Stillbirth should be given greater priority on the global health agenda

Qureshi, Zeshan; Millum, Joseph; Blencowe, Hannah; Kelley, Maureen; Fottrell, Edward; Lawn, Joy E; Costello, Anthony; Colbourn, Tim

doi:10.1136/bmj.h4620

Cited by 28 publications

(32 citation statements)

References 32 publications

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“…In the UK, about 4000 babies per year are stillborn . Globally, the figure is about two and a half million, yet stillbirth did not feature until recently on the global agenda . Breaking the silence on stillbirth is one of ‘parents’ most heartfelt wishes’ and has at last become a global priority .…”

Section: Introductionmentioning

confidence: 99%

“…Globally, the figure is about two and a half million, yet stillbirth did not feature until recently on the global agenda . Breaking the silence on stillbirth is one of ‘parents’ most heartfelt wishes’ and has at last become a global priority . Systematic reviews of more than 200 studies show that the socioeconomic impact of stillbirth on society is immense, ranging from stigma to disenfranchised grief; broken relationships to long term impact on the wider family; unresolved grief to clinical depression; chronic pain to substance use; increased use of health services to employment difficulties; and from staff despair to resignation .…”

Section: Introductionmentioning

confidence: 99%

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All bereaved parents are entitled to good care after stillbirth: a mixed‐methods multicentre study (INSIGHT)

Siassakos

Jackson

Gleeson

et al. 2017

BJOG

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ObjectiveTo understand challenges in care after stillbirth and provide tailored solutions.DesignMulti‐centre case study.SettingThree maternity hospitals.PopulationParents with a stillborn baby, maternity staff.MethodsThematic analysis of parent interviews and staff focus groups and service provision investigation.Outcomes1 Themes; 2 Triangulation matrix; 3 Recommendations.ResultsTwenty‐one women, 14 partners, and 22 staff participated. Service Provision: Care for parents after stillbirth varies excessively; there are misconceptions; post‐mortem does not delay follow‐up. Presentation: Women ‘do not feel right’ before stillbirth; their management is haphazard and should be standardised. Diagnosis: Stillbirth is an emergency for parents but not always for staff; communication can seem cold; well‐designed bereavement space is critical. Birth: Staff shift priorities to mother and future, but for parents their baby is still a baby; parents are not comfortable with staff recommending vaginal birth as the norm; there are several reasons why parents ask for a caesarean; better care involves clear communication, normal behaviour, and discussion of coping strategies. Post‐mortem: Parents are influenced by discussions with staff. Staff should ‘sow seeds’, clarify its respectful nature, delineate its purpose, and explain the timescale. Follow‐up: It is not standardised; parents wish to see their multi‐professional team.ConclusionsThere is unacceptable variation in care after stillbirth, and insensitive interactions between staff and bereaved parents. Understanding parents' needs, including why they ask for caesarean birth, will facilitate joint decision‐making. Every bereaved parent is entitled to good, respectful care.Tweetable abstractCare too varied & interactions often insensitive after stillbirth; national pathway & training urgently neededPlain Language SummaryWhy and how was the study carried out?Previous studies have shown that improving care after stillbirth is important for families. We investigated the opinions of bereaved parents and maternity staff to find ways to improve care.At three hospitals in 2013, all women who experienced a stillbirth were invited to an interview along with their partners. Thirty‐five parents of 21 babies agreed to participate. Twenty‐two obstetricians and midwives took part in focus group discussions.What were the main findings? Care was often not as good as it should and could be. Communication with parents was not always as sensitive as they would have liked because staff did not have appropriate training.Some women reported they did not ‘feel right’ before going to hospital. Once they arrived, there was no standard approach to how care was given. Sometimes there were long delays before the death of the baby was confirmed and action was taken.After it had been confirmed that the baby had died, staff focussed on the mothers’ needs, but the parents’ priorities were still with their baby. There were several reasons why parents asked for a caesarean birth that staff had not considered.Staf...

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

All bereaved parents are entitled to good care after stillbirth: a mixed‐methods multicentre study (INSIGHT)

Siassakos

Jackson

Gleeson

et al. 2017

BJOG

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“…While the proportion of births registered in Uganda has risen 21% between 2006 and 2011, the country is also home to 5 million children whose births are not registered at all [6]. Many of the countries with the highest burden of deaths have limited or non-existent civil registration systems, contributing to a ‘scandal of invisibility’ [7], particularly regarding stillbirths and newborn deaths [8]. In these settings, population-level data on pregnancy and child mortality outcomes frequently rely on nationally representative household surveys, such as Demographic and Health Surveys (DHS).…”

Section: Introductionmentioning

confidence: 99%

Comparing performance of methods used to identify pregnant women, pregnancy outcomes, and child mortality in the Iganga-Mayuge Health and Demographic Surveillance Site, Uganda

Kadobera

Waiswa

Peterson

et al. 2017

Global Health Action

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Background: In most low and middle-income countries vital events registration for births and child deaths is poor, with reporting of pregnancy outcomes highly inadequate or non-existent. Health and Demographic Surveillance System (HDSS) sites and periodic population-based household-level surveys can be used to identify pregnancies and retrospectively capture pregnancy outcomes to provide data for decision making. However, little is known about the performance of different methods in identifying pregnancy and pregnancy outcomes, yet this is critical in assessing improvements in reducing maternal and newborn mortality and stillbirths. Objective: To explore differences between a population-based household pregnancy survey and prospective health demographic surveillance system in identifying pregnancies and their outcomes in rural eastern Uganda. Methods: The study was done within the Iganga-Mayuge HDSS site, a member centre of the INDEPTH Network. Prospective data about pregnancies and their outcomes was collected in the routine biannual census rounds from 2006 to 2010 in the HDSS. In 2011 a cross-sectional survey using the pregnancy history survey (PHS) tool was conducted among women aged 15 to 49 years in the HDSS area. We compared differences between the HDSS biannual census updates and the PHS capture of pregnancies identified as well as neonatal and child deaths, stillbirths and abortions. Findings: A total of 10,540 women aged 15 to 49 years were interviewed during the PHS. The PHS captured 12.8% more pregnancies than the HDSS in the most recent year (2010–2011), though between 2006 and 2010 (earlier periods) the PHS captured only 137 (0.8%) more pregnancies overall. The PHS also consistently identified more stillbirths (18.2%), spontaneous abortions (94.5%) and induced abortions (185.8%) than the prospective HDSS update rounds. Conclusions: Surveillance sites are designed to prospectively track population-level outcomes. However, the PHS identified more pregnancy-related outcomes than the HDSS in this study. Asking about pregnancy and its outcomes may be a useful way to improve measurement of pregnancy outcomes. Further research is needed to identify the most effective methods of improving the capture of pregnancies and their outcomes within HDSS sites, household surveys and routine health information systems.

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“…Although they do not attempt to justify these particular choices, others have defended origination in the third trimester more thoroughly [7].…”

Section: Literaturementioning

confidence: 99%

“…It has been addressed in philosophy [1][2][3][4], global health [5][6][7], and cost-effectiveness analysis [8][9], amongst other disciplines. It could be defined at a single point in time, whether that be conception; the transition from embryo to fetus; the (ever-changing with technology) beginning of viability outside the womb; the onset of sentience and an ability to feel pain; birth; consciousness, which almost certainly comes after birth; or some other point altogether.…”

Section: Introductionmentioning

confidence: 99%

Perceptions Regarding the Value of Life Before and After Birth

Jamison¹

2016

Reprod Syst Sex Disord

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Objective: This paper aims to explain the practical importance of placing a numeric value on the relative values of lives (or deaths) at different ages, including just before and after birth, and to implement one feasible method for estimating concrete inputs into such values. Methods:The study population consisted of an online convenience sample of 1628 unique individuals. They were each asked to fill out a short survey consisting of six demographic questions and one question requesting an explicit comparison of numbers of lives saved across groups of humans at different ages. Subjects were randomized into one of ten treatment conditions, where each condition involved a different comparison. The age groups which were asked about consisted of fetuses at 10 and 39 weeks gestation; pregnant women at 10 and 39 weeks gestation; infants in the first week of life; 1-year-old children; and adult women. Results:On average respondents valued younger fetuses less than more developed ones; fetuses less than children; children less than adult women; and women less than pregnant women. However, there was no discernible difference in valuation between 39-week fetuses and early neonatal infants. Female subjects valued all fetuses and children (relative to adult women) more highly than did male subjects. Conclusion:Meaningful data can be collected about sensitive topics using online experiments. In this case we find support for a continuously growing valuation of life with developmental age, starting early in gestation and without any sudden jump at birth.

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Stillbirth should be given greater priority on the global health agenda

Abstract: Stillbirths are largely excluded from international measures of mortality and morbidity. Zeshan Qureshi and colleagues argue that stillbirth should be higher on the global health agenda.

Cited by 28 publications

References 32 publications

All bereaved parents are entitled to good care after stillbirth: a mixed‐methods multicentre study (INSIGHT)

All bereaved parents are entitled to good care after stillbirth: a mixed‐methods multicentre study (INSIGHT)

Comparing performance of methods used to identify pregnant women, pregnancy outcomes, and child mortality in the Iganga-Mayuge Health and Demographic Surveillance Site, Uganda

Perceptions Regarding the Value of Life Before and After Birth

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