Bevan says difficulties in talking about stillbirth stem, in part, from society’s wider inability to discuss women’s affairs, like menstruation or reproduction.
“It doesn’t come up in the workplace or even sometimes in people’s homes. If it does it’s in an unsupportive way, like ‘she’s hormonal’,” says Bevan. “I find it extraordinary that there is still so much mystery and lack of real understanding, among those of us outside the medical profession, about the physiological mechanisms of pregnancy and birth. It’s as if we prefer to remain in the dark, cross our fingers and hope everything goes well,” she adds.
Thankfully conversation around stillbirth is no longer confined to hushed hospital bereavement rooms. Years of campaigning, reports and research have helped place the issue squarely on the Department of Health’s agenda.
In November last year, the Government announced plans
to reduce the number of stillbirths, neonatal and maternal deaths in England by 50% by 2030. This means halving the rate of stillbirths from 4.7 per 1,000 to 2.3 per 1,000. Last month, NHS England launched the Saving Babies’ Lives Care Bundle
, which is series of practises that improve care and patient outcomes when performed together.
The guidance consists of four elements: reducing smoking in pregnancy; enhancing detection of fetal growth restriction; improving awareness of the importance of fetal movement and improving fetal monitoring during labour.
“The question is, is the NHS sufficiently resourced to actually do this?,” asks Silverton. While she says that resources are not an excuse, and we can do better, many of these practises will be difficult to implement with maternity services seriously overstretched and underfunded
. For example, cuts to local authorities’ public health funding make it harder to get entire families to stop smoking, which ultimately helps the pregnant woman give up and allows the baby to develop in a smoke-free environment.
Antenatal care monitoring babies’ growth can be improved, despite resource challenges, says Silverton. But even still, midwives are stretched for time – a typical 10-minute antenatal appointment is not long enough, she says.
Having a better understanding of why babies die at birth – and properly investigating the cause of death and improving data collection – will help reduce stillbirths, says Bevan. This is one of the reasons the Netherlands has improved its birth rate four times faster than the UK, she says. “What we endlessly have with stillbirths is the shrugging shoulders attitude of ‘there is nothing we can do about it’,” she says.
Nicole’s second pregnancy was closely monitored, with scans every two weeks, consultant-led care and the same midwife throughout. She fell pregnant three-months after Jessica’s death. “I was still coping with my grief – I still am. It was very raw, coupled with not knowing why she died and pregnancy hormones. It was really difficult,” she says. “I was petrified history would repeat itself.”
Another factor making Nicole nervous was that her second baby was due around the same time of year as Jessica’s death. To avoid this situation, the baby was induced on the 18th of December. It wasn’t until five days later that Tristan was born on the 22nd, one year to the day that Jessica died.
“It turned the day of her death into a happy occasion too. We marked her birthday by lighting a candle, with a two-day old baby in our arms,” says Nicole.
“People who don’t know you think having a Christmas baby must be exciting. Yes, it’s happy because of Tristian, but there’s also an immense sadness and void in our lives too,” she says. “Christmas will never be the same for us.”
With Tristan now 15-months old, Nicole continues to find the strength to raise awareness around stillbirth, while working as a learning advisor at a consultancy firm in London.
“In everything I do, I feel it’s my daughter’s legacy,” says Nicole. “If she can’t go on living, I feel like I need to do this for her. It’s in her memory.”