The majority of ‘unexplained’ stillbirths are actually due to babies not reaching their growth potential.

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    The fatalism around stillbirth is out of date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.

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    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.

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    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.

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    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.

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    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:

that
0%
had some type of major failing in growth screening
of which
0%
could have prevented the death
around
0%
related to measuring or plotting growth

If trusts adopted the Growth Assessment Protocol (GAP), a thousand babies could be saved

  • Provides customised growth charts for each mother

  • Endorsed by the NHS England Saving Babies Lives Care Bundle

  • GAP has won three consecutive national Patient Safety awards as well as the 2015 BMJ award for Clinical Leadership

  • It is also being introduced in an increasing number of maternity units abroad, including in The Netherlands, India, Australia and New Zealand.


GAP costs virtually nothing

Example of GAP in action


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    22% reduction in stillbirth rates

    In the West Midlands, where takeup rate was highest, stillbirth rates fell by 22% following its introduction.

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    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.

Further information


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Supports mums and midwives to help babies arrive safely. ‘Made to Measure’ campaign promotes use of customised growth charts


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Multiple award winning qualified provider of maternity support services, including education and training in fetal growth assessment.