Stillbirth has enormous psychosocial impact on parents and care providers, and wide-ranging economic impact on health systems and society at large (Heazell 2016). In The Lancet 2016 Ending Preventable Stillbirths series we emphasise that the poor global response to stillbirth has been a persistent injustice to families and communities.
As stated by Richard Horton, Editor in Chief of The Lancet,
“Not all global health issues are truly global, but the neglected epidemic of stillbirths is one such urgent concern”.
What is stillbirth?
- In Australia, stillbirth is defined as the birth of a baby without signs of life after 20 weeks’ gestation or 400g birthweight.
How frequent is stillbirth?
- The stillbirth rate (20 weeks/400g) in Australia is currently 6.8 per 1000 births (AIHW 2019).
- Each day in Australia, 6 babies are stillborn, affecting almost 2,200 families each year (AIHW 2019).
- In 2015, Australia’s late-gestation (>28 weeks) stillbirth rate was 2.7 per 1000 births (Flenady et al 2020).
- One in every 137 women who reach 20 weeks’ gestation will have a stillborn child.
- For Indigenous women and women from other disadvantaged groups, this risk is often doubled (Flenady 2016).
How does stillbirth affect parents and families?
- Parents who have had a stillborn baby face an increased risk of anxiety, depression, post-traumatic stress, and suicidal ideation (Heazell 2016).
- Stigma around stillbirth intensifies parents’ distress and often makes them feel more isolated in their grief. Our research has shown that up to 50% of bereaved parents in Australia and New Zealand feel unable to talk about their stillborn baby because it makes people feel uncomfortable.
- Many parents feel the death of their baby is not recognised as the same as the death of an older child (Flenady 2016).
Are stillbirth rates improving?
- There has been little improvement in overall stillbirth rates for over 30 years (Flenady et al 2020).
- Stillbirth rates after 28 weeks’ gestation have shown some improvements, but more needs to be done.
- Australia’s stillbirth rate after 28 weeks’ gestation is 30% higher than that of the best performing countries, such as Finland, Denmark, and Netherlands (Flenady 2016).
What are the causes of stillbirth?
- The major causes of stillbirth in Australia are congenital abnormality, 'unexplained death', perinatal conditions, and maternal conditions (AIHW 2019).
- Around 20% of stillbirths remain unexplained (and almost half of stillbirths occurring near full-term). The lack of a diagnosis adds to parents’ distress, as they struggle to understand “what went wrong” and “will it happen again” in a subsequent pregnancy.
- Many stillbirths are not adequately investigated, resulting in possible missed diagnoses.
- In 20-30% of stillbirths, the quality of care provided is a contributing factor to the death (De Rue 2000). National perinatal mortality audit programs can reduce these deaths. Without such a program in Australia, opportunities for prevention are often lost.
What are the risk factors for stillbirth?
- Risk factors include maternal perception of decreased fetal movements (strength or frequency), fetal growth restriction, smoking, hypertension, diabetes, overweight and obesity, pregnancy beyond 41 weeks’ gestation, primiparity, maternal age over 35 years (particularly for women aged 40 years or more), and previous stillbirth (Flenady 2011).
- Indigenous and other disadvantaged groups often have constellations of risk factors and suboptimal antenatal care. (Flenady 2016).
- South Asian women also have higher rates of stillbirth and the reasons for this remain unclear (Davies-Tuck 2017).
- Women who go to sleep in the supine position (lying on their back) also have an increased risk of stillbirth in late-pregnancy (Cronin 2019).
For information about our Research Program and how we are addressing the problem of stillbirth, see our research program.
Australian Institute of Health and Welfare (AIHW). Stillbirths and neonatal deaths in Australia 2015 and 2016: in brief. Perinatal statistics series no. 36. Cat. no. PER 102. Canberra: AIHW, 2019.
Davies-Tuck ML, Davey MA, Wallace EM. Maternal region of birth and stillbirth in Victoria, Australia 2000-2011: A retrospective cohort study of Victorian perinatal data. PloS one. 2017;12(6):e0178727.
De Reu PAOM, Nijhuis JG, Oosterbaan HP, Eskes TKAB. Perinatal audit on avoidable mortality in a Dutch rural region: a retrospective study. European Journal of Obstetrics & Gynecology and Reproductive Biology. 2000;88(1):65-9.
Flenady V, Middleton P, Smith GC, Duke W, Erwich JJ, Khong TY, et al. Stillbirths: the way forward in high-income countries. The Lancet. 2011;377(9778):1703-17.
Flenady V, Wojcieszek AM, Middleton P, Ellwood D, Erwich JJ, Coory M, et al, for the Lancet Ending Preventable Stillbirths series study group. Stillbirths: recall to action in high-income countries. The Lancet. 2016;387(10019):691-702
Heazell AEP, Siassakos D, Blencowe H, Burden C, Bhutta ZA, Cacciatore J, et al, for the Lancet Ending Preventable Stillbirths series study group. Stillbirths: economic and psychosocial consequences. The Lancet. 2016;387(10018):604-16.
Cronin RS, Li M, Thompson JMD, et al. An Individual Participant Data Meta-analysis of Maternal Going-to-Sleep Position, Interactions with Fetal Vulnerability, and the Risk of Late Stillbirth. EClinicalMedicine 2019; 10: 49-57.