'No time to talk about stillbirth' warns Royal College of Midwives

One suggestion to cut the stillbirth rate has been to offer an extra routine scan

The Royal College of Midwives (RCM) says a drop in midwife numbers in Wales could be taking vital time away from appointments which could be used to talk to women about the risks of stillbirth and how to help avoid it.

The statement comes as a committee of AMs found the number of stillbirths in Wales to be "unacceptably high" at an average of 180 each year.

They say evidence from a one-day inquiry into stillbirths held last June showed 64 babies could be saved each year if Wales could emulate Scandinavian success in reducing the rate.

Julia Chandler, national officer for the RCM in Wales, also told BBC News the way foetal growth was measured needed to be standardised, and customised growth charts which made allowances for things like the mother's ethnic group should be rolled out across the country.

A study published by the British Medical Journal (BMJ) in January concluded better monitoring of pregnancies including measuring foetal growth, using scans at a later stage and recording the movements of foetuses more accurately could save up to 600 babies a year in the UK.

It came two days after the RCM warned a shortage of midwives and a fall in students and any future cuts would risk the quality of services.

Ms Chandler said all midwives used tape measures to monitor foetal growth past around 24 weeks of pregnancy.

However she said one thing which both midwives and doctors seemed to find very hard to do was to talk to pregnant women about the possibility of stillbirth occurring.

A sign that something may be wrong is often a reduction in foetal movements, and getting that investigated promptly can make a difference to the outcome.

"What the reduction of midwives will do is reduce the amount of time midwives have with women. You need some continuity with someone so that they trust them," she said.

"You need some time with people and it's not the sort of thing you can do if you only have two minutes with them.

The British Medical Journal has published research on bettering monitoring of pregnancies

"It's easier to have a difficult conversation if the mother knows someone.

"If you have just met somebody it's difficult to say midway through, 'we need to have a chat about stillbirth'."

Screening

She said since the inquiry into stillbirths had begun, many people had commented on how common stillbirth was but it was not in the public's consciousness in the way other types of perinatal deaths were.

It is the most common form of infant death at around five per 1,000 births, with babies more likely to be stillborn than to die of sudden infant death syndrome (Sids), meningitis or road accidents.

Ms Chandler said the Back to Sleep campaign which encouraged parents to put their babies to sleep on their back rather than their stomachs to prevent Sids had "hugely changed" practice, and rates of what was known as cot death had plummeted.

"Maybe there ought to be a campaign, but the difficulty is whether you frighten people," she said.

"We seem to have been afraid to have that conversation."

"However we do screen for all sorts of things that could be health problems like Down's syndrome. It's better to get it out in the open."

One suggestion has been to offer blanket screening to all pregnant women at around 35 weeks of pregnancy to pick up on reduced growth that may have been missed by external measuring.

However Ms Chandler said there were mixed opinions on that.

She said: "It's a huge undertaking. It's bad enough getting people in for one [at 20 weeks].

"We're not really sure that scans are 100% safe because we have only been doing them for 30 years [even though] it seems at the moment that there are no ill-effects.

"It's capacity, costs and that as well."

She said where they knew there was a risk to the baby, then repeated scanning was recommended because the benefits clearly outweighed the risks, but if a mass screening programme was introduced, plenty of healthy women and babies would be scanned unnecessarily.