First national standard for nurses and midwives to reduce stillbirth rates: Q&A

An Australian-first standard has been released to educate healthcare workers, including nurses and midwives, about the prevention of stillbirths and care for families.

Each day, six babies are stillborn across the country.

For 30 per cent of these cases, the medical reason is unknown.

The Australian Commission on Safety and Quality in Health Care has issued a new Stillbirth Clinical Care Standard to support midwives caring for families who experienced a perinatal loss.

Clinical director associate professor Liz Marles said that continuity of care is crucial to minimise trauma families might experience.

"It's vital all workers involved in a person's care recognise what that person needs, but that's not always the case," Marles said.

"There are quite a lot of practical things that we can do to make it easier for them."

Join Nursing Review in a conversation with Marles about the role of healthcare workers in supporting families after a perinatal loss.

NR: Why was this standard needed and what information does it include?

LM: This is the first national standard we've had to try to reduce stillbirth rates in Australia. It has information about before you plan a pregnancy to the period during pregnancy and birth. Then, if a stillbirth occurs, the standard gives you guidance on managing the investigations and the conversations, bereavement care, and planning for another pregnancy if that's where the family wants to.

So, it's a comprehensive roadmap that covers the entire journey and looks at how we can improve outcomes by standardising care across the board from that very first moment of planning a pregnancy, reducing risks before you even get pregnant, all the way through to following up after a stillbirth has occurred.

What are some of the causes behind stillbirths? 

Even though six babies are stillborn every day, roughly one in 140 pregnancies will result in a stillbirth. Thirty per cent of those stillbirths are still unexplained. We don't know what the cause is.

Because of that, we think that maybe 20 to 30 per cent of these stillbirths are preventable. We know that other countries, like the United Kingdom, have managed to reduce the stillbirth rate.

Unfortunately, we're not going to be able to prevent every stillbirth. So where there are foetal abnormalities and unavoidable things that have occurred congenitally, we can't change that.

But we can certainly try and reduce some of the other risks by optimising the mother's health, for instance, if she's got any underlying health conditions like diabetes.

We need to ensure we address all the risks and have systems in place to support women, like high-quality ultrasounds, and also have regular reviews so we can notice a change in their baby's movements.

What stigma is there around stillbirths, and what challenges might that cause for nurses and midwives?

First and foremost, we probably don't discuss the issue as a risk. When someone's just gotten pregnant or planning a pregnancy, we don't talk about the risk of stillbirth in the same way that we might speak of the risk of a miscarriage, for instance. We've become quite good at talking to women about reducing the risk of SIDS, sudden infant death syndrome, and occurrence for their child.

But we're still not very good at talking about reducing the risk of stillbirth. When a stillbirth does occur, it happens when people are expecting a moment of joy, and instead, they're faced with the most enormous sadness and tragedy. So that can be quite confronting for health workers and midwives to know how to manage that.

We need to put in place guidance for nurses and midwives and for anyone involved in that birth. We must guide them on what they can do, how they can talk about it and why it is essential to talk about it. That way, midwives can help parents to create memories with their child, for example.

We've got to help healthcare workers avoid adding to the stigma that may occur because they don't really know how they should respond.

How midwives and nurses can offer support and guidance after a stillbirth?

First, after parents have had a perinatal loss, we need to provide verbal and written information about the care that meets their health literacy, language and cultural needs. So, ensure that the information we give them is appropriate. 

It also helps to provide a private location that's quiet and separate - away from mothers and newborn babies if possible, because you can imagine how distressing that would be for the family. It also minimises a woman having to retell the story over and over. 

It's vital to assist all the workers involved in that person's care to recognise that the parents have had a perinatal loss. For instance, using a discreet symbol on the woman's room or healthcare record so that you know before going there that this person has had a perinatal loss. This allows the family to spend as much time with the baby in private, where healthcare workers and the family may want to consider taking the baby home to make memories like photos, take a lock of the baby's hair and make impressions of the baby's hand and footprints.

When it comes to discussing investigations or why this happened, that's often a huge question, "Why has this happened?" It's important to allow the parents to talk through their experience and what they feel may have contributed to the stillbirth.

There are quite a lot of practical things that we can do to make it easier. But it's also mostly about being prepared to talk about it in the first place in a way that is educated. For example, Stillbirth CRE has produced a module called IMPROVE, which is an educational module that educates midwives and other healthcare professionals.

Continuity of care is crucial here. When the woman is discharged from the hospital, providing continuity of care through the general practitioner with good communication is essential. As much as possible, we want to minimise the trauma for women and families who have experienced a stillbirth. 

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