Stillbirth in Canada: A Call to Action
When she was in my womb, Little Judith was doing kickboxing, that much was obvious. She was full of energy, was moving frequently and was kicking hard. But at 37 weeks of pregnancy, I started noticing that my kickboxing baby was moving less frequently and kicking less hard.
Though slightly worried, I decided to wait a few days to speak with my doctor during my routine scheduled appointment. The doctor listened to a few heartbeats and told me it was normal to feel the baby move less towards the end of pregnancy. Reassured, I returned home.
Two days later, I could no longer feel my baby move. My husband and I made our way to the hospital but it was already too late: Little Judith’s heart had stopped beating. On Sept. 18, 2012, I delivered a baby girl, stillborn at 38 weeks of pregnancy. The autopsy report revealed that Little Judith was healthy and died from asphyxia, i.e., a lack of oxygen, caused by an inflammation of the umbilical cord. I now know that had I gone to the hospital a week sooner, Little Judith would probably be alive today.
In 2018, a House of Commons standing committee heard powerful witness testimonies from parents who, like me, have been affected by pregnancy and infant loss on what the government could do to ensure parents no longer suffer undue financial or emotional hardships after such a loss. Unfortunately, it did not lead to any concrete action. Moreover, the committee did not address what the government could do to prevent some of those losses from ever happening.
That same year, the Australian Senate established the Select Committee on Stillbirth Research and Education to report on the future of stillbirth research and education in Australia. In its report, the committee concluded:
“Stillbirth is one of the most devastating and profound events that any parent is ever likely to experience. It is 30 times more common than Sudden Infant Death Syndrome (SIDS) but stillbirth receives far less public or government attention than other infant and childhood deaths. Stillbirth is a hidden tragedy. The culture of silence around stillbirth means that parents and families who experience it are less likely to be prepared to deal with the personal, social and financial consequences. This failure to regard stillbirth as a public health issue also has significant consequences for the level of funding available for research and education, and for public awareness of the social and economic costs to the community as a whole.”
Similar to Australia, stillbirth is a public health issue that is neglected, invisible and absent in current Canadian public policies. Every year in Canada, more than 3,000 babies die in their mothers’ wombs. That’s 8.4 stillbirths every day. Research presented to the Australian committee estimated that for each stillbirth, there are another 99 births that narrowly avoided ending in death. In 2016, The Lancet published its series on ending preventable stillbirths, issuing a call to action for high-income countries as evidence shows that their stillbirth rate can be reduced further. For example, the Netherlands has reduced its stillbirth rate by an average of 6.8 per cent a year between 2000 and 2015 and Scotland saw a 19.5 per cent reduction in stillbirths between 2012 and 2015. In comparison, Canada’s stillbirth rate has not significantly improved in more than 20 years.
Countries that have taken action all have one central element to their strategies, and that is the implementation of care and education “bundles,” packages of information aimed at improving women’s health and pregnancy care. The Saving Babies’ Lives bundle, for example, contributed to a 20 per cent decrease in those maternity units in England where it was deployed. Australia is currently drafting its National Stillbirth Action and Implementation Plan that includes the Safer Baby Bundle and aims to reduce rates of stillbirth by 20 per cent or more over five years.
Raising awareness among pregnant women of the significance of fetal movements during the third trimester is an important component of care bundles. As Alexander Heazell, director of U.K.’s Tommy’s Maternal and Fetal Health Research Centre, explained at the 2011 Stillbirth Summit, the association between reduced fetal movements (RFM) and stillbirth has been known for years, but the importance of monitoring fetal movement is not communicated to all mothers and intervention by clinicians is not optimal. As I have found first-hand, this is still the case in Canada despite a 2007 recommendation from the Society of Obstetricians and Gynaecologists of Canada that all pregnant women be made aware of the significance of fetal movements in the third trimester and seek medical attention in case of RFM. Evidently, more concrete action is needed.
And Canada must act! That is why I have initiated a petition on the House of Commons website asking the Government of Canada to follow the lead of the aforementioned countries and take action to end preventable stillbirths in Canada. More specifically, the government should put in place:
1) A national committee to study stillbirth as a public health issue and make recommendations for reducing the number of cases; and
2) A national awareness campaign, similar to the one for SIDS, to inform pregnant women of the risk of stillbirth and the importance of fetal movement during the third trimester.
The petition is open until Feb. 4, 2021. We must tell the government that stillbirth is a national public health issue that needs to be addressed now. No parent should live through the death of their baby if that death can be prevented.