/ 3 June 2011

Education key to preventing stillbirths

It has to be one of most devastating tragedies to befall any parent -- when a baby in the womb develops health problems and fails to survive.

It has to be one of most devastating tragedies to befall any parent — when a baby in the womb develops health problems and fails to survive the full term.

Not to be confused with a miscarriage, which occurs when the foetus dies within the first 20 weeks of pregnancy, stillbirths occur any time after that. This is when the baby dies in the uterus, or within the birth canal, during labour or delivery.

Sadly, stillbirths are fairly common throughout the world, but there is a higher prevalence in developing countries, with 98% occurring in low- and middle-income countries.

South Africa has little to be proud of. As reported recently in Lancet, a leading medical journal, South Africa ranks 176 out of 193 countries for stillbirths. This amounts to an average of more than 61 a day, which is in addition to the 58 newborn deaths that occur daily.

Yet, pinpointing the exact cause is not easy. In fact it is estimated that in about 50% of cases the exact cause of death cannot be determined.

Some of the known causes include bacterial infection; birth defects such as pulmonary hypoplasia, when the baby’s lungs haven’t developed as they should; diseases afflicting the mother, such as diabetes and high blood pressure, including pre-eclampsia; the use of recreational drugs, alcohol and nicotine; physical trauma experienced by the mother; radiation poisoning; growth retardation when the foetus has experienced malnutrition; an abnormality in the baby’s chromosome make-up; Rh disease, which is a blood disorder; and intrahepatic cholestasis of pregnancy, which causes extreme itching without a rash and affects some women during the latter stages of their pregnancy.

One of the most common causes is when the umbilical cord twists around the baby and cuts off the flow of blood and oxygen. This is an extreme emergency that requires a doctor to be at hand within minutes.

Identical twins that share the same placenta and the same amniotic sac are always at some degree of risk of getting tangled in each other’s umbilical cords, which is why obstetricians recommend delivering the babies as early as 31 weeks of gestation.

Apart from women expecting multiple babies and those with pre-existing health conditions, other reasons that present serious high risk for unborn babies are smoking during pregnancy and the use of illicit drugs. Statistically, women over the age of 35 are also at higher risk.

Throughout the world, due to a better understanding of the causes of stillbirths, general advancements in medical research and improved treatments for expectant mothers, there has been a modest improvement in the number of stillbirths — a 1.1% drop to be exact.

But again, South Africa lags behind, with only a 0.9% improvement. It is obvious that the challenges affecting our country are immense, especially when one considers the understaffing in the ranks of experienced obstetricians and gynaecologists in our public healthcare facilities.

A key is to educate expectant mothers, especially those in rural areas, where infant mortality rates are highest. These women need to be taught how to minimise infections and the importance of routine antenatal screening and recognising conditions such as diabetes and high blood pressure.

Moreover, considering the shocking statistics of foetal alcohol syndrome in South Africa, it is obvious that drinking during pregnancy is par for the course in some parts of the country and has huge implications for the health and wellbeing of babies, born and unborn.

Again, education on preventing the use of alcohol, tobacco and illicit drugs during pregnancy has to be made available if we are to make a meaningful im­pact on our stillbirth statistics.

Stillbirth will be the topic of Bonitas House Call on June 11 on SABC2 at 9am

This article originally appeared in the Mail & Guardian newspaper as a sponsored feature