-18809/articlesstillbirths – The Conversation2019-08-28T05:00:52Ztag:theconversation.com,2011:article/1223132019-08-28T05:00:52Z2019-08-28T05:00:52ZWhen a baby is stillborn, grandparents are hit with ‘two lots of grief’. Here’s how we can help<figure><img src="https://images.theconversation.com/files/289739/original/file-20190828-184217-bj1mt5.jpg?ixlib=rb-1.1.0&rect=0%2C0%2C994%2C580&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Grandparents grieve for their child and their stillborn grandchild, a grief we need to acknowledge.</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/download/confirm/1401929171?src=-1-0&size=medium_jpg">from www.shutterstock.com</a></span></figcaption></figure><p><a href="https://www.stillbirthcre.org.au/resources/stillbirth-facts/">Six babies</a> are stillborn every day in Australia. This significant loss <a href="https://www.sciencedirect.com/science/article/pii/S1744165X12001023">affects parents</a> for years to come, often the rest of their lives. However, stillbirth also affects many others, including grandparents.</p>
<p>But until now, we have not heard the experiences of grandparents whose grandchildren are stillborn. Their grief was rarely acknowledged and there are few supports tailored to them.</p>
<p>Our recently published <a href="https://www.ncbi.nlm.nih.gov/pubmed/31387781">research</a> is the first in the world to specifically look at grandmothers’ experience of stillbirth and the support they need.</p>
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Read more:
<a href="https://theconversation.com/death-and-families-when-normal-grief-can-last-a-lifetime-32959">Death and families – when 'normal' grief can last a lifetime</a>
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<p>In Australia, a baby <a href="https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0037109">is defined as</a> stillborn when it dies in the womb from 20 weeks’ gestation, or weighs more than 400 grams. Other countries have slightly different definitions.</p>
<p><a href="https://www.stillbirthcre.org.au/resources/stillbirth-facts/">About 2,200</a> babies are stillborn each year here meaning stillbirth may be more common than many people think. And people <a href="https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(11)60107-4/fulltext">don’t tend to talk</a> about this openly despite it leading to significant grief.</p>
<p>To explore grandparents’ experience of stillbirth, we interviewed 14 grandmothers for our initial study, and a further 23 grandmothers and grandfathers since then. </p>
<p>Many grandparents were not aware stillbirth was a risk today. Most felt unprepared. Like parents, grandparents experienced grief like no other after their grandchild was stillborn.</p>
<p>Rose said: </p>
<blockquote>
<p>The grief is always there, it never leaves you […] I don’t know why but sometimes it is still very raw. </p>
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<p>Sally said: </p>
<blockquote>
<p>I [would do] anything in my power to take it away, even if it meant, you know, something dreadful happening to me, I would have done it. </p>
</blockquote>
<p>Grandparents also spoke of anticipating the arrival of their grandchild, and disbelief at their loss. </p>
<p>Donna said:</p>
<blockquote>
<p>It was as bad as it could be and […] I thought it just couldn’t be real, it couldn’t be real.</p>
</blockquote>
<p>Where grandparents lived a long way from their child, the loss was even more profound. Distance prevented them from holding their grandchild after birth, attending memorials, or helping their own children. </p>
<p>Iris said: </p>
<blockquote>
<p>I still miss her now […] When she was born and they had her in the hospital they would text me and say you know she’s got hair like her daddy […] and they would describe her and how beautiful she was, and that’s all they have, you know […] that’s all I have really. </p>
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<p>Grandparents said they wanted to hide their grief to protect their child from pain. This often made them isolated. Their relationships with family members often changed. </p>
<p>Mary said:</p>
<blockquote>
<p>It’s like two lots of grief […] but I don’t want it to sound like it’s as bad as my daughter’s loss. It’s different, it’s a different grief, because you’re grieving the loss of a grandchild, and you’re also grieving for your daughter and her loss and it’s like yeah you’ve been kicked in the guts twice instead of once.</p>
</blockquote>
<h2>What grandparents wanted</h2>
<p>Grandparents stressed the importance and ongoing value of being involved in “memory making” and spending time with their stillborn grandchild where possible. </p>
<p>Creating mementos, such as taking photos and making footprints and hand prints, were all important ways of expressing their grief. These mementos kept the baby “alive” in the family. They were also a way to ensure their own child knew the baby was loved and remembered.</p>
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Read more:
<a href="https://theconversation.com/five-ways-to-help-parents-cope-with-the-trauma-of-stillbirth-69622">Five ways to help parents cope with the trauma of stillbirth</a>
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<p>Our research also identified better ways to support grandparents. Grandparents said that if they knew more about stillbirth, they would be more confident in knowing how to help support their children. And if people were more aware of grandparents’ grief, and acknowledged their loss, this would make it easier for them to get support themselves, and reduce feelings of isolation.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/289743/original/file-20190828-184229-a1zksu.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/289743/original/file-20190828-184229-a1zksu.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/289743/original/file-20190828-184229-a1zksu.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=395&fit=crop&dpr=1 600w, https://images.theconversation.com/files/289743/original/file-20190828-184229-a1zksu.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=395&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/289743/original/file-20190828-184229-a1zksu.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=395&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/289743/original/file-20190828-184229-a1zksu.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=496&fit=crop&dpr=1 754w, https://images.theconversation.com/files/289743/original/file-20190828-184229-a1zksu.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=496&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/289743/original/file-20190828-184229-a1zksu.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=496&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
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<span class="caption">Families can encourage grandparents to seek professional support if needed.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/beautiful-family-beach-72116008?src=-1-6">from www.shutterstock.com</a></span>
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<p>Our research also found families can recognise that grandparents grieve too, for both their child and grandchild. Grandparents can be encouraged to seek support from other family and friends. Families could also encourage grandparents to seek support from professionals if needed. </p>
<p>In hospitals, midwives can adopt some simple, time efficient strategies, with a big impact on grandparents. With parent consent, midwives could include grandparents in memory making activities. </p>
<p>By acknowledging the connection grandparents have to the baby, midwives can validate the grief that they experience. In recognising the supportive role of grandparents, midwives can also provide early guidance about how best to support their child.</p>
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Read more:
<a href="https://theconversation.com/the-five-stages-of-grief-dont-come-in-fixed-steps-everyone-feels-differently-96111">The five stages of grief don't come in fixed steps – everyone feels differently</a>
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<p>Hospitals can help by including grandparents in the education provided after stillbirth. This might include guidance about support for their child, or simply providing grandparents with written resources and guiding them to appropriate supports. </p>
<p>In time, development of peer support programs, where grandparents support others in similar situations, could help. </p>
<p>And, as a community, we can support grandparents the same way they support their own children. We can be there, listen and learn.</p>
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<p><em>All grandparents’ names in this article are pseudonyms.</em></p>
<p><em>If this article raises issues for you or someone you know, contact <a href="http://www.sands.org.au">Sands</a> (stillbirth and newborn death support) on 1300 072 637. Sands also has <a href="https://www.sands.org.au/images/sands-creative/brochures/127517-For-Grandparents-Brochure.pdf">written information specifically for grandparents</a> of stillborn babies.</em></p><img src="https://counter.theconversation.com/content/122313/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Jane Lockton receives an Australian Government Research Training Scholarship</span></em></p><p class="fine-print"><em><span>Clemence Due receives funding from the ARC and the Stillbirth Foundation Australia</span></em></p><p class="fine-print"><em><span>Melissa Oxlad does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>The world’s first study of how grandmothers experience the death of their stillborn grandchild exposes a unique kind of grief. But there are many ways we can support them.Jane Lockton, PhD Candidate (Psychology, Health), University of AdelaideClemence Due, Senior Lecturer in the School of Psychology, University of AdelaideMelissa Oxlad, Lecturer in the School of Psychology, University of AdelaideLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/981632018-07-03T20:10:45Z2018-07-03T20:10:45ZThe dos and don'ts of supporting women after a miscarriage<figure><img src="https://images.theconversation.com/files/225872/original/file-20180703-116147-16ay5hk.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Our cultural discomfort with discussing any sort of loss means women are often met with a wall of silence.</span> <span class="attribution"><a class="source" href="https://unsplash.com/photos/0VFPFbhuyeY">Hermes Rivera</a></span></figcaption></figure><p>So your friend decides to forget the “12 week rule” and tells her family and social networks she is pregnant. She knows the stats – <a href="http://www.sands.org.au/miscarriage">one in four pregnancies</a> ends in miscarriage – but she wants to have the support of family and friends around her in case she needs it. </p>
<p>Then the worst happens: she miscarries. And she discovers many people around her, including health professionals, lack sensitivity when talking about the miscarriage. Some don’t even acknowledge her loss. </p>
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Read more:
<a href="https://theconversation.com/families-that-experience-pregnancy-loss-deserve-higher-standards-of-care-85345">Families that experience pregnancy loss deserve higher standards of care</a>
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<p>Miscarriage in Australia is defined as the loss of a foetus before 20 weeks. From a medical perspective, miscarriage is easily managed as a “routine pregnancy complication”. Emotionally, however, it can take a massive toll. As one interviewee in our yet-to-be-published research explained: </p>
<blockquote>
<p>Just because it’s common, doesn’t mean that it’s not extremely traumatic. (Ella) </p>
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<p>Women who experience miscarriage frequently feel grief and loss of a <a href="http://www.apsfa.org/docs/Grief%20Following%20Miscarriage%20A%20Comprehensive%20Review%20of%20the%20Literature.pdf">similar intensity to other major losses</a>. It’s common to have clinical levels of <a href="https://www.fertstert.org/article/S0015-0282(08)04743-2/pdf">anxiety</a>, <a href="https://obgyn.onlinelibrary.wiley.com/doi/pdf/10.1111/j.1471-0528.2007.01452.x">depression</a> and <a href="https://bmjopen.bmj.com/content/bmjopen/6/11/e011864.full.pdf">post-traumatic stress disorder</a> (PTSD) in the weeks, months or years following a miscarriage.</p>
<p>Family, friends and health professionals play an important role in supporting women affected by miscarriage: what they do or don’t say can have a lasting impact. Yet our cultural discomfort with discussing any sort of loss – especially one that is “unseen” – means women are often met with a wall of silence. </p>
<blockquote>
<p>It’s a bit like postnatal depression….people just don’t talk about it. (Linda)</p>
</blockquote>
<p>So how can we support women better? What do women need from family, friends and health professionals at the time of a miscarriage?</p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/225880/original/file-20180703-116126-g3r796.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/225880/original/file-20180703-116126-g3r796.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=338&fit=crop&dpr=1 600w, https://images.theconversation.com/files/225880/original/file-20180703-116126-g3r796.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=338&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/225880/original/file-20180703-116126-g3r796.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=338&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/225880/original/file-20180703-116126-g3r796.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=424&fit=crop&dpr=1 754w, https://images.theconversation.com/files/225880/original/file-20180703-116126-g3r796.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=424&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/225880/original/file-20180703-116126-g3r796.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=424&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<span class="caption">Grief can affect women’s mental health in the short and long term.</span>
<span class="attribution"><a class="source" href="https://unsplash.com/photos/Yv-WSE1n9nk">Nicolas Lobos</a></span>
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<p>While there is <a href="https://search.informit.com.au/documentSummary;dn=406186808261657;res=IELHEA">limited evidence-based research</a>, our yet-to-be-published pilot study of 14 women who had experienced miscarriage found their needs align with advice currently provided by Australia’s pregnancy loss support organisations. Here are the key dos and don'ts:</p>
<h2><strong>Dos</strong></h2>
<p><strong>1) Acknowledge their loss.</strong> While you may worry you will say the wrong thing and upset them further, saying nothing at all is worse. It can make women feel you don’t care or think their loss was insignificant. All you need to say is: “I’m sorry about your miscarriage.”</p>
<blockquote>
<p>…I think it’s better acknowledging it than not, because I guess if you’re not acknowledging it, then it feels like you don’t care. (Ellen)</p>
</blockquote>
<p><strong>2) Listen and let them grieve.</strong> Many women need to talk about their experience. Ask them how they are. Some women find it really helpful to talk about how they are feeling, others may not be ready, but will appreciate you asking. </p>
<blockquote>
<p>Talk to them, listen. Don’t just try to sweep it under the carpet … Give the person the opportunity to grieve, because you have lost a child…. (Jane)</p>
</blockquote>
<p><strong>3) Encourage them to talk to other women who’ve had a miscarriage</strong>. It’s often only when women start to talk about their miscarriage, that they find out others around them have experienced miscarriage too. Knowing they’re not alone and that others understand how they’re feeling can be really helpful. </p>
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<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/five-ways-to-help-parents-cope-with-the-trauma-of-stillbirth-69622">Five ways to help parents cope with the trauma of stillbirth</a>
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<p><strong>4) Offer practical support</strong>. Drop off a meal or help with childcare. Gifts and flowers show you care and are acknowledging their loss. </p>
<p><strong>5) End the silence around miscarriage</strong>. Women want miscarriage talked about more openly so they don’t feel so alone. </p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/225876/original/file-20180703-116143-1fpuyrd.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/225876/original/file-20180703-116143-1fpuyrd.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=401&fit=crop&dpr=1 600w, https://images.theconversation.com/files/225876/original/file-20180703-116143-1fpuyrd.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=401&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/225876/original/file-20180703-116143-1fpuyrd.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=401&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/225876/original/file-20180703-116143-1fpuyrd.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/225876/original/file-20180703-116143-1fpuyrd.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/225876/original/file-20180703-116143-1fpuyrd.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<span class="caption">You don’t have to say much.</span>
<span class="attribution"><a class="source" href="https://unsplash.com/photos/e92L8PwcHD4">Ben White</a></span>
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<h2>Don’ts</h2>
<p><strong>1) Avoid clichéd comments</strong>. While well intended, comments such as “it wasn’t meant to be” or “it’s so common” can be hurtful and dismissive of their loss. </p>
<blockquote>
<p>People saying, ‘oh you know, you’ll get pregnant again’ or ‘oh it wasn’t meant to be’. You know, that’s just the worst thing to say. And so many people say stuff like that … (Samantha)</p>
</blockquote>
<p><strong>2) Avoid blaming and offering unsolicited advice</strong>. Be sensitive and empathetic; don’t offer advice that could make a woman feel she is to blame.</p>
<blockquote>
<p>lots of unhelpful, unsolicited advice… it was all about ‘you’re working too hard’, ‘you’re stressing too much’, ‘you’re over-thinking it’. (Amy) </p>
</blockquote>
<p><strong>3) Recognise grief doesn’t have a time limit</strong>. Women’s levels of grief are not contingent on how many weeks pregnant they were – their baby has died. It’s OK for them to work through their grief in their own time. </p>
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Read more:
<a href="https://theconversation.com/women-pregnant-after-a-loss-need-better-support-81238">Women pregnant after a loss need better support</a>
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<h2>Where to go for help</h2>
<p>Outside social networks, there are a number of vital pregnancy loss support organisations across Australia which provide information, support and bereavement care to women affected by miscarriage. These include:</p>
<ul>
<li><a href="http://www.sands.org.au/">Sands Australia</a> </li>
<li><a href="http://www.bearsofhope.org.au/">Bears of Hope</a> </li>
<li><a href="https://pinkelephantssupport.com/">The Pink Elephants Support Network</a></li>
</ul>
<p>For further psychological support, Medicare covers up to three pregnancy counselling sessions through referral from a GP. </p>
<p>Improving support for women affected by miscarriage starts by speaking openly about it and letting women know they are not alone in the experience. </p>
<p><em>This article was co-authored by Anita Guyett from Sands Australia, a miscarriage, stillbirth and neonatal death charity.</em></p><img src="https://counter.theconversation.com/content/98163/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Jade Bilardi receives funding from a National Health and Medical Research Council Early Career Fellowship, No 1013135. </span></em></p><p class="fine-print"><em><span>Jayashri Kulkarni and Meredith Temple-Smith do not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and have disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Cliched comments like “it wasn’t meant to be” or “don’t worry, you’ll get pregnant” are hurtful and dismissive. Instead, acknowledge their loss, listen and let them grieve.Jade Bilardi, Senior Research Fellow, Central Clinical School, Monash UniversityJayashri Kulkarni, Professor of Psychiatry, Monash UniversityMeredith Temple-Smith, Professor, Department of General Practice, University of Melbourne, The University of MelbourneLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/696222017-10-25T19:04:30Z2017-10-25T19:04:30ZFive ways to help parents cope with the trauma of stillbirth<figure><img src="https://images.theconversation.com/files/182700/original/file-20170821-7956-13vguqp.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Millions of women around the world are estimated to be living with depressive symptoms after stillbirth.</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/download/confirm/575129968?src=bF6mWuReDT9Y0AWwYaH4GA-1-37&size=medium_jpg">from www.shutterstock.com</a></span></figcaption></figure><p>There are at least <a href="http://www.thelancet.com/journals/lancet/article/PIIS01406736(15)00837-5/abstract">2.6 million</a> stillbirths a year across the world. <a href="https://www.aihw.gov.au/reports/mothers-babies/australia-s-mothers-and-babies-2012/contents/summary">More than 2,000</a> families each year suffer the loss of a stillborn baby in Australia, equating to six stillborn babies every day. </p>
<p>The death of an unborn baby is a tragedy that deeply affects <a href="http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(15)00836-3/abstract">families, health systems and wider society</a>. Parents continue to grieve for their baby for years. Their functioning and sense of self can be <a href="https://bmcpregnancychildbirth.biomedcentral.com/articles/10.1186/s12884-016-0800-8">profoundly changed</a>. </p>
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<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/more-than-20-000-stillbirths-worldwide-are-avoidable-53367">More than 20,000 stillbirths worldwide are avoidable</a>
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<p>Here are five ways we can help parents cope with the tragedy of stillbirth.</p>
<h2>1. Acknowledge parents’ loss</h2>
<p><a href="http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(15)01020-X/abstract">Taboos and myths</a> about stillbirth make it a topic many family, friends and communities feel ill-equipped to deal with and are unprepared to talk about. But avoiding the topic can <a href="http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(15)00836-3/fulltext">magnify the trauma</a>.</p>
<p>Because others are uncomfortable with the topic, many parents feel unable to talk about their loss. And well-intentioned comments, such as “it was meant to be”, “these things happen” and “you can always have another baby”, minimise parents’ loss and may only leave parents feeling more isolated in their grief.</p>
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<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/death-and-families-when-normal-grief-can-last-a-lifetime-32959">Death and families – when 'normal' grief can last a lifetime</a>
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<p>Listening to parents and acknowledging their stillborn baby as a member of their family, and acknowledging their grief, is vital to improve care and reduce the impacts of this devastating loss. </p>
<h2>2. Offer ongoing support to parents</h2>
<p>Throughout the world, <a href="http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(15)00836-3/fulltext">4.2 million women</a> are estimated to be living with depressive symptoms after stillbirth. Many suffer in silence due to the taboo surrounding stillbirth.</p>
<p>Respectful and supportive care is essential in hospital. But it’s often when parents arrive home without their baby that the reality hits and the long and often lonely journey of grieving begins.</p>
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<a href="https://images.theconversation.com/files/185423/original/file-20170911-19223-k3j7pq.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/185423/original/file-20170911-19223-k3j7pq.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/185423/original/file-20170911-19223-k3j7pq.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/185423/original/file-20170911-19223-k3j7pq.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/185423/original/file-20170911-19223-k3j7pq.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/185423/original/file-20170911-19223-k3j7pq.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/185423/original/file-20170911-19223-k3j7pq.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/185423/original/file-20170911-19223-k3j7pq.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
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<span class="caption">When parents arrive home without their baby the reality hits and the long and often lonely journey of grieving begins.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/download/confirm/631177343?src=KeHm1ztUvetJSSgUkwNbuQ-1-48&size=medium_jpg">from www.shutterstock.com</a></span>
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<p>Yet <a href="http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(15)01020-X/abstract">less than half of parents</a> in high-income countries receive a follow-up visit or phone call from their hospital. And only around half receive information about who to contact for support after they leave hospital. These figures are even lower for parents in developing regions. </p>
<h2>3. Raise public awareness</h2>
<p>Until fairly recently, stillbirth has been a <a href="http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(15)01276-3/abstract">neglected issue</a>, largely absent from the global health agenda. We need to improve public awareness of stillbirth to make sure our social communities and workplaces are equipped to provide the kind of support and recognition parents need. </p>
<p>Women and their partners should also be equipped with knowledge about how to reduce their risk of having a stillborn child.</p>
<p>Hearing the voices of bereaved parents in the public will help break down taboos. For public health <a href="https://www.ncbi.nlm.nih.gov/pubmed/29030897">campaigns to be effective</a>, target populations need to be aware of the health threat as a first step, followed by messages that move the target audiences to action.</p>
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Read more:
<a href="https://theconversation.com/passed-away-kicked-the-bucket-pushing-up-daisies-the-many-ways-we-dont-talk-about-death-77085">Passed away, kicked the bucket, pushing up daisies – the many ways we don't talk about death</a>
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<p>One of the most successful public health campaigns are the back to sleep campaigns to reduce sudden infant death syndrome (SIDS). The simple, universally targeted messages reached new and receptive parents. </p>
<p>If campaigns are not universally agreed to by all stakeholders, a plethora of competing campaigns may arise. This will confuse the target population, diminishing the campaigns’ value or, worse, they may cause harm. </p>
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<figcaption><span class="caption">Among the most successful public health campaigns are the back to sleep campaigns addressing SIDS.</span></figcaption>
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<p>Organisations such as <a href="http://stillbirthfoundation.org.au/">Stillbirth Foundation Australia</a>, <a href="https://rednose.com.au/">Red Nose</a>, <a href="http://www.sands.org.au/">Sands</a>, <a href="http://stillaware.org/">Still Aware</a> and <a href="http://www.bearsofhope.org.au/">Bears of Hope</a> have a key role to play in supporting parents and raising public awareness. They are collaborating with the <a href="http://www.stillbirthcre.org.au/">Centre of Research Excellence in Stillbirth</a> to develop a unified campaign.</p>
<h2>4. Investigate each stillbirth</h2>
<p>A critical analysis of every baby’s death can identify contributing factors to help explain the event and prevent future deaths. Such investigations can not only determine the cause of death, but can also unearth systems issues such as a failure to implement evidence-based clinical practice guidelines.</p>
<p>Substandard care plays a role in <a href="https://theconversation.com/better-care-and-communication-can-cut-stillbirth-rates-and-avoid-unnecessary-trauma-49435">20-30% of stillbirths</a>. These cases often show the need to improve detection of women at increased risk during pregnancy. </p>
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Read more:
<a href="https://theconversation.com/better-care-and-communication-can-cut-stillbirth-rates-and-avoid-unnecessary-trauma-49435">Better care and communication can cut stillbirth rates and avoid unnecessary trauma</a>
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<p>New Zealand and the UK have national systems to ensure comprehensive review of every stillbirth and neonatal death. Australia’s federal government, through the NHMRC, has funded the <a href="http://www.stillbirthcre.org.au/">Centre of Research Excellence in Stillbirth</a>, to reduce the stillbirth rate and improve care after stillbirth for affected families, including in subsequent pregnancies. This is a step in the right direction.</p>
<p>The <a href="https://psanz.com.au/">Perinatal Society of Australia and New Zealand</a> in partnership with the stillbirth CRE sets out <a href="https://sanda.psanz.com.au/clinical-practice/clinical-guidelines/">detailed recommendations</a> for investigation and audit of these deaths, but the guidelines are yet to be fully implemented across Australia. Many stillbirths are not fully evaluated as to causes and contributing factors. </p>
<p>Training of health-care professionals in this area has <a href="https://www.ncbi.nlm.nih.gov/pubmed/27887578">begun</a>, and the stillbirth research centre will work with maternity hospitals to expand this training.</p>
<h2>5. Give parents answers</h2>
<p>Parents want to know why their baby died. Finding a cause of stillbirth, and the factors that led to that cause, helps parents begin to make sense of their loss. </p>
<p><a href="http://onlinelibrary.wiley.com/doi/10.1111/1471-0528.14424/abstract">Most parents will conceive again</a>, and understanding what caused their baby’s death means having a better idea of the likelihood of the cause recurring in future pregnancies. </p>
<p><a href="http://onlinelibrary.wiley.com/doi/10.1002/14651858.CD012203/abstract">Specific interventions</a>, such as low-dose aspirin, early scheduled birth, or treatment for anxiety and depression, may reduce the risk of recurrence and improve psychological outcomes.</p>
<p>In high-income countries, <a href="https://www.ncbi.nlm.nih.gov/pubmed/21496907">around 30%</a> of stillbirths are classified as “unexplained”, though many of these deaths are <a href="https://www.ncbi.nlm.nih.gov/pubmed/19566561">not comprehensively investigated</a>. By increasing the proportion of stillbirths that are appropriately investigated and improving diagnostic techniques, it may be possible to <a href="http://onlinelibrary.wiley.com/doi/10.1111/j.1753-6405.2007.00116.x/full">halve this figure</a>.</p>
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<a href="https://theconversation.com/why-we-dont-know-what-causes-most-birth-defects-78592">Why we don't know what causes most birth defects</a>
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<p>Problems with the structure and function of the <a href="https://www.ncbi.nlm.nih.gov/pubmed/24953162">placenta</a> are often linked to stillbirth.</p>
<p>However, many stillbirths occur unexpectedly in an otherwise healthy mother and baby, and remain unexplained after a full investigation. So, <a href="http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(15)01020-X/abstract">research is needed</a> to better understand the mechanisms for these unexplained stillbirths.</p>
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<p><em>Victoria Bowring, general manager of Stillbirth Foundation Australia, contributed to this article.</em></p>
<p><em>If you are a parent needing support, visit: <a href="http://www.bearsofhope.org.au/">Bears of Hope</a>, <a href="http://www.sands.org.au/">SANDS</a>, or <a href="https://rednose.com.au/">Red Nose</a></em></p><img src="https://counter.theconversation.com/content/69622/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Vicki Flenady receives funding from the National Health and Medical Research Council and the Stillbirth Foundation Australia</span></em></p><p class="fine-print"><em><span>Aleena Wojcieszek has received funding from the National Health and Medical Research Council and the Stillbirth Foundation Australia</span></em></p><p class="fine-print"><em><span>David Ellwood receives funding from National Health & Medical Research Council for research into stillbirth. He is a past-Chair of the International Stillbirth Alliance</span></em></p><p class="fine-print"><em><span>Fran Boyle has received funding from NHMRC, Stillbirth Foundation Australia and Sands Australia</span></em></p><p class="fine-print"><em><span>Jonathan Morris is the Chairman of Stillbirth Foundation Australia. He receives no remuneration for this role. He receives research funding from the NHMRC.</span></em></p><p class="fine-print"><em><span>Philippa Middleton receives funding from the NHMRC. </span></em></p>Stillbirth deeply and profoundly affects parents and families. Here are five actions in response to this hidden tragedy.Vicki Flenady, Professor, Mater Research Institute; Director, Centre of Research Excellence in Stillbirth, The University of QueenslandAleena Wojcieszek, Research Associate, Centre of Research Excellence in Stillbirth, Mater Research Institute, The University of QueenslandDavid Ellwood, Professor of Obstetrics & Gynaecology, Griffith UniversityFran Boyle, Lead, Care after Stillbirth Program, Centre of Research Excellence in Stillbirth, The University of QueenslandJonathan Morris, Professor of Obstetrics and Gynaecology and Director, Kolling Institute of Medical Research Obstetrics, Gynaecology and Neonatology, Northern Clinical School, University of SydneyPhilippa Middleton, Associate Professor, South Australian Health & Medical Research InstituteLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/800742017-06-28T20:10:33Z2017-06-28T20:10:33ZBeing South Asian is as great a risk factor for stillbirth as smoking<figure><img src="https://images.theconversation.com/files/175794/original/file-20170627-21898-6yffki.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">We need to change the way we monitor the pregnancies of women born in South Asia to reduce their chance of a stillbirth.</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/download/confirm/456672769?src=ODysdIv-g4OJeDuPHMDNkA-1-30&size=medium_jpg">from www.shutterstock.com</a></span></figcaption></figure><p>Australian women born in South Asia are more likely to have a stillbirth than other women, perhaps due to a rapidly ageing placenta that cannot support the pregnancy, new research suggests.</p>
<p>Our <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5460852/">study</a> looked at 700,000 births in Victoria over more than a decade. We found women born in India, Pakistan, Sri Lanka, Afghanistan and Bangladesh had a 1.5 increased chance of a stillbirth at the end of their pregnancy (known as a “term stillbirth”) compared with women born in Australia or New Zealand.</p>
<p>That’s equivalent to 2.6 term stillbirths per 1,000 births for South Asian-born women compared with 1.5 per 1,000 births to women born in Australia and New Zealand.</p>
<p>This is an increased risk equivalent to <a href="http://www.sciencedirect.com/science/article/pii/S0140673610622337">smoking, advanced maternal age or obesity</a>.</p>
<p>The risk of a term stillbirth increased earlier in pregnancy and rose more rapidly in women born in South Asia. Alarmingly, for South Asian-born women, the rate of stillbirths at 39 weeks’ gestation was almost equivalent to the rate in Australian- and New Zealand-born women at 41 weeks (when the chance of stillbirth would be higher than earlier in the pregnancy).</p>
<p>While other research has found the mother’s ethnicity places a role in the risk of a stillbirth, this has largely been put down to factors related to <a href="http://www.sciencedirect.com/science/article/pii/S014067361501020X">migration and social disadvantage</a>. What our research shows is women born in South Asia and giving birth in Australia are at increased risk even when other factors are taken into account.</p>
<p>This means we need to rethink how we monitor and manage the pregnancies of women born in South Asia, including redefining when some babies reach “term”.</p>
<h2>Why this matters</h2>
<p>About <a href="http://www.aihw.gov.au/WorkArea/DownloadAsset.aspx?id=60129557657">seven per 1,000</a> babies born each year in Australia are stillborn – when the fetus dies at or after 20 weeks’ gestation – a figure that has remained unchanged over the past two decades.</p>
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<p><em>Further reading: <a href="https://theconversation.com/reducing-the-heartbreak-and-burden-of-stillbirth-1983">Reducing the heartbreak and burden of stillbirth</a></em></p>
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<p>Advanced maternal age, maternal infections, non-communicable diseases (like pre-existing diabetes and high blood pressure), obesity and a prolonged pregnancy are known <a href="http://www.sciencedirect.com/science/article/pii/S014067361501020X">risk factors</a> for stillbirth globally.</p>
<p>Not only can a woman’s country of birth now be added to the list, our research suggests how we look after pregnant women of South Asian origin needs to change.</p>
<p>In another recent <a href="https://www.nature.com/jp/journal/v37/n2/full/jp2016190a.html">study</a>, we found that at 41 weeks’ pregnancy, South Asian-born women experienced rates of fetal distress at almost four times the rate of Australian- and New Zealand-born mothers. </p>
<p>Current <a href="https://www.ranzcog.edu.au/Statements-Guidelines">national</a> and <a href="https://pathways.nice.org.uk/pathways/antenatal-care-for-uncomplicated-pregnancies#content=view-node%3Anodes-pregnancy-after-41-weeks">international</a> guidelines recommend additional fetal monitoring and/or induction of labour for pregnancies that progress beyond 41 weeks due to the increased risks of stillbirth. </p>
<p>But for South Asian-born women this may be too late.</p>
<h2>Why might this be happening?</h2>
<p>There is growing evidence to suggest a mother’s ethnicity influences how fast her <a href="https://theconversation.com/explainer-what-is-placenta-28851?sr=2">placenta</a> ages as her pregnancy progresses.</p>
<p>For some women, they can go into spontaneous labour sooner. In our study, we found South Asian-born women went into labour a median one week earlier than Australian- or New Zealand-born women.</p>
<p>However, for others, an ageing placenta <a href="https://www.ncbi.nlm.nih.gov/pubmed/23452441">cannot meet</a> the fetus’ increasing metabolic needs at term and beyond. And this increases the risk of stillbirth.</p>
<p>We still don’t know which individual woman will go down which path.</p>
<h2>Can we spot ageing placentas?</h2>
<p>Biological markers – caps on the ends of chromosomes or “<a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3370421/">telomeres</a>” – can help us assess ageing. Each time a cell replicates, the caps on the chromosomes get shorter. So shorter telomeres are a sign of <a href="http://onlinelibrary.wiley.com/doi/10.1016/j.febslet.2004.11.036/full">more rapid cellular ageing</a>.</p>
<p>And the length of telomeres in placentas from pregnancies ending in stillbirth are <a href="http://www.tandfonline.com/doi/full/10.3109/14767058.2015.1046045">two times shorter</a> than those from live births. In other words, the placental cells had aged faster.</p>
<p>Some researchers have also studied ethnic differences in placental telomere length.</p>
<p>In an <a href="https://www.ncbi.nlm.nih.gov/pubmed/27865975">American study</a>, placental telomeres from pregnancies in black women were significantly shorter than from pregnancies in white women (the ethnic backgrounds of the women were not further defined in the study).</p>
<p>Whether telomeres are shorter in placentas from pregnancies in South Asian-born women is unknown. </p>
<h2>Does this matter?</h2>
<p>We don’t know the cause for up to <a href="http://www.aihw.gov.au/publication-detail/?id=60129557656&tab=3">one-quarter</a> of all stillbirths in Australia. So, better understanding the role of placental ageing may help.</p>
<p>Our research is also relevant as migration from South Asian countries to Australia is <a href="https://www.border.gov.au/ReportsandPublications/Documents/statistics/migration-trends-14-15-glance.pdf">growing</a>. Almost <a href="https://www.border.gov.au/ReportsandPublications/Documents/statistics/2015-16-migration-programme-report.pdf">one-third</a> of people migrating to Australia are from South Asian countries. So, the number of women giving birth in Australia from these countries is also increasing. Now, Indian mothers make up <a href="http://www.aihw.gov.au/publication-detail/?id=60129557656&tab=3">almost 4%</a> (roughly 12,000) of all women giving birth in Australia a year.</p>
<p>It’s time this was reflected in how we manage the pregnancies of women born in South Asia, particularly at the end of their pregnancies. We may have to more closely monitor their pregnancies and, if needed, recommend their labour be induced sooner than other women to reduce their chance of a stillbirth.</p><img src="https://counter.theconversation.com/content/80074/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Miranda Davies-Tuck receives funding from the NHMRC, Stillbirth Foundation and Red Nose Foundation She also has a secondment 1 day per week to Consultative Council on Obstetric and Paediatric Mortality and Morbidity (CCOPMM) at the Victorian Department of Health.</span></em></p><p class="fine-print"><em><span>Euan Wallace receives funding from from the Victorian Government Operational Infrastructure Support Program and is a CEO of Safer Care Victoria, Department of Health.</span></em></p><p class="fine-print"><em><span>Mary-Ann Davey is a part-time employee of the Clinical Councils Unit, which manages the Victorian Perinatal Data Collection data.</span></em></p>Women born in South Asian countries like India or Pakistan are more likely to have a stillbirth than women born in Australia or New Zealand.Miranda Davies-Tuck, Perinatal Epidemiologist and NHMRC Early Career Research Fellow, Hudson InstituteEuan Wallace, Chair professor, Hudson InstituteMary-Ann Davey, Senior Research Fellow, Obstetrics & Gynaecology, Monash UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/444552015-07-22T04:06:48Z2015-07-22T04:06:48ZStillbirths: a story of tragic neglect across the developing world<figure><img src="https://images.theconversation.com/files/88511/original/image-20150715-26284-14aesqq.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Every year, more than 20,000 babies are stillborn in South Africa.</span> <span class="attribution"><span class="source">Jim Young/Reuters</span></span></figcaption></figure><p>Maternal and child deaths have received significant attention in the effort to meet the Millennium Development Goals by the end of 2015, but stillbirths have been severely neglected. Stillbirth targets were omitted from these goals and remain absent from the post-2015 Sustainable Development Goals. </p>
<p>Giving birth to a stillborn infant is one of the most heart-breaking and tragic events for any parent and their family. These babies die either during pregnancy or during the process of giving birth. Deaths earlier than 28 weeks are called miscarriages. </p>
<p>Of the stillbirths that happen across the globe, 98% occur in low- and middle-income countries. The World Health Organisation has stressed the importance of ending these preventable deaths. Its Every Newborn action <a href="http://www.who.int/maternal_child_adolescent/topics/newborn/every-newborn-action-plan-draft.pdf">plan</a>, launched in 2014, sets a global target to reduce stillbirth rates to ten for every 1000 births by 2035. </p>
<p>South Africa, as a signatory to the plan, has set a national target of achieving this by 2016. While progress has been made in reducing the number of stillbirths, the current rate of <a href="http://www.biomedcentral.com/1471-2393/15/39">18 stillbirths</a> for every 1000 births is still too high. </p>
<p>In a ranking of stillbirths in 193 countries by the <a href="http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(10)62187-3/abstract">Lancet</a> medical journal, South Africa was placed 148. Comparatively, this is worse than Brazil at 79, Russia at 80 and China at 82, but better than India at 154 and Nigeria at 192. </p>
<h2>Risk factors in stillbirths</h2>
<p>The causes of stillbirths are closely connected to the same influences that affect maternal and newborn mortality. Many of the risk factors are, however, often identified too late, if at all. </p>
<p>Women over the age of 34 have a greater risk of pregnancy-related complications, including stillbirths. Conditions such as high blood pressure and diabetes account for about a quarter of stillbirths before the onset of labour. Obesity is also a risk factor. </p>
<p>Once a woman goes into labour, good clinical management is critical because half of stillbirths at this stage result from maternal bleeding and insufficient oxygen to the baby. </p>
<h2>How interventions would help</h2>
<p>There are various efforts to reduce stillbirths implemented at various levels of quality and coverage in South Africa. </p>
<p><a href="http://www.biomedcentral.com/1471-2393/15/39">Our research</a> has modelled the impact and cost of ambitiously scaling interventions to full coverage at high quality. </p>
<p>These include detecting and treating HIV earlier in pregnant women, managing their hypertension and diabetes better and improving both essential and emergency obstetric care during labour and delivery. With the rapid escalation of obesity in South Africa – particularly in in young teenage girls – one key to preventing stillbirths is good nutrition well before pregnancy. </p>
<p>Of the interventions modelled, improved labour and delivery management would have the highest impact and could potentially avert 60% of the stillbirths.</p>
<p>Scaling up these interventions could prevent an additional 5400 stillbirths each year. The interventions would also prevent additional deaths of 1300 mothers and 4900 newborns, resulting in a triple return on investment. South Africa’s stillbirth rate would reduce by 30%, meeting the World Health Organisation’s interim goal for <a href="http://www.who.int/maternal_child_adolescent/topics/newborn/every-newborn-action-plan-draft.pdf">2030</a>. </p>
<p>The full intervention package is affordable and would cost the country an additional R850 million annually – or R16 per person. This amounts to little more than 0.5% of the total <a href="http://www.treasury.gov.za/documents/national%20budget/2015/guides/2015%20People's%20Guide%20-%20English.pdf">health budget</a> and would make an enormous difference. </p>
<h2>Fixing the problems</h2>
<p>But in addition to providing access to services, there are three more challenges that need attention if South Africa wants to reduce its stillbirth rates. </p>
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<span class="caption">Research shows that one of the reasons women and babies die is as a result of a delay in accessing services.</span>
<span class="attribution"><span class="source">Jorge Cabrera/Reuters</span></span>
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<p>First, the quality of care is crucial. Although the majority of women give birth in health centres and hospitals, many women and babies die due to delays in accessing services. At the centre of improving and monitoring quality will be the newly created Office of Health Standards Compliance, whose evaluations will impact whether health facilities receive funding and accreditation under the planned National Health Insurance. </p>
<p>The compliance office has identified cleanliness, infection prevention, reduced waiting times, drug availability and improved staff attitudes as immediate priorities. All of these would improve labour and delivery management. But more effort is needed on the demand side in communities to empower and enable families to recognise danger signs and seek care promptly. </p>
<p>Second, more research is necessary to understand the causes of stillbirths before labour, half of which are occurring for unknown reasons. Even in high-income countries, many stillbirths do not undergo a medical autopsy and there is a reluctance to perform additional tests to determine the cause of death. These questions are difficult for families who want answers. </p>
<p>Finally, there is a high degree of under-reporting. In many countries stillbirths do not appear in any official statistics. In South Africa, stillbirths can and should be captured through vital registration by the Department of Home Affairs, but these deaths are not always registered by the families. </p>
<p>One possible reason for not registering these stillbirths may be that families can then avoid the high costs associated with a formal burial. Others may feel a stigma about reporting stillbirths that occur at home. More advocacy is needed to inform families and training for health care workers about the importance of counting every birth and death. </p>
<p>Added to this, the grieving from a stillbirth is often left to the mother to shoulder alone and in silence. Providing support services is a missing link and community health workers could be important if sufficient guidance is provided.</p>
<p>While some causes of stillbirth are unknown, many of the deaths are preventable. For South Africa to fulfil its promise as a signatory to the World Health Organisation’s stillbirth alleviation plan, it needs to prioritise stillbirth prevention and related interventions to ensure it meets its targets. </p>
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<p><em>Priceless researcher Julia Michalow assisted in the research and writing of this article.</em></p><img src="https://counter.theconversation.com/content/44455/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Karen Hofman currently receives research funding from the South African Medical Research Council and The Bill and Melinda Gates Foundation. In the past she has also received funding from the IDRC (Canada), the WHO and UNFPA. She is a member of the board of directors of The Soul City Institute for Health and Development Communication. </span></em></p>For South Africa to reduce its stillbirth rate in line with its international pledges, it will have to scale up its several of its maternal health programmes.Karen Hofman, Director, Priority Cost Effective Lessons for Systems Strengthening (PRICELESS SA), Wits School of Public Health, University of the WitwatersrandLicensed as Creative Commons – attribution, no derivatives.