The stillbirth rate in Australia has remained largely unchanged over the last 30 years, with six babies stillborn every day around the country, as experts highlight the urgent need to remove stigma and taboo around the issue.

“No words can describe the feeling of dread and shock that come with being told your baby does not have a heartbeat”, said Heidi and Ned Mules, whose daughter, Sophie, was stillborn on 7 December in 2011.

“The next thing that comes is disbelief that this is even possible. How could our baby, who we had seen healthy and normal on the ultrasound the day before, suddenly pass away?”

“We knew that it was possible for a baby to be stillborn, but of course we didn’t think it could happen to us because we didn’t personally know anyone who had lost a baby, it was never mentioned as a possibility by our doctors and there is generally very little public awareness of stillbirth”, said the Mules family.

Jane Wiggill, Chief Midwife at Red Nose Australia, told HealthTimes that "stillbirth is a topic that historically hasn't really been spoken about.”

“There seems to be a lot of shame around stillbirth and miscarriage, and there just shouldn't be. We need to make conversations open and honest, so that this becomes a normal topic that gets spoken about and not something that we shy away from." 

Ms Wiggill was commenting on a recently published paper in the peer-reviewed Stillbirth Series, which highlighted how Australia’s late gestation stillbirth rate was over 30% higher than that of the best-performing countries globally.

Lead author of the paper Professor Vicki Flenady, Director of the Stillbirth Centre of Research Excellence (Stillbirth CRE), told HealthTimes that almost 2,200 families each year are affected by stillbirth in Australia.

“In the past, stillbirth was often viewed as a private tragedy, rather than a public policy issue. The 2018 Senate Inquiry into Stillbirth Research and Education was a turning point in Australia, validating the silent pain and suffering of so many families.”

The Mules family said that in the aftermath of Sophie’s death, they felt very lucky to have the support of their family and friends.

“They were all as shocked as we were to learn how common stillbirth is in Australia and how little is known about its causes and indicators.”

In more recent years, research has been able to identify some key risk factors associated with stillbirth risk including smoking, fetal growth restriction, decreased foetal movements (strength or frequency), hypertension, diabetes, obesity, pregnancy beyond 41 weeks’ gestation, maternal age over 35 years, and previous stillbirth.

However, Professor Flenady added that “nearly 40% of stillbirths that occur after 28 weeks’ gestation in Australia are unexplained.”

Ms Wiggill emphasised the importance of health practitioners having open conversations with women about stillbirth – despite how difficult a topic it may feel to raise.

"We understand it’s a hard thing, because there’s a fine line between wanting to inform your patient, without inducing extra anxiety.”

“We already have this underlying feeling of worry for our babies before they're born, so it’s a balance between being really open about the possibility that stillbirth can happen, but be reassuring that there are things you can do, and risk minimisation approaches to help protect the pregnancy and protect your baby.”

“This includes being really in tune with your baby's movements, and that if you notice any change to those whatsoever, you call for help straight away and never wait till the next day. You'll never waste anyone’s time if it’s a false alarm.”

“We also know now that maternal side sleeping is something mothers can do to help reduce the risk of stillbirth – certainly in late term pregnancy – and this is all about ensuring good blood flow and placenta to the baby.”

“Also, really important is the cessation of smoking - that's a huge risk factor for stillbirth, and that carries on to SIDS as well".

Professor Flenady agreed. “I’d advise maternity healthcare workers that women want to understand all the risks associated with pregnancy, especially since there are positive things that they can do to reduce the risk of stillbirth.”

“Education and training can help maternity health providers communicate the risk factors for stillbirth. All women should be assessed early in pregnancy for the presence of risk factors and subsequent care should be planned accordingly.”

“It's essential to have these open discussions to arm women with the knowledge they need to have a safer pregnancy.”

Professor Flenady said research to date indicates that in up to 30% of stillbirths, the quality of maternal care provided is a contributing factor to death.

“It is hoped the Safer Baby Bundle, which is being implemented around Australia, will reduce the numbers of these deaths through improving pregnancy care. The Safer Baby Bundle is a set of a set of clinical recommendations designed to reduce the rate of late pregnancy stillbirth (from 28 weeks) by 20 per cent.”

The Safer Baby Bundle is focused on five risk factors:

1. Supporting women to stop smoking in pregnancy.
2. Improving detection and management of fetal growth restriction.
3. Raising awareness and improving care for women with decreased fetal movements.
4. Improving awareness of sleeping on either side after 28 weeks, which can halve the risk of stillbirth compared to going to sleep on your back.
5. Improving shared decision-making about the timing of birth for women with risk factors for stillbirth.

Both Ms Wiggill and Professor Flenady agreed on the need for more awareness-raising initiatives in the community.

“Raising awareness and removing stigma around stillbirth is vital. This includes sharing stories, including parent and advocate voices in policy making, and ensuring respectful investigations and care after stillbirth”, said Professor Flenady.

Ms Wiggill said that early next year, Red Nose Australia will launch a broad-based stillbirth awareness campaign.

“It’s all about educating women and their families about all the things that they can do to prevent stillbirth, and it's centred around the side sleeping message and smoking cessation.

“The goal is to get the information out there, but also make sure that it is accessible to everyone and that it’s easy to understand.”