Monique Rainford - HER HEALTH

As I approach the home straight of my first pregnancy, I can unequivocally say that feeling my baby move is my favourite part of this experience. It is a reminder of his or her presence and that this developing baby is a living being. It also strengthens the bonding experience. However, what if a baby stops moving?

I have had the difficult task of telling expectant mothers that their babies have died. I remember vividly some of these earliest experiences. For example, there was a young woman who had a routine clinic visit. She was within a week or two of her due date and she informed me that her baby had been moving. However, I was unable to detect the heartbeat. After completing her evaluation, it was confirmed that the foetus had died. I remember the grief of this mother as she had to give birth to her now lifeless baby.

I can also remember the experience of another woman at the same institution. Her loss was at about seven months into the pregnancy but her grief was no less. She had an extended stay in the hospital because of pregnancy-related complications and I remember her passionate groans and laments every time I visited the room.

Why do stillbirths occur?

But why do stillbirths happen and what can be done to prevent them?

If a woman has certain medical conditions, she is at a higher risk of stillbirth. These include lupus (systemic lupus erythematosus), kidney disease, high blood pressure ( hypertension), diabetes, thyroid disease that is not controlled and obesity.

However, these conditions represent less than one-third of the causes of stillbirth. Other causes include infection, abnormalities of the structure or the chromosomes of the foetus, growth problems of the baby and if the women remains pregnant for an excessive period of time (more than 41 to 42 weeks). Unfortunately, in at least 20 per cent of cases, cause is not found and this is more likely to be the case as the pregnancy is further along.

When a doctor delivers a stillborn baby, it is important that he or she carefully examines the baby for any abnormalities. Pictures should be taken, if possible, as well as weights and measurements of the stillborn baby. An autopsy should be done with the parents' permission. Special testing should be done on the placenta and foetal tissue, where possible. The mother's medical and obstetric histories should be thoroughly evaluated. Laboratory tests for the conditions mentioned earlier and for other possible related conditions should be carried out.

Regular antenatal visits can help a doctor identify possible causes of a stillbirth and to order tests when appropriate to ensure the foetus' well-being. It is important that the woman completes her tests and promptly follows up on the test results. A bio-physical profile uses an ultrasound to look for certain activities of the foetus such as movement and breathing. There is also an assessment of the amount of fluid around the foetus. The heart rate can also be traced on special monitors. The expectant mother's daily monitoring of foetal movement can also help to prevent foetal death.

Unfortunately, no obstetrician can prevent every stillbirth nor can every child's life be saved, but I encourage all expectant mothers to be partners in their own care. Please keep your antenatal appointments, pay attention to the movements of your developing baby and immediately notify your physician or visit your planned delivery hospital if your baby is not moving well.

Dr Monique Rainford is a consulting obstetrician and gynaecologist; email: yourhealth@gleanerjm.com.