WARNING: This article discusses the issue of stillbirth and the death of a newborn.
Sydney nurse Nerida Rosenthal was 33 weeks pregnant with her first baby when she suddenly felt worried that she hadn’t felt her daughter move in a long time.
“I was at work, and I remember it was a really busy day,” she said.
“I sat down in the afternoon and thought, ‘Oh, I haven’t really been paying attention to the movements.'”
Nerida Rosenthal pictured in hospital after the birth of her daughter Mia, who was stillborn. (Supplied)
Stressed, Rosenthal left work for a regular acupuncture appointment.
It was during this quiet time that she usually felt her daughter move.
“I just thought, ‘No, I’m not feeling her’,” Rosenthal said.
Now very concerned, Rosenthal called her husband, who took her to the hospital.
“I went in and was sat in the waiting room,” Rosenthal said.
“It was obviously a very busy shift in the delivery suite.”
A staff member came out to the waiting room and put a cardiotocography (CTG) monitor on Rosenthal to measure the baby’s heart rate.
The measurements reassured staff, who detected a heartbeat before returning to the ward.
However, Nerida wasn’t reassured and suspected it was her own heartbeat, elevated by anxiety, that was picked up by mistake.
Instinct told Rosenthal something was very wrong, and she refused to leave the hospital despite being given the all clear.
“I knew it in my gut and I said, ‘I’m not leaving here based on a CTG, I need a scan’,” she said.
Rosenthal’s obstetrician arrived at the hospital and immediately performed an ultrasound, which confirmed her worst fears.
“The doctor just turned to me, and he had tears in his eyes. He said, ‘You’re right. There’s no heartbeat’,” she said.
Nerida Rosenthal, pictured with her daughter Mia, who was stillborn. (Supplied)
Rosenthal’s daughter had suffered an umbilical cord accident.
The cord was wrapped around her neck twice and kinked, stopping the blood flow.
Around 2380 families are affected by stillbirth every year in Australia.
It’s a rate that has remained largely unchanged over the last two decades.
In 2022, the rate of stillbirths even increased slightly to 8.0 per 1000 births, up from 7.2 per 1000 births a year earlier, according to the latest available data from the Australian Institute of Health and Welfare.
In 2018, a Senate inquiry examined the lack of movement on Australia’s stillbirth rate.
While Rosenthal believes her daughter Mia’s death was unpreventable, she, alongside many other bereaved parents, is calling for change around this issue
“It’s just crazy that the stats haven’t changed in all of this time,” she said.
“We know that some of these stillbirths are preventable. So what can we do to prevent them?
“You’re not going to save everyone, but we still need to raise awareness for the type of early checks that can save someone.”
In September, a parliamentary petition collected more than 6000 signatures, calling for a national stillbirth awareness campaign.
The petition was launched by Tim McCranor, who, along with his wife Michelle, lost their baby daughter Celeste in 2001.
The couple’s advocacy has also included the making of a recently released documentary called Her Name is Celeste.
Why haven’t stillbirth rates improved?
Despite medical advancements in other areas of health, stillbirth rates have stagnated and even showed a slight uptick in 2022, when the highest rate in 20 years was recorded.
In its analysis, the Australian Institute of Health and Welfare (AIHW) said there had been no consistent trend over the past few decades when it came to the number of stillbirths.
However, some fluctuations had coincided with key events, such as the COVID-19 pandemic, the 2019–20 bushfires, and changes in the underlying birth rate, AIHW said.
A graph showing the rates of stillbirth in Australia over the past two decades. (Australian Institute of Health and Welfare)
Some of the increase in 2022 could be attributed to the improved capture and inclusion of cases in some areas, it said.
Vicki Flenady is the director of the Stillbirth Centre of Research Excellence (CRE), a peak body leading the effort to prevent stillbirths in later gestation, from 28 weeks onwards.
Flenady said possible factors which may have influenced stillbirth rates included disruptions to maternity care during the COVID-19 pandemic and inequity in care.
“Stillbirth disproportionately affects marginalised groups, including Aboriginal and Torres Strait Islander women, women from some migrant and refugee backgrounds, women under the age of 20, and women from rural and remote areas,” Flenady said.
“These disparities are linked to factors like social disadvantage, intergenerational trauma, and limited access to culturally safe healthcare.”
It is estimated that about 20-30 per cent of stillbirth deaths in late gestation are preventable.
Nerida Rosenthal and other bereaved parents are calling for the federal government to implement a national stillbirth awareness campaign. (Supplied)
While the national overall figures for stillbirths measured deaths from 20 weeks onwards, one area which had shown improvement was in later gestation from 28 weeks, Flenady said.
“In this group, there has been a downward trend,” Flenady said.
“The average annual rate reduction reveals a 3.1 per cent decrease in late gestation stillbirth rates in the decade to 2022.”
A key stillbirth prevention strategy in the National Stillbirth Action and Implementation Plan has been the rollout of a Safer Baby Bundle in higher-risk communities and clinical settings through Stillbirth CRE.
The bundle helps clinicians identify women at a higher risk for stillbirth and provides strategies for their care.
Modelled on the UK’s National Health Service’s (NHS) Saving Babies’ Lives Care, the bundle has shown promising early results, Flenady said.
“Pre-COVID Victorian data show a 21 per cent reduction in stillbirths occurring at 28 weeks’ gestation or more where the Safer Baby Bundle has been embedded.”
Lack of real-time data hinders efforts
One major factor hampering the efforts to reduce the stillbirth rate is the lack of real-time data, Flenady said.
There is currently a three-year delay in the release of stillbirth statistics by the Australian Institute of Health and Welfare.
“Access to timely, comprehensive data limits the ability to measure, in real time, the impact of prevention initiatives or other factors that influence stillbirth rates,” Flenady said.
“In addition, there is a two-year delay between the occurrence of a stillbirth and its inclusion in data sets made available for analysis.”
The National Stillbirth Action and Implementation Plan identified the need to improve data collection on stillbirths and committed in the medium term to “develop and implement a standardised approach to data collection on causes and contributing factors for perinatal deaths, across maternity services linked to perinatal mortality review committees to ensure timely review and reporting of stillbirth deaths”.
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