Britain ranks 24th out of 49 high-income countries for stillbirth rates and last year around nine babies were stillborn here every day. These rates are too high and we need to find out why.
During the Baby Loss Awareness Week debate held in Parliament in October, Patricia Gibson, SNP MP, whose baby was stillborn in 2009, asked for coroner inquests in England and fatal accident enquiries in Scotland to be instigated where babies are stillborn at term and are otherwise healthy (those born at 37 or more weeks gestation).
This request was acted on last week in the update report into safer maternity care which was released by the Department of Health and presented by Jeremy Hunt at the MBBRACE conference. The report confirmed that the Healthcare Safety and Investigation Branch (HSIB), set up earlier this year, will carry out investigations into stillborn babies who were thought to have been alive during labour, as well as babies who pass away in the week after birth and mothers who die as a result of childbirth, and will lay out standards for what these investigations should look like. At present, the internal investigation processes within hospitals are acknowledged to be inconsistent and often leave parents with very little understanding of why their baby died. While any improvement to the investigation process, such as is proposed by HSIB, is welcomed, these changes do not go far enough as they will not capture any babies who pass away before labour commences.
Significantly, the report also highlights the fact that the Government is now considering the extension of inquests to include those babies who were stillborn at term. An inquest is a legal investigation to establish the circumstances surrounding a person’s death, including how, why and when the death occurred. This has been the difficulty with the investigation of stillbirths to date – a baby who dies before birth does not become a legal person in their own right and therefore the current Coroners Rules do not apply to these deaths. Expanding the remit of coroners to enable them to investigate a stillbirth would ensure that a full and proper investigation into the cause of a baby’s death takes place, and would remove the arbitrary distinction that currently exists between the need to investigate the reason a baby dies if it took a breath, but not if it passed away minutes before it entered the world.
Around a third of stillbirths are categorised as unexplained, which can be agonising for parents. Not only would inquests into babies who are stillborn at term allow parents to gain answers to questions about what went wrong, they would also help them to come to terms with their loss and identify any contributing medical factors, which may benefit them in future pregnancies. Inquests would also ensure that the reason for our higher stillbirth rate could be forensically examined and greater focus placed on the correct areas.
Helen Hammond, senior associate in Penningtons Manches’ clinical negligence team in Basingstoke, comments: “We are pleased to see that the possibility of broadening the coroner’s remit to include a category of stillbirths is being discussed. If this discussion is turned into action and consideration is also given to capturing information about why so many babies pass away before 37 weeks, a greater number of lives could be saved in the future.”