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Concern that progress on reducing stillbirth may have stalled

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The rate of stillbirth and neonatal deaths in the UK remained about the same in 2016 as the year before, suggesting that progress in recent years may have stalled.

The report by MBRACE-UK, a research unit based at Oxford University, recorded a stillbirth rate for the UK in 2016 of 3.93 per 1000 births, up slightly from 3.87 in 2015.

“It’s saddening that today’s report shows there was little change in the rate”

Clea Harmer

The rate of neonatal mortality – babies who die within 28 days of birth – was 1.72 per 1,000 births, a slight decrease on the previous year’s figure of 1.74.

The Perinatal Mortality Surveillance Report said that the overall rate for stillbirth and neonatal deaths in the UK in 2016 was 5.64 per 1,000 births down from 6.04 in 2013. There was wide regional variation in rates of stillbirths and neonatal mortality, according to the report.

At country level, Wales had the highest rate of stillbirths at 4.44 per thousand births and Scotland the lowest at 3.67. For neonatal deaths Northern Ireland had the highest rate at 2.2 per thousand births and Wales the lowest at 1.43.

The time at which deaths were reported to MBRACE-UK also showed wide variation. Data entry was started within six months of a death for 95.1% of cases in Wales, 86.7% in England, 71.7% in Northern Ireland and 64% in Scotland.

Over the 2014-2016 period, there was a small increase in the consent rate for stillbirth post-mortems, up from 47.25% to 49.4%, the report said.

“The variation in stillbirth rates across the UK remains a concern”

Mandy Forrester

In all, 780,043 babies were born in 2016. There were 3,065 stillborn babies, 889 babies died between 22 and 24 weeks’ gestation, and 1,337 died in the first four weeks of life after 24 weeks’ gestation.

Dr Clea Harmer, chief executive of charity Sands, said that progress had stalled. She said: “It’s saddening that today’s report shows there was little change in the rate and overall number of babies who died between 2015 and 2016.

“It’s still the case that almost 15 babies died every day in the UK either before, during or shortly after birth in 2016,” she said.

Dr Harmer noted that the UK’s stillbirth rate remained “relatively high” among wealthy countries.

“Today’s report reminds us too that the wider societal picture is important. Poverty, inequality, ethnicity all increase a woman’s risk of losing her baby, as do smoking and obesity,” she noted.

“This is MBRRACE-UK’s fourth annual report and [it shows] once again that until we have a healthier, better informed, and more equal society, some women will remain at greater risk than others,” she added.

Sands

Clea Harmer

Clea Harmer

It remained to be seen whether the health secretary’s target of reducing stillbirths and neonatal deaths by 20% by 2020 was achievable, she said.

The Royal College of Midwives welcomed the improved survival rate for twins in recent years. The stillbirth rate for twins fell by 44% for the period of 2014 to 2016, while twins’ neonatal mortality fell by a third over that time.

“The variation in stillbirth rates across the UK remains a concern,” said Mandy Forrester, the RCM’s head of quality and standards.

“This could be because of the socio-economic wellbeing of communities – we know inequality is linked to higher stillbirth rates and poorer outcomes for babies,” she said. “It may also be in the quality of local services and this needs investigation.”

Health professionals must learn from “each of these tragic deaths”, said Ms Forrester.

“Maternity services must strive to learn from each other about the best ways to reduce stillbirths and neonatal deaths and improving data collection and sharing safety strategies is key to this,” she said.

Royal College of Midwives

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Mandy Forrester

The Royal College of Nursing welcomed the report but said it was “vital” that healthcare provision learnt from the investigation.

Carmel Bagness, the RCN’s professional lead for midwifery and women’s health, highlighted concerns around the continuing variation in post-mortem examination rates and delays in reporting data on neonatal and stillbirth deaths.

She noted that the RCN was developing a Bereavement Care pathway for Pregnancy and Baby Loss.

It was “one initiative that should help to create greater parity of care, as well as compassion to all those affected by such tragic losses,” said Ms Bagness.

She urged the government to continue investing in specialist units as well as public health messaging on smoking and obesity to help reduce risk factors.

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