Stillbirth Certification

Dan Poulter Excerpts

Wednesday 31st October 2012 Westminster Hall

[The Parliamentary Under-Secretary of State for Health (Dr Daniel Poulter)]

Thank you, Mr Owen, for calling me to speak. It is a great pleasure to serve under your chairmanship; like my hon. Friend the Member for Daventry (Chris Heaton-Harris), it is the first time that I have done so.

I pay particular tribute to my hon. Friend for raising this matter in Westminster Hall today. He and I have worked together in the past to raise awareness of the need to do more to support those families who have had the terrible experience of stillbirth. We have also worked together in the past to discuss the need for greater research in this area. He is absolutely right to highlight a number of the issues that he has raised today, and I will deal with the issues that he has raised in turn.

In my own medical career as a doctor, I have never seen anything more tragic than either a very badly injured or ill child, or a dead baby. The death of a baby is probably the worst situation that I came across, and losing a child is the worst experience for family and friends; it lives with people for ever. For some families, there is no coming to terms with the death of a child. It is a very difficult thing to live with and we must continue to do all we can to support those families, working with Sands and the other organisations that do a very good job in supporting those families; we must continue to do more.

My hon. Friend quite rightly highlighted the unacceptable regional variation in stillbirths. From the figures for 2011, we know that the strategic health authority for the north-east of England reported 5.8 stillbirths per 1,000 live births, whereas the SHAs for the east of England and the south-west of England reported 4.7 stillbirths per 1,000 live births. As I say, that is an unacceptable variation. There is an acknowledgment by the Royal College of Obstetricians and Gynaecologists, by the Royal College of Midwives and by Sands and many organisations that we need to do more to reduce the rate of stillbirths in this country. We must continue to do more to research the factors that cause stillbirth. As my hon. Friend said, in many cases the cause of a stillbirth is still unclear. We also need to continue to crack down on this unacceptable regional variation, and learn where there is good practice in combating and reducing stillbirth rates and where the NHS is doing things better, so that that good practice can be rolled out across the country.

As I said, the death of a baby, whether during pregnancy or following birth, is probably the worst tragedy that anybody can face, and that is true both from the point of view of a health care professional and from a family’s perspective. Stillbirth is not only the loss of a child, but the loss of all the hopes and dreams that the family would have had about what that baby would have become and what it would have meant to them in the years ahead. That is why it is particularly important that this is an area that we continue to focus on, to reduce stillbirth rates and so that both the Department of Health and medical professionals take this issue increasingly seriously. As my hon. Friend rightly highlighted, our stillbirth rates are 33rd out of 35 high-income nations and as a country we need to do better than that and improve on those rates.

[Jonathan Lord]

I am glad to hear my hon. Friend the Minister and my hon. Friend the Member for Daventry (Chris Heaton-Harris) talk about the work of Sands. I myself have had constituents come to me with the help of Sands, and my hon. Friend the Minister speaks very well about that organisation and about the real hurt of those families who have suffered a stillbirth.

However, could my hon. Friend the Minister just give us a little bit more information as to why he thinks the stillbirth rates in this country are higher than they should be, and why they are higher than the rates in many other western countries? What are the reasons behind that? That is the crucial thing—to stop this terrible tragedy happening to other families.

[Dr Poulter]

I thank my hon. Friend for that question, and he makes a very good point. As we have said today, we have high stillbirth rates in this country. One factor that the Royal College of Obstetricians and Gynaecologists has picked up on is the fact that there are sometimes variations in clinical practice, including in picking up on early warning signs that we know are associated with stillbirth, for example reduced foetal movements during pregnancy. That sort of thing always concerned me as a front-line professional and it concerns many midwives.

However, we need to have in place across the NHS better systems so that professionals can work with women to identify those early warning signs that something may be wrong in a pregnancy and to ensure that women come in quickly and seek help, or hopefully, rather than seeking help because something is going wrong, in many cases they can seek reassurance. However, where things are not right for a baby, we must ensure that the medical help is on hand to intervene quickly and to support the pregnant woman and hopefully mum-to-be.

There are parallels that can be drawn between where we are now with stillbirths and the situation with cot deaths a number of years ago. Back in the 1980s, the cot death rate was very high, peaking at 2.3 deaths per 1,000 live births in 1988. Following the launch of the “Back to Sleep” campaign in the early 1990s, the rate declined dramatically, falling to 0.6 deaths per 1,000 live births in 1995. This reduction has continued as awareness of the key messages on reducing the risk of cot death has increased. By 2010, the rate was 0.22 per 1,000 live births. To put that in real life rather than statistical terms, we are actually talking about a reduction from some 3,000 cot deaths a year to 300 or 400, which is not perfect, because we still have babies dying of cot death, but raising awareness and targeting cot death has proved to be an effective way of reducing rates. That is something we can learn from in the discussion we are having today about stillbirth.

The point that all hon. Members have made today is that the decline in stillbirths in the United Kingdom has not kept pace with that of comparable countries. According to The Lancet, we rank 33rd in the world for stillbirths. We need to ensure that we do better and take this issue seriously.

Both my hon. Friends have spoken about Sands. It is worth highlighting what that organisation has done. It provides tremendous support for families who find themselves in very difficult situations. It has highlighted the vital importance of the Government and the medical profession—midwives are taking this issue on board and are taking it more seriously—supporting families to make sure that in future pregnant women and families do not have to suffer the problems associated with stillbirth.

Sands has raised a number of issues, including research, which we have talked about and which I will come on to in a moment, and the fact that action is required to raise awareness, as we saw with cot death in the past, of the known risk factors for stillbirth so that prospective parents can make better choices and understand what could go wrong in pregnancy and what the warning signs may be—for example, reduced foetal movements. We need to ensure that parents are informed and that health care professionals know how to support parents and pregnant mums to help them to recognise the warning signs. They need to provide reassurance and care where appropriate and need to intervene when very serious concerns are raised.

We have said that it is not acceptable that the UK has one of the worst stillbirth rates in the developed world. We have developed a stillbirth prevention work programme, which my hon. Friend the Member for Daventry alluded to earlier. The Government are taking this piece of work very seriously, in conjunction with the Royal College of Midwives, the Royal College of Obstetricians and Gynaecologists, and the NHS to help to iron out the unacceptable variations in practice and the unacceptable regional variations that we have talked about.

The development of this work programme has been informed by a workshop jointly hosted by Sands and the Department of Health, which took place on 1 March this year. Discussions focused on key areas such as raising awareness and improving identification of babies at risk and improving perinatal reviews. We are continuing with this work to ensure that we can put that into practice throughout the NHS so that we provide pregnant mums with the support that they deserve.

My hon. Friend rightly raised the issue of research. It is important that we fully understand stillbirths. We do not always know what the cause of a stillbirth was. It is important that we do research and look into what the unknown causes and reasons might be. What are the factors that cause stillbirths? We know some of the causes; we do not know all of them. Continuing to research and focus on that is important.

The Government have funded a number of research programmes. Most recently, the Department has funded research through the National Institute for Health Research and the policy research programme. An estimated spend relating to maternal and foetal health has increased from £4.4 million in 2006-07 to £12.7 million in 2010-11. The issue of improving foetal health, babies’ health and maternal health is something that we take very seriously.

Working with Sands, the Department’s policy research programme has funded a policy research unit in maternal health and care at the national perinatal epidemiology unit at Oxford university. Research themes focus particularly on pregnancy loss, perinatal morbidity, maternal morbidity and maternal mortality.

The National Institute for Health Research in Cambridge has an ongoing programme of research on women’s health. A major focus of that research is understanding the determinants of stillbirth risk and using that understanding to improve clinical care of pregnant women. Indeed, last week I visited Manchester where there is a very high quality of care for pregnant women and for newborn babies. The university of Manchester’s maternal and foetal health research centre is currently leading projects in understanding the reasons for stillbirth. I know it will be looking to feed that in nationally so that we can continue to reduce stillbirth rates.

Research on its own is not enough. When we have the research, we have to ensure that we get it out there to the professionals, sharing it and the information from that with parents, to help them to make informed choices about their care and to be aware of the risks and the possible warning signs of stillbirth. Raising awareness is so important. It is an issue highlighted in particular by the Royal College of Midwives and the Royal College of Obstetricians and Gynaecologists. They have said that there is unacceptable variation, as we have accepted in this Chamber, in the rate of stillbirth and in how some health care professionals interact with families and pregnant women during pregnancy. Working up national guidelines that focus on professionals supporting families, as well as being aware of the other factors, is an important part of reducing stillbirth.

Another point made by my hon. Friend is that families who have suffered a stillbirth have not always received good bereavement support. We know that a lot of care and attention has been paid to ensure that more support and care is given to families—the royal colleges have taken that on board—and we are looking seriously at how we can provide more support. Many hospitals and trusts have invested in bereavement rooms and quiet areas for families when they have had early pregnancy loss or a stillbirth. That is right, because although maternity things generally go well and we have a good outcome, when things go badly we need to ensure that we are prepared and have a supportive environment to look after families in such circumstances.

Finally, it is important to focus on certification, an issue raised by my hon. Friend. I will look into the matter in more detail and get back to him in writing as well, rather than try to put together an answer in the two or three minutes available to me. He made the point that some mums who give birth have to go through the whole birthing process—they actually give birth to a dead baby—and that is an incredibly traumatic and difficult thing to do, because they know that their baby is not alive. Some mums, however, have to do that. In such situations, although the law, with such things as birth and death certificates, is there for good reason, the human reality is sometimes not recognised in the law as effectively as we might like. There will, though, sometimes be difficulties with law, however we have it. As best we can, we have tried to mitigate such situations by beginning to provide more supportive environments for parents after a stillbirth and by providing certificates recognising that there has been a stillbirth after 24 weeks. That goes some way towards recognising the difficult and tragic event—we recognise that a baby has been born, although the baby was not born alive. I will write to my hon. Friend in more detail in the next few weeks, because the issue deserves more than a few sentences at the end of the debate.

I thank my hon. Friend and pay tribute to his work on raising awareness of such an important issue. The Government are very much committed to taking forward our work with Sands and ensuring that we reduce stillbirth rates in this country, as well as providing more research to investigate the causes of stillbirth and better support for bereaved parents in what is perhaps the most difficult thing I have ever seen in my medical career.

Question put and agreed to.