Earlier this month Victoria launched a new public health campaign in the hope of reducing the rate of stillbirth for the first time in 20 years. But will it work? Safer Care Victoria’s Senior Midwifery Adviser Tanya Farrell takes you behind the scenes of the campaign.
Every year in Victoria, about 500 babies are stillborn. Across our country each year there are about 2,200 and we’ve not made a dent in those figures for more than two decades.
If you pause to think of the impact of just one of those stillbirths – the grief of the parents, their families and support network – we all come to the same conclusion. We need to do everything possible so more babies can go home in their parents’ arms.
Not all stillbirths can be explained. In fact, it’s believed only a third of all stillbirths after 28 weeks may be prevented. And while we are finding new evidence all the time, unfortunately for some families we may never know the reasons why their baby or babies were stillborn.
The leading causes of stillbirth are congenital anomalies. We also know that women with diabetes before they get pregnant have a higher chance of stillbirth.
During pregnancy it’s important that we ensure babies are growing well and continuing to move well. Few know that fetal growth restriction (delayed or no growth in the womb) is associated with problems during pregnancy, labour, and after birth. Changes in fetal movements is another sign a baby may not be well – half of all women who have had a late stillbirth, report they had noticed a change in their baby’s movements.
Plagued by myths and old-fashioned practice, it’s these two risk factors for stillbirth that we have been working on for the past six months in the hope of improving outcomes for Victorian mothers and babies.
Recently, fresh research out of the UK suggested that raising awareness of decreased fetal movements, particularly through using public campaigns, might not be as effective as first thought and may even raise the rate of inductions and caesareans for women. Known as the AFFIRM trial, it suggested a reliance on one aspect alone – for example, reduced fetal movements –will not lead to a reduced number of stillbirths that we all wish to see.
Although it’s only one study among others in support of awareness raising, we had the chance to pull the pin on our public campaign. But we didn’t.
That’s because #Movementsmatter isn’t just a public awareness campaign for women. It’s for women, their partners and families as well as for healthcare providers and services. For the past six months, we have been working with maternity services to ensure obstetricians, doctors, midwives, nurses and other care providers know what to do if a pregnant woman reports a change in their baby’s movements. In recent times, some clinicians believed ‘have a cold drink and put your feet up’ was acceptable clinical advice. They don’t anymore! Instead, they understand they need to tell the pregnant women at every opportunity about getting to get to know their baby’s movements and ensure they know what to do if a woman raises concerns.
The new research actually gave us more clarity for our messages. It found preventive efforts were best concentrated in the last four weeks before due date. Meaning it was particularly important for women to pay attention to their baby’s movements in the final four weeks of pregnancy. The AFFIRM trial reinforces a multi-faceted approach to reducing risks, including surveillance of fetal growth restriction along with fetal movements awareness. Something we are working on at Safer Care Victoria, having run clinical workshops on fetal growth restriction for the past three months. The results also suggest that further research is required in this space.
It may be this campaign alone won’t make a significant change to our stillbirth rates. Taking a close look at our most recent data, about 180 babies were stillborn after 28 weeks gestation in a year. We believe around 30 of these could have been prevented. If we can save just one family from mourning a child they never got to know, then this campaign has succeeded.
But what we know beyond doubt is that this campaign will help women feel more confident in speaking up at any time about anything if they are concerned. We know their clinicians will listen, care and hopefully act according to the latest guidelines. And those factors will result in better care, experience and outcomes for women and their families.
The Movements Matter campaign is a collaboration between Safer Care Victoria, the Stillbirth Centre for Research Excellence (CRE) and other national bodies. For more information, go to movementsmatter.org.au