Why Are So Many Preventable Stillbirths Happening?

Trigger warning: child loss

An explosive study out of the Journal of Obstetrics and Gynecology made some shocking findings about the United States’ rate of stillbirths. In the study, researchers defined stillbirth as occurring after 24 weeks and excluded fetuses with congenital deformity — then discovered that nearly 25% of stillbirths in the United States are preventable. The most common cause was placental insufficiency, or when the placenta is not adequately able to support the baby.

As if these findings weren’t bad enough, they get worse.

The Huffington Post reports that in the last decade, the United States’ rate of stillbirth decline has “largely flatlined,” while other wealthy countries, like the UK and Denmark, continue to see declines. Using a benchmark of 28 weeks, The Lancet reports the US to have a 3% stillbirth rate in 2013; Sweden’s was only 2.8% the same year, the same as Spain’s. Singapore hit 2%; Portugal 2.2%. All of these countries saw drops from their 1995 numbers. And so did the United States. But not as much of a drop.

This all may be related to the United States’ having the highest maternal mortality rate in the developed world. More Americans, reports NPR, die of pregnancy-related complications than in any developed nations — and only in the US is the number of women who die rising.

Moreover, federal and state funding shows that out of all the money allocated for “maternal and child health,” a staggering 6% goes to the health of the mother. Moms simply don’t get the cash to get the medical care they need. 60% of maternal deaths are preventable, found ProPublica. This just illustrates the amount of care showered on the baby — and the way the mother is ignored, leaving her to grope her own way through a medical system that’s not skewed in her best interest. Leaving her open to problems that may slip by an inattentive doctor or nurse.

That is, if she can get medical care at all during her pregnancy. According to ChildTrends, mothers who receive no prenatal care are more likely to lose their child. Many women, especially poor women, receive no or inadequate prenatal care — they can’t afford to miss work to get to doctor’s appointments or have no childcare. They may smoke or be on drugs — both risks for placental insufficiency, according to Healthline — or be undocumented, like an estimated 4.1 million women in 2008. They may be teens hiding their pregnancy.

Even if they are simply uninsured, like 11% of women are, there are serious barriers to care. The Health Journalism Center says, “Applying for [Medicaid] coverage once they’re pregnant means wading through a daunting form that’s 15 times the length of a 1040 tax form and then waiting for approval, which can take weeks.” Then you have to find a doctor that accepts Medicaid. Then you have to wait for an appointment. All of these barriers to care increase the risk of not seeing a doctor, which, in turn, increase the risk that a woman’s baby will be one of those preventable stillbirths.

Take the most common preventable cause of stillbirth: placental insufficiency. It can be screened for, but, as study author Robert Silver, professor of obstetrics and gynecology at the University of Utah Health Sciences Center, says, the tests to screen women for problems of the placenta are not as sensitive as they should be — and this for women who actually receive care.

“The problem, right now, is that our methods for screening for the placenta not working are relatively crude,” he said. “And they’re not very precise … so what we have to do is focus on developing better tests.”

We also have to focus on helping women who are smoking or doing drugs — with compassion, with kindness, and with understanding rather than judgment.

Another two major causes of preventable stillbirths are maternal hypertension (high blood pressure) and diabetes — both of which are very treatable (or preventable) with things like diet, exercise, and medication. I was a severe gestational diabetic, and my son was born with zero complications. I also received excellent prenatal care and knew enough to insist on a test at 12 weeks gestation, far earlier than most women get it, because I knew the signs. I was on immense amounts of insulin by the end of my pregnancy. If I hadn’t had prenatal care, my son may not have made it. And his death would have been 100% preventable.

We also need to level the playing field. According to the Huffington Post, the stillbirth rate for Black women is twice that of white and Asian women — and Black women are three times more likely than white women to die during childbirth. And if you’re poor and on Medicaid, you’re more likely to have a stillbirth. It’s the old American tale of the haves and have-nots, brutally played out in the delivery room.

It is not acceptable.

The good news is that we can fix this. Silver and his team recommends that we work on better detection for placental issues, and improvement on maternal health and delivery room complications. However, these are big problems, with lots of players, with lots of stakes. It discounts the women outside the system — and doesn’t offer them a way in, other than “get Medicaid.”

So, in the end, while it’s good to know why we have so many stillbirths, we’re left with our hands in the air, turning around and around, wondering what to do and who to help first. How do you triage when every death is equally preventable?