UNDERSTANDING STILLBIRTH 2019

14 August 2019

At Curtislaw the specialist clinical negligence team are regularly instructed concerning stillbirths and neonatal deaths. These are extremely harrowing events for families and often very challenging cases as many families just want to know why it happened and are often going through a period of mixed grief and blaming themselves, almost always without any good cause.

Stillbirth is a delivery of a lost baby at greater than 24 weeks gestation. Maternal and fetal testing is done to determine the cause. The often harrowing element is that management is as for routine care after live delivery.

Unfortunately this is not as rare an occasion as may first be thought. In the UK stillbirths occur in approximately 4 pregnancies in ever 1000. An additional 2 babies may be lost in the neonatal period. (The actual statistic was 3.92 stillbirths and 1.72 neonatal deaths, meaning a 5.64 loss per 1000 live births – MBBRACE-UK).

The most recent statistics deal with 2016.

The findings were that:

Key findings for babies born in 2016

  • 780,043 babies were born in 2016
  • 3,065 were stillborn (died before birth after 24 weeks of pregnancy)
  • A further 889 died between 22 and 24 weeks’ gestation
  • 1,337 died in the first four weeks of life (after 24 weeks’ gestation)
  • 70% of stillbirths or deaths happened before 37 weeks of pregnancy
  • 1 in 6 babies who died had a congenital anomaly that was likely to be fatal
  • The UK stillbirth rate fell between 2013 and 2016 to around 3.9 stillbirths for every 1,000 births, but remained much the same between 2015 and 2016
  • The stillbirth rate in twins fell by 44% and the death of newborn twins reduced by a third between 2014 and 2016
  • Overall 300 fewer babies died either before or shortly after birth in the 4 years between 2013 and 2016, but that fall occurred mostly before 2016

In November 2015 the Secretary of State’s set a target for England, to reduce stillbirth, neonatal death, maternal death and brain injuries sustained around the time of birth by half by 2030 with a reduction of 20% by 2020. Without making too much of an assumption this means that many of these losses or injuries are avoidable.

Those of us who have acted for the bereaved for many years have seen these promises before. While we hope that the targets will be met, this will not be possible without investment in the NHS in training, staff recruitment and retention, and in equipment such as more scanners.

Directly taking the information for the locality of our offices it is perhaps concerning that all of the areas were serve save Chorley and South Ribble exceeded the national statistics.

Blackburn with Darwen (4.06 stillbirths per 1000, 5.64 total loss per 1000), Blackpool (3.94 and 5.79), Bolton (4.04 and 5.64), Bury (3.9 and 5.75), Chorley and South Ribble (3.82 and 5.49), East Lancashire (4.04 and 5.93), Greater Preston (4.03 and 5.62), Manchester 3.84 and 5.67, Salford (4.10 and 5.74).

Even more concerning their crude figures (not adjusted for mother’s age; socio-economic deprivation based on the mother’s residence; baby’s ethnicity baby’s sex; whether they are from a multiple birth; and gestational age at birth (neonatal deaths only) some were significantly above the average.

Ignoring the Level 3 NICU’s which accept for surgical intervention which will unfortunately typically have higher than average loss rates as they are dealing with critically ill babies, Bolton NHS Foundation Trust and East Lancashire Hospitals NHS Trust, both with Level 3 non surgical NICU’s had loss rates of up to 10% above the national average.

There was a clear statistical increase in stillbirths for the youngest mothers (less than 20 years old) and older mothers (40 +) and also for what was considered the most deprived socio-economic status.

It was recently discussed on Womens Hour on radio 4 that there was a significantly increased risk of maternal death if you were a Black or minority ethnic woman. This should not be happening.

We have recently concluded a matter for a family concerning a stillbirth following mismanagement of Group B Streptococcus. The family really just wanted answers and felt at the time when they were trying to get the answers the Trust failed to provide them. This is unfortunately all too common.

It is simply not acceptable for an avoidable stillbirth, neonatal death, maternal death or brain injuries to occur. One death is simply one death too many. One more avoidable brain injury during delivery is one more too many.

We will be supporting baby loss awareness week in October. We are proud to work alongside a number of charities in this respect.

Jerard Knott

The Clinical Negligence and Catastrophic Injury Team at Curtis Law is led by Jerard Knott, Senior Associate Solicitor, an APIL Accredited Senior Litigator and Clinical Negligence Specialist. It also includes Lynne Ainsworth, a Law Society Accredited Clinical Negligence Panel Member. We are committed to promoting Patient Safety. The team only acts for Claimants and is dedicated to providing a client care centered high level of service, providing the best possible advice and maximising damages. The department acts on a large number of fatal (including representation at Inquests) and high value cases. The department regularly advises on cases with valuation exceeding £1,000,000. We can be contacted on 01254 297130 or MedNeg@curtislaw.co.uk.

Follow us at @curtislaw for up to date commentary and sector advice.