Stillbirths

65 babies die every day in the second half of pregnancy in the US, which totals to 23,000 stillbirths annually in one of the most developed countries in the world. Although the rate of stillbirths has decreased in the US since 1990, it has recently begun to level off in the past two decades. From 2000 to 2015, the US stillbirth rate has decreased by only 0.4%, which shockingly contrasts the 6.8% drop in the Netherlands. This issue is awful and unacceptable, but it can be prevented if proper measures are taken.

Stillbirth is defined as the loss of a baby anytime after 20 weeks of a pregnancy. Some likely causes and contributors to stillbirth include problems with the placenta, birth defects, infections, problems with the umbilical cord, high blood pressure disorders, and maternal medical problems. A research project that studied over 500 stillbirths over the course of 2.5 years also determined that women were more likely to have a stillbirth if they experienced stress before their delivery. Furthermore, the risk of stillbirths was doubled or tripled when the mother smoked tobacco, marijuana, took prescription painkillers, or used illegal drugs during pregnancy.

A study analyzing 512 stillbirths showed that one quarter of stillbirths that were due to medical complications, placental insufficiency, multiple gestation, spontaneous preterm birth, or hypertensive disorders were all preventable. These preventable stillbirths were correlated with low socioeconomic status, public health insurance, and smoking.

The cause of stillbirths is never determined in one half to one third of stillbirths, and therefore labeled an anomaly. This statistic shows the lack of education, research, and attention surrounding the epidemic of stillbirths in the United States. One of the most shocking statistics regarding stillbirths is that 50% occur at or near full term, and many of the babies are completely healthy. This data further supports the claim from the well known organization, Every Mother Counts, that “almost all global maternal deaths can be prevented by ensuring that women have access to quality, respectful, and equitable maternity care.”

Among stillbirths in the US, major racial disparities exist. For instance, Black women are more than twice as likely to experience stillbirths. These stillbirths are more likely caused by infections or complications during labor which could stem from lack of access to quality healthcare, institutional bias, increased stress during pregnancy, and racism. However, the cause of these racial disparities is yet to be fully understood and studied through a statistical lens.

Many organizations like Every Mother Counts and Push Pregnancy have focused on advocating for greater research, raising awareness around stillbirths, and specifically cutting the US Stillbirth rate by 20% by 2030. However, there is still a dire lack of awareness and change surrounding this topic, many motivated mothers who have personally experienced stillbirth have begun to take action. After seeing the stillbirth rate in Scotland improve by 23% since the Children Quality Improvement Collaborative began in 2013, a young mother who lost her son to a preventable stillbirth took action to work with Ariadne and the Star Legacy Foundation to implement these proven preventative strategies through the Implementation Innovation Learning Collaborative. The goal of this program is to reduce the stillbirth rate by 15% and focus on hospitals predominantly serving Black women.

The shockingly high rate of stillbirths in the US not only highlights racial disparities in our healthcare system, but also sheds light on a major flaw in our medical system: 23,000 deaths per year that are preventable through greater awareness, effective fetal monitoring, and reducing smoking. Overall, a lack of information surrounding the causes of stillbirths exists, which is why it is imperative to invest in research surrounding this global health issue.

Edited by: Rohan Gupta

Graphic Designed by: Kidest Wolde

References

1. Mission & Values. PUSH Pregnancy. (n.d.). Retrieved October 23, 2022, from https://www.pushpregnancy.org/mission

2. Page, Jessica M. MD; Thorsten, Vanessa MPH; Reddy, Uma M. MD, MPH; Dudley, Donald J. MD; Hogue, Carol J. Rowland PhD; Saade, George R. MD; Pinar, Halit MD; Parker, Corette B. DrPH; Conway, Deborah MD; Stoll, Barbara J. MD; Coustan, Donald MD; Bukowski, Radek MD, PhD; Varner, Michael W. MD; Goldenberg, Robert L. MD; Gibbins, Karen MD; Silver, Robert M. MD. Potentially Preventable Stillbirth in a Diverse U.S. Cohort. Obstetrics & Gynecology: February 2018 - Volume 131 - Issue 2 - p 336-343 doi: 10.1097/AOG.0000000000002421

3. Centers for Disease Control and Prevention. (2022, September 29). What is stillbirth? Centers for Disease Control and Prevention. Retrieved October 23, 2022, from https://www.cdc.gov/ncbddd/stillbirth/facts.html#:~:text=Stillbirth%20affects%20about%201%20in,stillborn%20in%20the%20United%20States.&text=That%20is%20about%20the%20same,the%20first%20year%20of%20life

4. U.S. Department of Health and Human Services. (n.d.). What are possible causes of stillbirth? Eunice Kennedy Shriver National Institute of Child Health and Human Development. Retrieved October 23, 2022, from https://www.nichd.nih.gov/health/topics/stillbirth/topicinfo/causes#

5. Ibid

6. Ibid

7. Page, Jessica M. MD; Thorsten, Vanessa MPH; Reddy, Uma M. MD, MPH; Dudley, Donald J. MD; Hogue, Carol J. Rowland PhD; Saade, George R. MD; Pinar, Halit MD; Parker, Corette B. DrPH; Conway, Deborah MD; Stoll, Barbara J. MD; Coustan, Donald MD; Bukowski, Radek MD, PhD; Varner, Michael W. MD; Goldenberg, Robert L. MD; Gibbins, Karen MD; Silver, Robert M. MD. Potentially Preventable Stillbirth in a Diverse U.S. Cohort. Obstetrics & Gynecology: February 2018 - Volume 131 - Issue 2 - p 336-343 doi: 10.1097/AOG.0000000000002421

8. Ibid

9. Meshdesign. (2022, May 4). The issue. Every Mother Counts (EMC) | Improving Maternal Health. Retrieved October 23, 2022, from https://everymothercounts.org/our-story/the-issue/

10. Pruitt, S. M. (2020, September 17). Racial and ethnic disparities in fetal deaths - United States, 2015–2017S. Centers for Disease Control and Prevention. Retrieved October 23, 2022, from https://www.cdc.gov/mmwr/volumes/69/wr/mm6937a1.htm

11. U.S. Department of Health and Human Services. (n.d.). What are possible causes of stillbirth? Eunice Kennedy Shriver National Institute of Child Health and Human Development. Retrieved October 23, 2022, from https://www.nichd.nih.gov/health/topics/stillbirth/topicinfo/causes#

12. After A Death, Bringing Stillbirth Prevention To The US, Marny Smith, Health Affairs 2022 41:1, 147-149

13. Ibid