The majority of ‘unexplained’ stillbirths are actually due to babies not reaching their growth potential.
The fatalism around stillbirth is out of date
It is a myth that most stillbirths are unpreventable – this is the legacy of ineffective classification systems that label 2/3 as ‘unexplained’. Under modern systems, the real ‘unexplained’ figure is well under 10% – most are connected to placental dysfunction and growth restriction.
Monitoring growth is key, but errors are far too common
An independent confidential inquiry found evidence of a failure to monitor fetal growth properly in the majority of term stillbirths. This was either by not taking symphysis fundal height measurements, not plotting the measurements on a chart or not responding appropriately when growth was abnormal.
Midwives need more training and support
Incredibly, the correct technique for measuring a mums bump size does not even form part of the core training for midwives.
Current guidelines are flawed
They focus only on the size of the baby, rather than the rate of growth. Some babies are naturally small – its when growth is too fast, too slow, or stalls that babies are in danger. A one off measurement tells you very little – more regular surveillance is needed.
Best practice is ignored
Guidelines have recommended the use of customised growth charts since 2002. Every baby is unique, but many trusts don’t take that into account – whereas they should be using customised charts that are personalised for each mother, taking into account their age, size, ethnicity etc.
The 2015 confidential enquiry into term stillbirths shockingly found:
If trusts adopted the Growth Assessment Protocol (GAP), a thousand babies could be saved
GAP costs virtually nothing
Example of GAP in action
22% reduction in stillbirth rates
In the West Midlands, where takeup rate was highest, stillbirth rates fell by 22% following its introduction.
Having a national impact
The small improvements in national stillbirth rates can be attributed to significant downward trends in stillbirths in three regions where the majority of units have taken up GROW training & accreditation for the use of customised growth charts and protocols. In contrast, stillbirth rates remained unchanged in areas with low uptake of training.