Sands Awareness Month: raising awareness of stillbirth and neonatal deaths

Posted: 11/06/2018

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June is stillbirth and neonatal death (Sands) Awareness Month. The charity focuses on raising awareness of stillbirth and neonatal deaths as well as supporting those families that have been affected by a loss of this nature.

Sadly, the death of a baby is not rare and every day in the UK around 15 babies die before, during or soon after birth. Despite this number, most people are not aware of how common and devastating it is to experience the death of a baby and the long-lasting effects it has on families. This is why the work that Sands does to raise awareness is so important.

There are a number of causes of stillbirth and in the majority of cases the baby appears to be completely healthy and, for around one third of babies, there is no clear cause of death which is described as ’unexplained’.

Some of the well-known causes of stillbirth include:

• bleeding before or during labour;
• placental abruption – this is where the placenta separates from the womb before the baby is born;
• pre-eclampsia, which causes high blood pressure in the mother;
• cord prolapse;
• gestational diabetes, a type of diabetes that develops during pregnancy;
• infection; and
• fetal growth restriction (FGR) – which usually results in a baby being delivered early.

Unfortunately, whilst a large proportion of stillbirth and neonatal deaths are unavoidable, there is still a significant percentage of deaths that could have been avoided. Of the clinical negligence claims that NHS Resolution (formerly the NHS Litigation Authority) were notified of in 2016 / 2017, obstetric claims represented 10% of the volume of cases and 50% of the overall value of compensation paid to those affected. To put this into context, over the past few years NHS Resolution has spent more than £5 billion settling claims surrounding obstetric care. Although the majority of these negligent claims involve babies who sustained hypoxic brain injuries during delivery, a large number involved avoidable stillbirth and neonatal deaths.

It is Sands’ aim that by 2020, the number of babies dying is reduced by at least 20%, but in order to work towards this, it needs continuing research funds to better understand what causes the unavoidable deaths. The Government is only too familiar with this issue, with the Health Secretary Jeremy Hunt pledging to improve mortality rates among mothers and newborns and to reduce the number of stillbirths and neonatal deaths by 2025. Most recently, this has involved announcing plans to create more than 3,000 places on midwifery training courses to help meet NHS staffing demands, particularly in maternity services. Research suggests that women who benefit from continuity of care are 19% less likely to miscarry, 16% less likely to lose their baby and 24% less likely to give birth prematurely.

Amy Milner, an associate in the clinical negligence team at Penningtons Manches, comments: “We continue to support the fantastic work that Sands does, not only in supporting families that have suffered such a devastating loss, but also in raising awareness and funds for research. Sadly, however, we are continuing to see an increase in the number of new enquiries we receive from mothers / families who have lost a baby and want answers about what went wrong and whether the death could have been avoided with different care.

“One of our recent cases relates to the failure to detect FGR and refer the mother to the fetal medicine department for further review. The mother was under the care of a consultant obstetrician (who had managed her care during her first pregnancy). She attended regular antenatal appointments with her obstetrician and had regular ultrasound scans which were all thought to be normal. The mother presented for an ultrasound scan at approximately 27 weeks, which at the time this was interpreted as being normal, and no concerns were flagged by the consultant. When the mother attended a further routine appointment at 30 weeks, she raised concerns that her bump was a lot smaller than the same stage of her first pregnancy and a further ultrasound scan was performed. An intrauterine death was confirmed on ultrasound scan and the consultant advised the mother that the stillbirth was unexplained. The mother, not only trying to come to terms with the loss of her baby, then had to endure an extremely traumatic labour and was, understandably, left devastated by what she had been through. As a result, she approached our clinical negligence team and an investigation was instigated. Evidence obtained from an obstetrician and an expert in fetal medicine identified that there was a failure by the obstetrician to carry out an accurate assessment of the baby during the ultrasound scan at 30 weeks, specifically in terms of the baby’s fetal weight, and that this scan showed evidence of FGR. The experts then went on to say that had an accurate assessment been performed at 30 weeks, FGR would have been apparent and with appropriate care an intensive programme of fetal surveillance would have been instituted and the baby would have been delivered earlier and born alive prior to the subsequent stillbirth.

“In a recent article we explained the link between small babies and stillbirth, and the case above highlights the devastating impact the failure to monitor FGR in babies can have.”

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