Spike in stillbirths caused by lockdown

[bd67thSaysReinstateLangCleg]

www.nature.com/articles/d41586-020-02618-5

Birth data from a large hospital in London showed a similar trend. In July, Asma Khalil, an obstetrician at St George’s, University of London, and her colleagues reported a nearly fourfold increase in the incidence of stillbirths at St George’s Hospital, from 2.38 per 1,000 births between October 2019 and the end of January this year, to 9.31 per 1,000 births between February and mid-June.

Khalil calls this the collateral damage of the pandemic. She says that during lockdown, pregnant women might have developed complications that were not diagnosed, and might have hesitated about coming to hospital and therefore been seen by doctors only when a complication was advanced, when less could be done.

Add to the list of ways in which the pandemic and how it's been mismanaged has disproportionately affected women.

I’m so sorry @BitOfFun

I’m 10 weeks pregnant and my husband is not allowed to attend my scans. I can go to the pub with him and my parents but not a scan where I find out if my pregnancy is viable. It’s bullshit.

I’ve had to pay privately for a scan earlier as if there’s bad news I want my husband there for support. I understand that’s not a viable financial option for every woman though. As always we’re second class citizens.

That's awful

BitofFun flowers

I gave birth during lockout, April and I was one of the lucky ones who was given appointments physically as i was in my third trimester. BUT after lockdown the diabetes clinic was a ghost town whereas before there used to be a lack of space and dh getting a seat was a gamble.

I don't know how the women in first and second trimester got their urine tested or had their blood pressure measured. Maybe they had other days or it turned to telephone conversation.

I personally feel like I had the best care. But during my last appointment with my obstetrician, she handed me my medication by hand. That was surprising, but she said some pharmacies were having trouble stocking medicines and with gp closing down to telephone consultation and only taking repeat perception orders by email only, a lot of her mothers were having trouble getting their medication on time.

@islandislandisland yeah that's what they say the reasons are! It's terrible!
My fasting levels were fine and so was my hba1c (this is the method they are using at the mo) so I wouldn't have been diagnosed! Even with the GTT I was one the cusp, had no glucose in my urine and I had GD. My baby was measuring small due to my placenta not working properly (a complication of GD) so I was induced at 37 weeks as they said she was better out than in! It was the correct decision. I probably would have lost her if we waited till 41 weeks undiagnosed 😔 xx

Just thought I'd add my experience.
I had complications with DC1 that could have ended in a stillbirth but was luckily picked up (by chance) just in time and he was delivered prematurely and is doing fine.
I was told due to this any future pregnancy would require consultant led care, medication and extra monitoring etc part of which included growth scans.
Found out I was pregnant just before pandemic. An absolute catalogue of errors/poor care from my maternity services but I've been really willing to overlook and be forgiving due to the circumstances. However I was told I wouldn't be receiving the monitoring I would normally and that there was a blanket ban on growth scans for all pregnant women at our trust unless a midwife referred them for one because they'd identified a problem.
I'd coped with all the other changes of care and appointments alone etc but this just felt completely unsafe to me. I was told there was no risk assessment for individuals it was a blanket ban.
I'm a HCP and this really didn't sit right with me, I looked up the Royal Colleges guidelines and NHS recommendations on this issue. They clearly state in someone with my history even on the lowest staffing capacity and during Covid I should be monitored, including growth scans. I emailed the evidence to my Trust who backtracked.
Those scans have picked up complications with this pregnancy that a midwife wouldn't and I'm currently under close observation by a fetal medicine specialist and in a really difficult period where the team is deciding whether baby is safer in or out.
I've had extremely poor care, poor communication, lost results, no results, some missed chances for treatment etc
However like I said I'm a HCP, to some extent I can manage my own risk and I have the education and ability to argue for care where I really feel it's been lacking.
In the next county all growth scans have been going ahead as normal.
I can well believe if there is a mix of different Trusts implementing restrictions incorrectly with women who aren't aware/empowered enough or scared to fight for care than bad outcomes will happen.
It shouldn't be such a lottery and it shouldn't be on the mum to advocate for basic care her and her baby are entitled too. Its a breeding ground for inequality and disparity of outcomes.
I feel like priorities during this epidemic have been really warped.
And this is of course a sex-based issue.
Losing a child can happen to both parents.
Poor maternal care happens to the mother.

@BitOfFun
I really feel for you.

I was having cancer treatment through lockdown. It’s really shown up the postcode lottery in ugly ways.

I gave birth 3 weeks ago and I would say there has definitely been a change in care. This is my 3rd pregnancy and I developed complications during pregnancy that were not picked up or monitored well. I also found post natal care to be not so good. I had a difficult birth that ended with 2 tears and 2 cuts, the Dr says i am unable to give birth naturally again. I was rushed out of hospital so quickly despite finding movement incredibly painful and it has been impossible to get medication or appointments for me and my baby. My daughter has had issues with feeding and reflux and I still can't get support. Thankfully I know a little about what I am doing but if I were a first time mum I would be struggling I think.

Maternity care has been treated as a nice to have, not an essential service. It is no surprise that if you remove the services that are specifically to support maternal health care that this is going to cause issues.

It honestly feels like pure arrogance to me that they thought they were so disposable. Clearly we're going to see the same happen in other areas where vital care has been removed.

@Wheresthebiffer2

In a still-birth, the dad-to-be also loses his baby, so it's not really true that this is a female issue. Is it? The parents both suffer the loss.

How about pregnancy? Do you consider that to be something both parents suffer any repercussions from equally as well?

I find it quite saddening that a mother of a woman who has just given birth seems to think her son in law would be just as hard-hit by a stillbirth as her daughter would be. If your own mum is so dismissive of her own daughter experiencing the most traumatic birth imaginable, then who does she have in her corner?

Of course poor maternity care for women is a feminist issue.

I also agree with a PP that it would take enormous political will to get maternity care back on track, and I don't think politicians really care enough about women-specific problems like this. I fear this level of care will become the "new normal".

So upsetting.

I fear this level of care will become the "new normal

The only hope I have that this won't be the case is that there is hardly any private maternity care to speak of outside London so there's going to be a critical mass of women impacted who will hopefully be vocal about it.

And sorry, to clarify, the type of woman who could normally opt out of NHS care I imagine have far more sway. Just because we always know money talks loud.

My dd was stillborn
Do not come at me with "it's a fathers loss too"
My body carried my dd, felt her kicks, nourished her, gave birth in the knowledge she was gone, my body bled, my milk that came in, my arms that ached to hold her, my "maternity leave" my ptsd, my lived horror.
Yes my dh was devestated, but this was not his personal physical horror-that is why it's a feminist issue,

God how awful. And for bitoffun. Awful all round.

As for the ‘what about the dads’ comment it really beggars belief that women can’t centre women in a discussion about failures of healthcare during pregnancy and labour meaning women have to go through the physical anguish of birthing a stillborn.

This makes me so sad. A stillbirth is truly awful (my DD died 18months ago) and so much effort and work has gone into lowering the rate it's horrible to see it increase again.

Too soon to blame lockdown for rising number of still births.

It would be interesting to compare stillbirth curve in countries that didn't lockdown.

Maybe covid itself causes foetal abnormalities and miscarriage.

@GingerAndTheBiscuits

I wonder if this goes someway to explain the “lack of babies in NICU” which was discussed at points during the mid-part of lockdown. I think the research is still being done but at the time it was hypothesised that babies weren’t being born early possibly because of a reduction in maternal stress with workplaces being closed. But perhaps it’s a much, much sadder explanation :(

Possibly not and if it does, not by that much.

This increase in stillbirths appears, so far, to be just St Georges hospital in UK (I can't find any reports for other UK hospitals despite St. Georges raising concerns about their own figures months ago). The Nepalese study is compromised by the swing to home births - which will likely be the less complicated births - and the lack of coverage of those stats. None of that is to say it isn't a concern and shouldn't be looked at, just that the data is far from conclusive that this is more than a localized issue.

Even if the Nepalese Study is documenting something that isn't skewed by its selection method while, obviously, everything counts, the drop in pre-term births is far, far greater than this increase in stillbirths (assuming the reports on prem rates are also documenting a real phenomenon and not just the result of normal variation or selective reporting).

Pre-term births are roughly 10% (so 100 in every thousand births) and are down 40% - 90%. So, splitting the difference, down by approx 65 in every thousand births. The Nepalese study and St George's saw stillbirths increase by about 7 in a thousand births. A good dent in the prem birth numbers but not really an explanation for the phenomenon as a whole.

Honestly, this makes me livid. When are we going to realise that vital care must continue? Someone, anyone with the power should have been tasked with working out how antenatal care could have been continued. The horrific stories we hear about women fighting for early scans when they were bleeding, having to wait until 12 weeks or between 12 and 20 weeks and attend the scan alone, being denied D&C and being sent home with pessaries to pass their babies over an extended, painful period. This has been barbaric.

I have no words for people who think there couldn’t have been protocol developed to protect mothers and babies.

Can we really fucking not “poor menz too” on the feminist board?

BitofFun I’m so sorry, that’s shit

@2bazookas it's not even clear, yet, that there is a rising number of stillbirths.

I'm so sorry deathswiftlyfollows and bitoffun.

Maybe covid itself causes foetal abnormalities and miscarriage.

We don't know that the women had coronavirus infections, and they probably didn't. Most people haven't had one yet.

This increase in stillbirths appears, so far, to be just St Georges hospital in UK (I can't find any reports for other UK hospitals despite St. Georges raising concerns about their own figures months ago).

Is it normal for hospitals to report their own stillbirth figures? Absence of evidence isn't evidence of absence and other hospitals may be keeping quiet.

The Nepalese study is compromised by the swing to home births - which will likely be the less complicated births

That's a legitimate criticism.

Amongst the things that help to reduce stillbirths are good, accessible, antenatal care, close monitoring of high risk mothers, and having a reliable birth partner to advocate for the woman.

All of which have been affected by lockdown and the changes to healthcare delivery. It’s devastating, but sadly not too surprising. Women need good perinatal care, pandemic or not.

A note of caution about the numbers though, which are small enough that percentages could look very skewed.

to bitoffun and anyone else whose healthcare has been affected.

Is it normal for hospitals to report their own stillbirth figures? Absence of evidence isn't evidence of absence and other hospitals may be keeping quiet.

Absolutely agree that absence of evidence isn't evidence of absence. But absence of evidence certainly isn't support for the claim!

I'm pointing out that the evidence we have for the claim that the pandemic has lead to increased stillbirths in the UK consists of the data from one hospital. To draw the conclusion that this is a national concern, let alone that it is one that is due to the policies implemented by the NHS as part of the pandemic response, requires quite a bit more than that.

We may well get more data that does indeed show that. We may not. Neither would be a huge surprise based on what we have now.

I’ve been reading through all these comments and nodding hard. I’m in my third trimester and absolutely agree that antenatal care has been treated as a ‘nice to have’ throughout lockdown. I’ve had to chase appointments, samples and blood pressure readings. My trust have lost so many of my blood test samples (including GTT) that I suspect they’re selling them on the dark web. Every time I go for a check up, someone is shocked at an oversight on the part of a previous midwife or sonographer. This week it was shock that I hadn’t been referred for a growth scan at my last appointment. Stories from other pregnant women in my area are all so similar and this is definitely a feminist issue.

I’m not surprised that women are reluctant to get things checked out either. I hated going to my clinic in March/April because staff were so hostile and receptionists wouldn’t even return my hello when I walked through the door. I recognise now that this stemmed from their own fear of Covid rather than hostility (they’re now quite lovely). But in the hormonal stages of early pregnancy during peak pandemic, I used to dread calling my community midwives to ask questions because they were so clearly stressed and brusque. I doubt I’d have gone in for fetal monitoring had it not been for the encouragement of the fab people on the Mumsnet pregnancy threads.

I’m usually pretty good at advocating for my own healthcare but pregnancy can make us so vulnerable. Add a pandemic and it’s a recipe for disaster. I used to volunteer at a clinic for undocumented migrants and the antenatal care those pregnant ladies received was definitely better than mine during this pandemic.