Stillbirth has an enormous and devastating impact on parents and their wider families.
***Key Points***
Stillbirth is when a baby has no signs of life after 20 weeks of pregnancy.
Before 20 weeks it is known as a miscarriage.
In Australia, there are approximately 6 babies stillborn each day. This impacts around 2200 families each year.
Our rate of stillbirth in Australia is 7.4stillbirths per 1000 babies born.
There are evidence-based ways to reduce the likelihood of a stillbirth occurring. The information to follow helps you to understand these risk factors in 5 key areas.
We share this knowledge with you, so they can better understand and manage these risk factors.
***Key Points***
***5 key areas***
There are evidence-based ways to reduce the likelihood of a stillbirth occurring. The information to follow helps you to understand these risk factors in 5 key areas.
- Quit Smoking
- Monitor you baby’s growth
- Monitor your baby’s movements in pregnancy
- Sleep on your side
- Timing of birth
***5 key areas***
***Quit Smoking***
- Quit Smoking
Smoking cigarettes in pregnancy is one of the major contributors to stillbirth. Every time you smoke a cigarette it has an immediate effect on the baby. Nicotine reduces the flow of blood through the umbilical cord to your baby and some of the oxygen in your blood stream is replaced by carbon monoxide.
Your care provider will ask you about smoking cigarettes (or anything else) at your first visit for confirmation of pregnancy and at your booking visit.
Quitting at any time during pregnancy reduces the harm to your baby. However, planning to quit as early as you can means a better start in life for your baby.
What are the risks for my baby from my smoking?
Smoking during pregnancy increases your risk of miscarriage or stillbirth. Smoking increases the likelihood your baby may be born premature (before 37 weeks’ gestation), there is also an increased risk of placental problems, increased risk of Sudden Unexplained Death of an Infant (SUDI or cot death), low birthweight and breathing problems.
What can help you quit smoking in pregnancy?
Your care provider can help if you are thinking about quitting.
It is key to understand and help address your triggers and for some women, quit smoking products may be needed. They can assist you with a quit plan and behavioural support.
The most common counselling service offered by Health services is Quitline, which is staffed by specially trained counsellors who will support you to quite without judgement.
Contact your local Quitline for free on 13 7848 or download the ‘Quit for you – quit for two’ app designed for pregnant women
***Quit Smoking***
***Monitor as your baby grows***
- Monitor your Baby’s Growth
Big or small. Your baby’s growth matters.
Your pregnancy is unique to you and all women and babies are different. What is most important is a healthy rate of growth for your baby so your baby can reach its growth potential.
- Assessing your Risk: Early in pregnancy your risk for fetal growth restriction (FGR) will be assessed. For women at a higher risk of FGR it may be necessary to monitor the growth of your baby with regular ultrasound.
- Measure: At each antenatal visit from 24 weeks onwards, your baby’s growth will be measured and plotted on a growth chart.
You can plot your baby’s growth on the growth chart yourself within the app.
- Monitor: If your baby is growing slower than expected, increased monitoring may be required, and any concerns will be discussed with you.
What is Fetal Growth Restriction?
Fetal Growth Restriction (FGR) is when a baby is growing slower than expected and indicates that the baby is not reaching it’s growth potential.
How will my baby’s growth be measured?
Starting from 24 weeks the growth of your baby will be measured at each of your antenatal visits. Your maternity healthcare professional will use a measuring tape to measure the size of your abdomen. This is called the symphysial fundal height (SFH). This measurement should be plotted on a growth chart and shows your babies growth over the period of your pregnancy.
For some women it may be necessary to monitor the growth of your baby by ultrasound.
Why is my baby growing at a slower rate – what is causing this?
If a baby is growing slower than expected your maternity healthcare professional should investigate the cause. At times this may be related to the placenta and how it is working but sometimes a cause cannot be found.
What can I do to monitor my baby’s health?
It’s important to come to each antenatal visit to have your baby’s growth checked. Additionally, every baby has its own unique pattern of movements, which you will get to know. If your baby’s movements pattern changes, you should always let you maternity healthcare professional know.
***Monitor as your baby grows***
***Monitor movements***
3.Monitor your Baby’s Movements in pregnancy
Your baby’s movements really do matter
Being aware of your baby’s movements during pregnancy is one of the simplest things you can do to know your baby safe and healthy. Regular and healthy movements are a good indication of your baby’s wellbeing.
You will start to feel your baby move between weeks 16 and 24 of pregnancy, regardless of where your placenta lies, and you should feel your baby’s movements right up until they are born,
There is no set number of normal movements. You should get to know your baby’s movements and what is normal for them.
A baby’s movements can be described as anything from a flutter or kick, to swish and roll. These are signs that your little one is well! When babies become unwell, they may slow down their movements in order conserve energy- this could be an early indication of something being wrong with them so contact your care provider immediately if you have any concerns about changes in activity levels.
It’s important that this information be shared with partners, family and friends so that they too can understand the importance of your babies’ movements.
Common myths about baby movements
It is not true that babies move less towards the end of pregnancy. You should continue to feel your baby move right up to the time you go into labour and whilst you are in labour too.
If you are concerned about your baby’s movements, having something to eat or drink to stimulate your baby does not work. This is outdated advice. You should always phone your care provider
Guide to help you to get to know your baby’s movements:
Sit or lie down in a quiet place, try to relax, and focus on feeling your baby’s movements
Some babies are more active than others. Its important to get to know your baby. The easiest way to learn your baby’s normal pattern of movement is to choose a time when baby is usually active and focus on their movements. You may wish to record each movement you feel but be mindful of any changes in strength of the movements as well as the number.
If you are still concerned about your baby’s movements after doing this, contact your doctor of midwife that very day or night. Your doctor of midwife might suggest that you take some time to focus on movements, so let your doctor of midwife know that you have already done this. You do not have to wait until the end of the suggested recording period of 2 hours to contact them.
What if I am concerned about my baby’s movements?
If at any point you are concerned about your baby’s movements, please contact your doctor or midwife. It is very common for pregnant women to have concerns about their baby at some point in their pregnancy. It is part of the natural role of a mother or mother-to-be to do things to look after your baby and your midwife or doctor is there to help you, no matter what time of night or day.
Please don’t feel silly about contacting your doctor of midwife if you want to. And remember that no one knows your baby better than you do. It’s your body and your baby, so trust your instincts.
What happens at hospital?
If you have contacted your doctor or midwife and your doctor or midwife suggests that you come in to hospital, there are a few things that you can expect to happen.
First, your doctor or midwife will likely ask you questions about any known risk factors or issues you might have had during pregnancy. Then he or she may do a CTG (cardiotocograph)1. This will involve placing an elastic belt around your belly to measure your baby’s heart rate. Your doctor or midwife will also feel your belly to see where your baby is positioned and to check his or her growth.
After this, your doctor or midwife might do an ultrasound of your baby if this has not been done recently (1). You may have had an ultrasound scan in early pregnancy to work out your gestation. Ultrasound scans can also be used to measure your baby’s heart rate and blood flow, and to check on growth.
Your doctor or midwife may also do a blood test.
***Monitor movements***
***Sleep on your side***
4. Sleep on your Side
Research shows that going-to-sleep on your side from 28 weeks of pregnancy can halve your risk of stillbirth, compared to going-to-sleep on your back.
After 28 weeks of pregnancy, lying on your back presses on major blood vessels which can reduce blood flow to your uterus and the oxygen supply to your baby.
You can go to sleep on either the left or the right side – either side is fine. It’s normal to change position during sleep and many pregnant women wake up on their back. That’s OK! The important thing is to start every sleep lying on your side (both for daytime naps and at night). If you wake up on your back, just roll over on your side
***Sleep on your side***
***Timing of birth***
5. Timing of Birth
If there are health concerns that might increase your risk of stillbirth, your health care professional will discuss with you how the timing of birth might reduce risks, with your pregnancy continuing as long as it is safe for you and your baby.
We talk a lot about shared decision making in pregnancy and this is one of the key times where it is important decisions about whether you wait for labour to begin on its own is the best option for your baby.
For all pregnancies, there’s an optimal time for a baby to be born. If your pregnancy is healthy and progressing without any issues, then waiting for labour to begin on its own is the ideal plan.
Through research we’re discovering that every week your baby continues to grow inside you makes a difference to their short- and long-term health and developmental outcomes
***Timing of birth***
Resources
Stillbirth Centre of Research Excellence
The Safer Baby Bundle
Safer Baby Bundle flyer
