We need to talk about stillbirth.

Emma Beck's second pregnancy in 2010 ended with an unexplained stillbirth at 36 weeks. At a routine antenatal appointment she discovered that her baby had died. Professor Gordon Smith from Cambridge University talks about the predictability of stillbirth; a third of deaths are unexplained. Joanne Watson, from Musgrove Hospital, Taunton, has a special unit for at risk pregnancies and have initiated a care bundle; they look at women who smoke, promote awareness of foetal movement, identify small babies and foetal monitoring. Smoking outside the unit is prevented by an audio loop of a child commenting on smoking behaviour. However, low risk mothers are not necessarily offered enough monitoring to discover problems with babies. Jane Laykin, bereavement support midwife, talks about a personalised service which looks at guessing the size of a baby more tailored to the mother rather than look at out of date growth charts which have been in use since the 1940s. Emma is given a personalised chart and discovers that her baby would not have been identified as at risk through this medium. A couple lost their second baby in a similar way; they also experienced a sudden stillbirth at 38 weeks. A doctor from St George's, London, talks about the ineffectiveness of this technique; instead they use a Doppler ultrasound for all first time mothers. This identifies problems with the placenta and the blood flow. One consideration for the future is the problem with the risk of over medicalising pregnancy for low risk mothers. Professor Gordon Smith has established a biobank of samples to work towards creating a simple blood test to identify placental problems. Another initiative, AFFIRM, is a scheme promoted by Professor Jane Norman director of the Edinburgh's Tommy's Centre which looks at empowering women to speak up when they are concerned about foetal movements. Dr Alex Heazell is researching problem pregnancies. There is concern about trialling new medicines especially in light of the thalidomide scandal. Heazell considers drugs which have already been trialled - he cites Viagra as a potential drug which can aid blood flow to the placenta. Standard antenatal care does not cater for the higher risk factor of having a stillbirth in subsequent pregnancies, but the Rainbow Clinic offers reassurance for parents and supports them through the stress of pregnancy and memories of their loss. Stillbirth is still a taboo subject, mentioned considered to be like discussing cancer in the 1960s - but things do look like they are improving.