The video, titled 'We are all born of the stars', explains the origins of stillbirth in plain language, illustrating that mothers are not at fault when a baby is stillborn. It is accompanied by an article published in the American Journal of Obstetrics and Gynecology.
The team behind this collaborative project, spearheaded by the Mothers and Babies Research Centre at the HMRI, wanted to address common feelings of guilt in new mothers who have experienced stillbirth and believe they are to blame for their baby's death.
Ageing of the placenta
The project follows on from a 2019 discovery by the same team, which showed that unexplained stillbirth could result from the ageing of the placenta, a complex process unaffected by the behaviour of a pregnant mother.
"What many people don't realise is that the placenta is an organ of the baby, not the mother," explains HMRI lead Professor Roger Smith.
"As such, the mother has little to no control over that organ. She can't prevent the ageing from happening."
Placental ageing is just one of many possibilities for why stillbirths occur, though none are considered a direct result of action or inaction on the part of a mother.
Smith explains that, in a developing country like South Africa, fetal death may occur during the delivery for various reasons, including late presentation to a healthcare facility (especially in an emergency), inadequate healthcare facilities, or a lack of appropriately trained staff present during delivery.
"This differs from a fetal death during pregnancy [caused by an ageing placenta]. But, even in developing countries, it is still valuable for women who have experienced a stillbirth during pregnancy to know that it was not their fault," he says.
According to Bettercare, the primary causes of stillbirth can include hypertensive disorders, antepartum haemorrhaging, intrauterine or placental infections, birth trauma, fetal abnormalities, intrauterine growth restrictions and maternal disease.
In 22% of stillbirths in South Africa, the primary cause of death is unexplained. A simple explanation for grieving parents Nevertheless, the overwhelming guilt, anger, shame and confusion experienced by parents of stillborn babies are universal.
Smith and his team partnered with University of Newcastle artist Lee Dedman and composer David Banney. They aimed to combine science with art to cut through the complexity of stillbirth and reach grieving parents in a gentle and accessible way.
"I strongly believe in the power of animation to communicate complex science to a lay audience," says Smith, overseeing four Natural History postgraduate students currently illustrating complex scientific concepts, like quantum chemistry and the roles of different elements in human biology.
Concerning research and development around stillbirth, Smith and his team at the HMRI are developing drugs to prevent placental ageing. They are also working on a maternal blood test to help identify women at risk of stillbirth due to placental ageing.
In this way, women whose pregnancies are flagged as at-risk could schedule an early delivery to prevent fetal death.
To promote the video and additional information about stillbirth, the American Journal of Obstetrics and Gynecology has made the HMRI video freely available worldwide to obstetricians, midwives, and counselling services, who can use it as a tool to help grieving families.
How are South African parents of stillborn babies supported?
According to certified birth and bereavement doula Samala Kriedemann, there is no standard protocol that South African healthcare workers follow when a mother births a stillborn child.
"Stillbirth protocols vary from hospital to hospital. Very often, the staff members on duty can make a significant difference regarding how that birth is managed and what opportunities are given to the parents," says Kriedemann.
Parents who have lost a baby in birth or pregnancy have the right to see or hold their baby. Parents can also bathe or dress their baby, depending on the condition of the baby at birth, as well as their gestation.
"Best-case scenario is that a hospital understands how important it is for a mom and dad to be allowed to make some decisions around the birth of their baby. This can be very healing for couples," says Kriedemann.
While hospital protocols around stillbirth in South Africa are dependent on hospital group policy and, in the case of government hospitals, the National Department of Health, the buck often stops at maternity wards or midwife and obstetric units and their resident healthcare workers.
Kriedemann's hope as a bereavement facilitator and as someone who trains other bereavement facilitators is for all hospitals to have a proper stillbirth and birthing protocols and for the appropriate care processes to become standard for grieving parents.
"I've worked with many families who never got to see or hold their baby and had no memory-making opportunities. It can be extremely traumatic and difficult for them, especially in terms of closure. It just complicates the grieving and healing journey," she tells News24.
Kriedemann adds that many nurses and doctors are ill-equipped to handle grieving parents emotionally. According to several of the families she counsels, nurses and doctors are unsure how to appropriately deal with families facing a stillbirth.
They forget – or don't know – that these families need care and support before, during and after birth. Sometimes, they even struggle to make eye contact.
Anecdotally, couples who need to birth a stillborn child are often isolated and often left alone because nurses are busy supporting live births. Some couples even end up birthing the child themselves.
"It would also be amazing if midwives at hospitals were well trained in dealing with stillbirths from an emotional viewpoint, so that they manage those births and a couple appropriately, from the moment the couple arrives," she says.
Stillbirth rates in South Africa According to the latest statistics available, the average stillbirth rate in South Africa is between 12 and 20 per 1000 live births, against a worrying global average of 13.9.
This means that roughly 12 000 to 20 000 pregnancies end in stillbirth each year in South Africa, considering that around a million live births have been recorded in recent years.
According to Bettercare's Saving Mothers and Babies training manual, the stillbirth rate in South Africa is mainly inconclusive, as many deaths in South Africa are left unreported.
The stillbirth rate may also vary depending on several factors, such as whether babies under 1000g are included in the research parameters.
Better care also states that the stillbirth rate is more significant in rural and outlying areas than in cities.
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