Hidden tragedy: 2.6 million women suffer stillbirths each year

Yesterday I attended the launch of the Lancet Stillbirth Series, which revealed an estimated 2.6 million women suffer stillbirths every year. The majority of the women — 98% — are from low and middle-income countries.

In my experience as a midwife I’ve found that women and families deal with a stillbirth in their own way. The pain caused by the loss of the child they have been waiting for is palpable, as is the love that is evident if women choose to hold their dead babies. For the women I have seen and cared for in the UK and in developing countries there seemed to be one main difference. In the UK the sadness and loss is often accompanied by shock, a feeling that this never happens. In the UK, a woman becomes pregnant and then has a baby, nothing else is usually expected. For the women I have worked with overseas, this element of shock doesn’t always seem the same. Maybe because stillbirths are more common, maybe because pregnancy is not expected with the same certainty to end in the birth of a live healthy baby, either way the pain is no less and the sadness is the same for both.

In the UK, when a baby is stillborn we ask the mother and babies family if they wish to hold the baby and have the baby dressed. We offer to take photographs and footprints, precious memories and mementos to hold on to in the future. Overseas I haven’t seen this happen, and my colleagues have been stunned when I’ve explained that we have a camera on labour ward especially for this purpose. It is important to acknowledge and mark stillbirths, but the way in which this is done must always be according to the wishes of the baby’s mother and family wherever they may be.

The Lancet series shows that the leading causes of stillbirth include:

• complications experienced during childbirth
• infections
• maternal disorders, such as hypertension (high blood pressure) and diabetes.

Labour and the time immediately after birth are also when women and newborns are at greatest risk of death. In developed countries the number of stillbirths that occur during labour is very small, but in developing countries this is when many deaths happen. For example, a woman in Africa is 50 times more likely to experience stillbirth in labour than a woman in the UK.

The series identifies ten evidence-based interventions found to be effective in reducing stillbirth. The one with the greatest potential to reduce the number of stillbirths is high quality care during labour, which includes emergency obstetric care and access to caesarean sections when needed. Care during labour is not cheap and it’s not simple, but it does save lives. It provides what the Lancet calls a “triple return on investment” — a reduction in stillbirths, newborn and maternal deaths.

Stillbirths aren’t formally recorded everywhere, which means it isn’t on the global health agenda. However, with this new estimate we now know the scale of the problem and how we can prevent such deaths.

Better health systems and health workers

For good quality care during labour to reach as many women and babies as possible, the world needs well funded and fully staffed health systems that reach the poorest and most vulnerable. Developing countries need clinicians able to perform caesarean sections, midwives and others with midwifery skills able to provide care during birth and basic emergency obstetric care must be available.

If we are to prevent the hidden tragedy of stillbirth it has to be made visible, it has to count and it has to take its place where it belongs alongside maternal and newborn health.

The previous Lancet series on newborn, child and maternal health has had a huge impact; I am hoping this series will follow suit.