The Department of Health answers our questions

What is the department doing to reduce the number of stillbirths in Northern Ireland?

The death of a baby is always a tragic loss for the families involved however the Department would wish to reassure women in Northern Ireland that stillbirth rates are similar across the UK and in line with many other developed countries.

The stillbirth rates of the UK nations are approximately 4 stillbirths in every 1,000 births. As the number of stillbirths is small, there will always be a small change in rates from year to year.

Northern Ireland has been fully involved in the long running series of confidential enquiries into maternal and child deaths including stillbirths. While this work is being reviewed at present the Public Health Agency is continuing to collect data relating to stillbirths to ensure trends are understood and any lessons are learnt for future practice.

The Department has endorsed the NICE guidelines on Antenatal Care which are designed to ensure best outcomes for mothers and babies.

How many stillbirths were there in Northern Ireland over each of the last five years (2005-2010), broken down into figures for each year?

Year Stillbirths

2005 96

2006 100

2007 109

2008 118

2009 120

2010 107

Source: KP19 Departmental Return

Information shown for 2010 is provisional and may be subject to change.

Should post-mortem examinations be carried out with all stillbirths? Are they always offered to parents?

The parents make the decision to hold a post-mortem examination. The departmental regional care pathway for women who have had a miscarriage, stillbirth or neonatal death indicates that post-mortem examination should be discussed by appropriately trained staff, with the parents. A copy of the care pathway is available on the DHSSPS website. Over 90% of parents are offered post-mortem examination following stillbirth. Around 60% of these decide to have a post-mortem examination.

Many stillbirths are “unexplained” and in pregnancies previously considered low risk. Is enough done to investigate the causes and learn from them?

The series of confidential enquiries highlights risk factors for stillbirths. In the majority of cases there are factors associated with either the development of the baby or obstetric complications in the mother. Just under 30% of stillbirths have no known cause. In addition Trusts investigate stillbirths as part of ongoing clinical governance.

Why do the number of stillbirth deaths recorded by NISRA not match CEMACH (The Confidential Enquiry into Maternal and Child Health) statistics? For example, in 2004 NISRA states there were 118 stillbirths in NI, compared with 113 recorded by CEMACH? And in 2003 CEMACH says there were 111 stillbirths in NI, compared with 108 recorded by NISRA. Is the department concerned by this discrepancy? Can it be explained?

CEMACH (NI) records all stillbirths that have died from the 1st January – to 31st December of year of death. NISRA records all stillbirths that have been registered that year. Therefore, looking at the figures 2003/2004:

1. a stillbirth could have occurred in the previous year (say end of December) and not registered until the following year (January).

2. a stillbirth is classified as 24 weeks gestation, but a mother might have lost her baby at 23 weeks +5 days gestation, CEMACH (NI) identify this as a Late Fetal Loss but the mother might want it registered as a stillbirth.

All reports highlight that CMACH figures will not match GRO/NISRA figures.

Has anything been done by the department since the launch of the Every Baby Matters briefing by Bliss, SANDS and Tiny Life last year?

This report made a number of recommendations many of which are being considered by the department, for example public health initiatives to reduce the risk factors for stillbirths and continuity of care are being considered as part of the maternity review currently ongoing. A neonatal evaluation of the current service is ongoing and will consider the compliance with BAPM standards and the impact of transfers. Neonatal transport service has been established.

What does the department think of the recent Lancet report on stillbirths which found that stillbirth rates in the UK are higher than in almost any other high-income country?

The department and the Public Health Agency are aware of the series of reports in the Lancet. The report on “National regional and worldwide estimates of stillbirth rates” drew attention to the problems of data collection across different countries, including lack of statistics, differences in definition of still births and using data from several sources. It estimates the stillbirth rate for the UK to be similar to the whole high income region.

The CEMACH report published earlier this year said that a separate report was compiled on each maternity provider in Northern Ireland – please send me a copy of each of these reports and any report which summarises Northern Ireland as a whole.

Individual reports are issued directly to the trust and therefore you should contact trusts regarding these. The NI report shows that the NI rate of stillbirths is the same as the rest of the UK, and that each trust has stillbirth rates within the statistically expected range.

Please also send me a comment on the recent legal settlement between Siobhan Desmond and Altnagelvin Hospital. Siobhan’s son Axel was stillborn in 2001.

The department would wish to offer its condolences to the family. The death of a baby in any circumstances is a very tragic and traumatic event for everyone involved. While maternity services in Northern Ireland are of a high quality the department is committed to continuously improving services for pregnant women.