Stillbirth is a tragic event and has a profound impact on families. It is a global health crisis, as Dr Margaret Murphy, Programme Director BSc Midwifery, School of Nursing and Midwifery, University College Cork, explains and addresses ways research and resources are aiming to prevent and support those who experience stillbirth and miscarriage.
Stillbirth, the loss of a baby before or during birth, represents a profound global health crisis. Every day, the world witnesses the tragedy of over 5,000 stillbirths, translating to nearly 2 million families experiencing this devastating loss annually. This burden is not evenly distributed, 98% of stillbirths occur in low- and middle-income countries, with rural and marginalised populations bearing a disproportionate share.
The impact of stillbirth extends far beyond the immediate loss of life. It encompasses:
· Bereavement and Trauma: The emotional toll on families, including grief, trauma, and psychological distress, is immense.
· Social and Economic Consequences: Stigma, social isolation, and economic hardship compound the suffering, particularly in resource-limited settings.
Despite its magnitude, stillbirth has historically been overlooked in global health initiatives. While the Millennium Development Goals and Sustainable Development Goals focused on reducing neonatal mortality, stillbirth prevention received comparatively little attention and therefore funding. It is acknowledged that interventions aimed at reducing neonatal deaths will have a positive impact on stillbirth rates, highlighting the interconnectedness of these issues. The World Health Organization (WHO 2014) responded to the crisis of stillbirth and newborn deaths with Every Newborn Action Plan (ENAP), a roadmap for ending preventable deaths. This plan emphasises the importance of improving the quality of maternal and newborn care, strengthening health systems, and addressing inequities in access to care.
Many stillbirths are preventable especially if access to quality maternal healthcare is available. A significant proportion of stillbirths, approximately 40%, occur during labour, underscoring the critical role of skilled birth attendants, particularly midwives, in preventing these deaths. The “triple return on investment” concept highlights the importance of investing in skilled birth attendants, essential commodities, and well-functioning health systems to reduce stillbirth rates (ten Hoope Bender et al 2016). This is also echoed in ENAP – improving quality of care around the time of birth will save the most lives, but this requires educated and equipped health workers, including those with midwifery skills, and availability of essential commodities (WHO 2014).
A grassroots response to rising global stillbirth rates was the establishment of the International Stillbirth Alliance the only organisation focused on stillbirth and neonatal death at a global level that integrates bereaved family members, clinicians, researchers, and policy makers. ISA’s whose mission is to raise awareness and promote global collaboration for the prevention of stillbirth and newborn death and provision of appropriate respectful care for all those affected
In Ireland stillbirth remains a significant pregnancy complication. The National Perinatal Epidemiology Centre (NPEC) 2022 data reported 192 stillbirths, 98 early neonatal deaths, and 34 late neonatal deaths (NPEC,2024). The Perinatal Mortality Rate (PMR) was 5.31 deaths per 1,000 total births; corrected for Major Congenital Anomaly (MCA), the rate was 3.75 per 1,000 total births; the stillbirth rate was 3.51 per 1,000 total births (corrected stillbirth rate was 2.69 per 1,000 total births). The perinatal mortality rate is comparable to the EU average. The NPEC report shows that maternal age, and socio-economic factors play a role in the rate of stillbirth. Key findings from Irish data include increased risk associated with maternal age (under 25 and over 40), overrepresentation of certain ethnic groups, such as Irish Travellers and Asian ethnicities, strong association between low birthweight and stillbirth. Data also shows that placental conditions, and congenital anomalies are a leading cause of stillbirth in Ireland (NPEC 2024).
One of the recommendations from the NPEC report is that all healthcare professionals (obstetricians, GPs and midwives) should see every interaction with a woman as an opportunity to address weight, nutrition and lifestyle to optimise her health. This also supports the HSE Programme ‘Making Every Contact Count’ (MECC). ‘’The NPEC advocates the introduction and use of a ‘Care Bundle’ approach to lower perinatal mortality; similar approaches in other countries have achieved a reduction. ‘’
The Health Service Executive, National Women and Infants Programme has published several updated clinical practice guidelines on First Trimester Miscarriage, Assessment and Management of Recurrent Miscarriage, and Stillbirth- Prevention, Investigation, Management, and Care
In addition to late pregnancy loss, miscarriage i.e. pregnancy loss at less than 24 weeks gestation remains the most common complication of pregnancy. One in four pregnancies will end in loss, and for some people, it occurs more than once. However, despite how common it is, or how early the loss has occurred, having a miscarriage can be a very distressing life event.
The Pregnancy Loss Research Group was established and leads national research to better understand pregnancy loss experiences and impacts, and the development of resources and evidence-based advice and interventions, to improve health care (quality) and health and social outcomes for women, babies and their families. The group has developed an excellent online resource
On April 2nd the Pregnancy Loss Research Group has launched a suite of resources to improve the care of people who experience miscarriage and recurrent miscarriage.
These were developed as part of the Health Research Board-funded RE: CURRENT study – with the involvement of people with lived experience, health professionals and decision-makers in the maternity services – resources include:
· Information booklets on miscarriage and recurrent miscarriage
· Multi-lingual videos regarding information and supports around recurrent miscarriage in various languages: Arabic, Catalan, English, French, Greek, Irish, Irish Sign Language, Italian, Polish, Portuguese, Romanian, Russian and Spanish. More languages will follow
· An appointment letter template for recurrent miscarriage clinics
· A checklist for use within emergency rooms/departments for staff to use when people initially present with signs or symptoms of miscarriage
· Case studies of hospital spaces.
With the support of the National Women and Infants Programme, printed copies of the information booklets have been distributed to all 19 maternity hospitals/units. All the resources are available to view/download via the Pregnancy and Infant Loss Ireland Website, with information booklets and videos also available on the Cork Miscarriage Website .
References
San Lazaro Campillo I, Manning E, Corcoran P, Keane J, McKernan J, Greene RA, on behalf of the Perinatal Mortality National Clinical Audit Governance Committee. Perinatal Mortality National Clinical Audit in Ireland Annual Report 2022. Cork: National Perinatal Epidemiology Centre, 2024. https://www.ucc.ie/en/npec/clinical-audits/
ten Hoope-Bender, P., Stenberg, K. and Sweeny, K., 2016. Reductions in stillbirths—more than a triple return on investment. The Lancet, 387(10018), pp. e14-e16.
World Health Organization (2014) Every Newborn: an action plan to end preventable deaths. Geneva: WHO Every Newborn Action Plan
Dr Margaret Murphy
Programme Director BSc Midwifery, School of Nursing and Midwifery, University College Cork https://research.ucc.ie/profiles/[email protected]
Contact details [email protected]