Stillbirths, silent tragedy women experience daily

Worldwide, prevention of most stillbirths is possible with improved health systems. In this report by Sade Oguntola, experts say this sad reality for many families is preventable in about 60 per cent of all cases.

FOR too long, pregnancy loss has been a silent grief women are expected to bear alone and it takes a serious toll on families’ health and well-being.

But this devastating outcome of pregnancy; a baby growing inside its mothers suddenly, and often inexplicably dying is more common than people realize.

In 2015, World Health Organisation recorded 2.6 million stillbirths globally, with more than 7,178 deaths a day. The majority of these deaths occurred in developing countries.

An estimated 313,700 infants died as stillborn across Nigeria in 2015, ranking the country second after India, with some 592,100 stillbirths, according to a study report by Lancet.

Unfortunately, the stillbirth rate in sub-Saharan Africa is approximately 10 times that of developed countries. “Ironically, over 60 per cent of these deaths were preventable,” said Dr Sesan Oluwasola, a consultant obstetrics and gynaecologist at the University College Hospital (UCH), Ibadan, said.

A stillbirth is the death or loss of a baby before or during delivery. Both miscarriage and stillbirth describe pregnancy loss, but they differ according to when the loss occurs.

In Nigeria, a stillbirth is the death of a baby during pregnancy before the age of viability that Dr Oluwasola puts at after 28 completed pregnancy weeks.

“Most women lose their babies at about 25 completed pregnancy weeks, what many people refer to as a miscarriage, “he added.

The causes of many stillbirths are unknown. But known contributors to stillbirth include problems with the baby (birth defects or genetic problems); problems with the placenta or umbilical cord and certain conditions in the mother such as an infection like malaria, uncontrolled diabetes, high blood pressure, anaemia, and obesity. Others include genetic factors, rhesus incompatibility, the poor women’s health, age, drug use, and lifestyles such as obesity, heavy drinking, and smoking.

Following a stillbirth, women are at higher risk of another one; however, most subsequent pregnancies do not have similar problems.

Problems with the placenta, what is medically termed placental insufficiency, are thought to be the most common cause of a baby dying in the womb. About two-thirds of babies who die in the womb are thought to be lost because of placental insufficiency.

According to Dr Oluwasola, “In some cases, babies could have their umbilical cord twinning on themselves or form a knot. When the cord gets strangulated, it can cause cord accident. It is one of the common causes of a baby dying in the womb.”

Cord accidents do occur when, for example, there is too much amniotic fluid and then as the baby is swimming around; it twinned the cord around it. Also, if the cord is short, the baby can probably pull the cord around his neck.

The exact reasons why the placenta may not work properly are not fully understood. But doctors do know that if the placenta is not working well, the blood vessels that connect the mother to her baby become constricted.

The expert declared that some women also end up losing their babies due to cervical incompetence and severe anaemia in pregnancy, adding also that where there is a rhesus incompatibility and the mother has not been immunised earlier, her baby may also die in the womb.

Nonetheless, Dr Oluwasola said although stillbirth occurs in families of all races, ethnicities, and income levels, and to women of all ages, some women are at higher risk of having a stillbirth.

He declared that stillbirth was higher in teenage mothers, women that smoke or obese, having certain medical conditions, such as high blood pressure, sickle cell disease or diabetes as well as multiple pregnancies.

He said that domestic violence and falls had accounted for some stillbirths, adding, “usually in those situations, what happens is that the placenta separates. When the placenta separates suddenly, the baby can die within five minutes due to drop in nutrients and oxygen.”

Dr Oluwasola, however, declared that detachment of placenta can also occur in mothers with hypertension and diabetes, or who smoke.

Nonetheless, he said prevention of stillbirths starts with taking a good history from the patient. They are supposed to attend the preconception clinic to help plan and ensure the incidence does not repeat itself.

“Some of them are usually not truthful. For example, if a woman smokes or drinks alcohol and refuses to disclose this, you will not be able to envisage if it may be contributory when doing a full investigation. Such investigation may include carrying out a post-mortem examination (autopsy) of the baby to identify the cause of the death.

“Some people will say they have never had an abortion before to their husband. They thought all is well, but they are rhesus negative. They had been sensitive because of a previous pregnancy. These are things that we need to know.

“If you have that history, whatever is making their baby not to grow, those can also kill the baby. So we pay more attention to such,” he explained.

Dr Oluwasola said although the womb is the best incubator for a baby, where mothers stand a higher risk of delivering the baby before 34 weeks, some medications are given to prepare the lungs for maturity and improve chances of survival outside the womb.

In addition, weight control in pregnancy, he said is also important in mothers with pregnancy induced diabetes.

“With diabetes, babies have access to too much sugar. So the baby lays up much fat, becomes big and then their lungs are not developed.  The lungs of the normal baby would have developed by 34 weeks, for the diabetic, it is about 36 weeks,” he added.

Moreover, he said that changes in the consistency in baby movements in the womb may signal that the baby is in distress or even dead.

He added that extra attention should be given if mothers notice a change or reduction in the baby’s movements. If a baby is having problems in the womb they are likely to move less to conserve energy.

“Babies do not die suddenly, they give you enough sign.  Where the problem is, when you do not pick the signs early,” he declared.

Dr Oluwasola, however, said myths still abound on stillbirths. “Some people still believe that somebody can kill their babies from a distance; some attribute these deaths to witches. That is actually one of the reasons people do not want to tell you about their stillbirths. But these are not true.”

But “some of these deaths would have been prevented in some instances when mothers agree to have a caesarean delivery,” he concluded.