It is unacceptable that Australia’s health system fails to properly investigate all stillbirths, according to the lead author of a global study that found that women from disadvantaged areas of Australia are at twice the risk of having a stillborn baby than women from wealthier areas.
Associate Professor Vicki Flenady from the University of Queensland’s Mater Research Institute led research on stillbirths in high-income countries. The results were published in the international medical journal, the Lancet, on Tuesday.
In 2015, Australia had an estimated 2.7 stillbirths per 1,000 births, ranking it 114th globally, the study found. If the stillbirth rate was at the same level as the top-performing high-income countries, this rate would be closer to two stillbirths per 1,000 births, saving 210 lives per year.
The countries with the lowest stillbirth rates are in Iceland, at 1.3 stillbirths per 1,000, followed by Denmark and Finland at 1.7 deaths per 1,000, and the Netherlands at 1.8 deaths per 1,000.
Flenady said many stillbirths in Australia were preventable, and described Australia’s improvement on stillbirth rates by 1.4% each year as disappointing and slower than improvements made by other high-income countries.
“For disadvantaged Australian women, there is a higher prevalence of all those factors we know determine health outcomes for babies, so things like overweight and smoking, and health conditions associated with that like hypertension and diabetes,” Flenady said.
“The health service is letting these women down, and in particular Indigenous women down, by not providing them with antenatal care that meets their needs in a culturally sensitive way.”
Ensuring women in disadvantaged areas – which were often also remote and regional areas – had regular access to antenatal services was essential because this was often when complications were detected and treated, Flenady said.
But she added these factors did not explain all stillbirths. Stillbirths could affect healthy women and often in their last weeks or days of pregnancy, she said. aBecause Australia has no national reporting system and database of stillbirths, it was difficult to investigate why.
“What we could be doing better is investigating every case of stillbirth more throughly than we are now to identify factors that may have gone wrong,” she said.
“That’s where we fall down in Australia, we need to implement a national program where every case is investigated and an autopsy carried out. Countries like the Netherlands and New Zealand have such a national audit program and have seen significant reductions in stillbirth rates.”
Autopsies were carried out on as few as 30% of stillborn babies in some areas of Australia, Flenady said. It could be difficult for doctors to discuss the prospect of an autopsy with bereaved parents, which meant the conversation sometimes never occurred.
Although substandard care contributes to between 20% to 30% of stillbirths in high-income countries, many remained unexplained, making strong collection of data vital.
“Stillbirth is a devastating time for families, but we know more often than not that parents who do not have an autopsy often regret that,” Flenady said.
“Being able to have these conversations openly is important.”
While the Perinatal Society of Australia and New Zealand have clinical guidelines for stillbirth, there needed to be an education campaign to inform doctors and midwives about them, Flenady said.
Using the World Health Organisation’s definition of stillbirths as being a foetal death after 28 weeks of pregnancy, there were 810 stillbirths in Australia last year.
Other research published on Tuesday as part of the Lancet’s ongoing Ending Preventable Stillbirth research series found half of all stillbirths globally occurred during labour and birth, usually after carrying a pregnancy to full term, and that up to 1.3 million of these deaths worldwide could be prevented with better quality health care. Around the world 2.6 million stillbirths occur every year.
The series is a collaboration between more than 200 researchers across 43 countries and 100 research and health organisations.
While factors contributing to stillbirth around the world include infections such as malaria and syphilis, the three most common risk factors in Australia are being overweight, smoking or giving birth later in life.
President of the Australian College of Midwives, Professor Caroline Homer, said the stillbirth rate of a country was a key indicator of the quality and equity of women’s healthcare in that country.
She said the findings highlighted the importance of support throughout pregnancy from midwives.
“Midwives can play a critical role in the prevention of stillbirth and are the most cost-effective providers of the essential care that helps save the lives of mothers and babies, she said.