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If we put aside the enormous emotional implications for a moment by definition, perinatal mortality refers to the numbers of babies who are stillborn, or those who die within the first week of their life per 10000 live births. Another name for this is perinatal death. Gaining an accurate estimate of the incidence of perinatal mortality relies on precise recording and completion of data by health care professionals. Only then can research be directed towards the ever important goal of lowering the numbers.
The perinatal mortality rate is a good indication of how a country is caring for its maternal and infant population. Funding, planning and improved health care for mothers and their babies is never wasted. It can provide a very small level of comfort to parents to know that through sharing their experiences, the risks are reduced for future generations of families who may be affected by perinatal mortality.
The major cause of perinatal mortality rate comes from babies who are stillborn at birth. This can be in association with prematurity, which accounts for nearly 30% of the numbers of neonatal deaths. Birth defects and respiratory distress syndrome due to prematurity also contribute to many of the figures.
Death of a baby can occur when it is still within the uterus and before labour has started. It can also happen during labour or shortly after birth. Sometimes, it is not possible to identify exactly when a baby’s death has occurred.
Stillbirth is what occurs when a baby dies whilst they are still in the uterus. When a pregnancy has reached 20 weeks of gestation, then stillbirth, rather than miscarriage becomes the correct terminology.
When a baby has passed 20 weeks of gestation and dies, their death must be registered and a burial or cremation performed.
It is a fact that having good quality, regular ante-natal care is the first step towards having a healthy pregnancy and delivering a healthy, live baby. However, this is not a guarantee. Avoiding risky behaviours such as smoking, drinking alcohol or taking illicit drugs, and aiming to stay well all help to support a healthy pregnancy and delivering a healthy, live baby at term.
If you fit into the category of having a high risk pregnancy or have experienced repeated miscarriages or stillbirths, then you will meet the criteria for specialist obstetric management. Many large maternity hospitals have teams of medical staff who specialise in complicated pregnancies.
A change, decrease or lack of foetal movements is one of the earliest signs of problems. Vaginal bleeding, abdominal pain, an impending feeling of doom or just a vague feeling that something is not right with the baby can all provide an indication of problems.
Ultimately, a diagnosis of foetal death is confirmed via ultrasound when there is an absence of a foetal heart beat. The sonographer may request a second opinion from a colleague to ensure that their diagnosis is accurate.
The tragic loss of a baby leads to many physical and emotional changes. After a baby dies in utero, labour will often commence spontaneously. The uterus will start contracting and/or the membranes will rupture. Some women prefer to have their labour medically initiated as soon as they are told their baby has died. They feel they want to have the pregnancy over and done with as soon as possible and will request a caesarian section delivery. Though understandable, this is not ideal. There is an increased likelihood of complications during and after caesarians and a much longer recovery period. This can also influence future labours and deliveries, potentially increasing the risks of complications in the future.
Some mothers feel they want to savour the remaining days of their pregnancy and have the opportunity to grieve for their baby whilst it is still a physical part of them. For this reason they decline offers of induction and aim to spend some time alone or with their family. Every woman is unique and there is no one right way to respond to the devastating news of their baby’s death.
Problems can arise though if delivery has not occurred within a week or so after the baby has died. There is a risk to the mother of contracting a blood clotting problem which could compromise her own health. For this reason, if labour has not spontaneously begun within a week, then an induction is recommended.
What about Kick Charts?
There is currently some disagreement regarding the value of mothers writing up kick charts to record their baby’s movements. Some experts report they lead to an unnecessary degree of anxiety and don’t allow for the normal peaks and flows of foetal movement and then relaxation. Others claim they are helpful and can alert a mother to potential problems.
For clarification on what is right for you, speak with your own health care provider.