How Can We Reduce Surprising U.S. Stillbirth Numbers?

Since the advent of modern medicine, it’s custom to account for why deaths occur and what we can do to prevent them in the future. But there’s a certain type of death in the U.S. that remains a mystery—the death of a life that hasn’t even begun yet.

In the recent publication of the “Ending Preventable Stillbirth” research series, which was developed by more than 200 experts and published by The Lancet, researchers found that more than 2.6 million stillbirths, or, according to the World Health Organization, fetal deaths after 28 weeks of pregnancy, occur worldwide each year. What might, however, be most surprising to us is that, of the 186 countries profiled, the United States ranks 22nd in highest number of fetal deaths, with about 3 stillbirths for every 1,000 births.

While researchers cannot pinpoint a single reason why the U.S. carries a rate higher than other industrialized nations, they can say that, in the last 15 years, our fetal demise rate has declined an underwhelming 0.4 percent. The lack of progress might have something to do with the quality of care received by underprivileged women in the U.S.; the report makes clear that, in high-income countries, women in the most disadvantaged communities face at least double the risk of fetal demise than their privileged counterparts.

What the report also makes explicit time and again is that priority actions to accelerate the reduction of all stillbirths includes “investigation into crucial knowledge gaps.” The closing of these gaps relies upon more research: audit programs, somewhat like coroners’ inquests, to see if anything might have been done to prevent the loss of life, and autopsies.

However, stillbirths are rarely investigated. This flies in the face of statistics that show when appropriate procedures are undertaken, causes for stillbirths are often identified, meaning parents can better understand not only why a stillbirth occurred, but also if fetal demise might remain a future risk for the family.

So why is the autopsy rate in the U.S. for stillbirths, according to the American College of Obstetricians and Gynecologists, the lowest among high-income countries?

In the U.S., fetal autopsies and audits require very precise expertise that’s rare in the field of clinical pathology; even if we want these procedures performed, it can be difficult (and expensive) to find the right people to undertake them. Still, what might be more compelling is that the shock of a stillbirth and the grief that follows means most parents are initially resistant to the idea of having their children autopsied. And doctors, knowing all too well the chaos of mind in which many parents find themselves after a stillbirth, are often too uncomfortable to suggest the procedure.

I initially found this frustrating, to say the least; it is a scientist’s obligation to answer questions, especially those of life and death.

But then I wondered: How does one salvage the memory of a child who never spoke a word, never grasped a fingertip? How does one hold on to his reality, his fleeting presence in this world?

Parents have so little by which they can remember their stillborn children. Perhaps their initial unwillingness to put the these bodies through autopsies and audits has much to do with their need to salvage the preciousness of what few memories they can make of a child’s existence.

That’s why, just as The Lancet study advises, we must see these parents have more time with the remains of their children if they choose, and far more support once those children are finally taken away. “It is vital we, as carers,” wrote Dr. Alexander Heazell, co-author of The Lancet series, “see the loss through the eyes of those parents affected to provide sensitive and respectful bereavement care.”

Human decency dictates we must give those who grieve absolutely everything they need — from counseling, to financial support for expensive funerals — as they struggle to find some sense of normalcy after stillbirth. This is not only a means of doing right by them, but a call to hope that these same parents find comfort in allowing their children to play a part in potentially eliminating similar pains for future mothers and fathers.

45 comments

Jennifer Sanchez
Past Member 3 months ago

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Siyus Copetallus
Siyus Copetallus3 years ago

Thank you for sharing.

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Jim Ven
Jim Ven3 years ago

thanks for the article.

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Cela V.
Cela V3 years ago

tyfs

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Steve McCrea
Steve McCrea3 years ago

The author does not cite a very likely contributing factor: US hospitals heavily rely on technological interventions rather than using a midwifery model of care. In most of Europe, midwifes are the primary attendants at births, and doctors are only brought in if something goes seriously awry. Whereas in the US, midwifery was illegal for years and in most states is only legal under a physician's guidelines. It is well established that midwives have lower C-section rates, lower intervention rates in general, and better birth outcomes, including fewer stillbirths. It is past time to make midwifery care the standard of care in the USA!

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Marie W.
Marie W3 years ago

Thanks

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Elizabeth Brawn
Elizabeth Brawn3 years ago

interesting

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Sherry Kohn
Sherry Kohn3 years ago

Many thanks to you !

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Elena Poensgen
Elena Poensgen3 years ago

Thank you

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Margie FOURIE
Margie F3 years ago

How terrible. To have carried a baby for nine months and then find that he/she is stillborn must really affect one. Here is a tribute to all the parents who have had a stillborn baby. Even though I am not in your shoes, my thoughts are with you.

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