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Breaking the baby loss taboo

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Midwives have a role both in preventing stillbirth Midwives have a crucial role both in preventing stillbirths and caring for families when they do happen

Last month another major societal taboo was finally debated in parliament. Antoinette Sandbach MP and the co-chair of the All Party Parliamentary Group for Baby Loss spoke about the ‘devastating’ experience of losing her five-day old son in 2009. She was then joined by a number of other MPs including Vicky Foxcroft and Will Quince in sharing their own stories.

Stillbirth and neonatal death rates are surprisingly high in the UK with more than 6000 cases of child loss every year.1 Analysis published in The Lancet ranked the UK 24th out of 49 high-income countries in stillbirth and neonatal mortality rates.1

Rewinding back to the end of 2015 the government pledged to cut these high rates of stillbirth in the UK, by aiming to reduce rates by 20% by 2020 and to halve them by 2030.

Following the debate, a strategy was released by the Department of Health outlining measures to meet these targets.This plan was split into five key areas including leadership, learning and best practice, teams, data and innovation. Heidi Eldridge from the MAMA Academy, a national charity that provides stillbirth prevention information and resources for expectant mothers, says that she was pleased that the government had pledged to put £8million into safety training.

Better bereavement training for midwives was unanimously agreed on by clinicians and politicians alike when speaking to Independent Nurse.

‘There needs to be better and more effective training for healthcare professionals. It is really not acceptable that such limited pre-qualification bereavement training –sometimes as little as an hour is given to midwives, given the current stillbirth rates,’ says Ms Sandbach.

Ms Eldridge believes that ‘as there aren’t enough midwives, they don’t have enough time to spend with mothers both antenatally and on the maternity ward. If there were more midwives, there would be more continuity of care and that would save lives ultimately’.

Just recently the Royal College of Midwives (RCM) released a report, Why do midwives leave, highlighting that many are deserting the profession due to unbearable workloads and staff shortages. Sadly, only 9% of the respondents felt that the government valued midwifery as a profession.

However, Gail Johnson, the education advisor at the RCM, says that stillbirth and neonatal deaths are the result of a multitude of factors such as poor lifestyle choices and poverty as well as midwife shortages. ‘Stillbirth is highly prevalent in women who have public health issues, social housing issues, poverty. While I would very much welcome more midwives to help improve the care for all women, whole systems would need to be looked at too,’ she says.

Reasons for baby loss
The death of a baby could be attributed to many different reasons. While it is widely believed that stillbirths happen due to a developmental or genetic problem, according to Sands, the stillbirth and neonatal death charity, fewer than one in 10 stillbirths is caused by a major congenital abnormality. Very often, the baby can appear completely healthy in the womb.

There are many identifiable conditions that could lead to a stillbirth such as bleeding before or during the labour, placenta abruption, pre-eclampsia, a genetic problem, gestational diabetes or an infection, among others.3 However, for around one third of babies there is no clear cause of death.3

Researchers believe that some ‘unexplained’ stillbirths can be attributed to the placenta working less well or if the foetus is apparently healthy but smaller than expected.

Midwives are important in outlining the risk factors that women should watch out for and to provide resources for women to help them recognise if there are any problems.

One such organisation that creates these resources is The MAMA Academy set up by
Ms Eldridge following the loss of her own son in 2009. ‘I found that there was a lack of information, no one was really talking about [stillbirth].
I didn’t know that it still existed, especially in this country, so we aim to raise awareness and hopefully break the taboo,’ she says.

The role of the midwife

However there are areas of good practice where midwives and healthcare professionals are talking about baby loss. Jane Laking, a bereavement support midwife at Whittington Hospitals NHS Trust, provides this training to midwives in her Trust, as well partnering with colleagues.

The community midwife will deal more with the physical after-effects, while Ms Laking will provide emotional support. ‘[Community midwives] will take the woman’s blood pressure, make sure their bleeding is lessening, make sure they don’t have any pain. Women who have lost a baby will still often have breast milk come in, so their breasts will become swollen and engorged, so the midwives will offer practical advice on how to help that go down,’ she says.

Ms Laking says that her own role focuses more on offering women the space to talk about what has happened to them. She also helps families to sort out the practical side of the post-birth such as making funeral arrangements and allowing them to create mementos of the baby such as hand and foot prints.

However, while the system at the Whittington Hospital clearly puts a major emphasis on providing bereavement care for parents many other Trusts lag behind. In fact, a Freedom of Information (FOI) request sent out by Ms Sandbach, revealed that approximately 25% of maternity hospitals do not have bereavement suites.

Ms Sandbach highlighted that it wasn’t just maternity units in hospitals and acute Trusts that need to be tackled. ‘We have now switched our targets and are looking at the bereavement care pathway and the link between hospital Trusts and CCGs. I put FOI requests to all the CCGs and will be analysing the response and looking at the interplay between the NHS Trusts and the CCGs because it seems to me that counselling and support is a matter for primary healthcare and at the moment, that seems to be a weak link,’ Ms Sandbach tells Independent Nurse.

Ruth Bender-Atik, the national director of the Miscarriage Association, says that both the ‘facts and feelings’ around baby loss need to be looked at to reduce the high levels currently experienced in the UK. Bereavement suites, training and midwife recruitment and retention can all help, not only to reduce the statistics but also to give families the support they desperately need through such a tragic time.

References
1. Hansard transcription on baby loss. October 2016. https://hansard.parliament.uk/commons/2016-10-13/debates/721CDF48-A721-4408-AA94-BE694FA1E7FC/BabyLoss.

2. Department of Health. Safer Maternity Care. 2016. https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/560491/Safer_Maternity_Care_action_plan.pdf.

3.Sands. Possible causes of still birth. https://www.uk-sands.org/why-babies-die/explaining-stillbirth/possible-causes.


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