Stillbirths significantly reduced over last 10 years
23rd September 2019
The rate of stillbirths is reducing for Māori and NZ European mothers, a report by the Perinatal and Maternal Mortality Review Committee (PMMRC) has found.
The PMMRC is an independent committee that reviews deaths of mothers and babies in New Zealand, and advises the Health Quality & Safety Commission on how to reduce those deaths. It also reviews cases of neonatal encephalopathy, which can be caused by lack of oxygen in babies during pregnancy or birth.
Committee chair Mr John Tait says he would like to acknowledge the mothers and babies whose lives have been lost, and the families and whānau who bear the grief of losing their loved ones.
‘It is their stories that allow us to strive for and promote system change to reduce preventable death.’
The report shows that the rate of stillbirth has significantly reduced overall since 2007, and has reduced for babies of Māori and NZ European mothers, but not for other ethnic groups.
Mr Tait says while, overall, these figures are very pleasing, there are still areas where urgent improvement is needed.
‘The rates of stillbirth for Indian and Pacific mothers remain significantly higher than those for NZ European mothers. We need to improve our models of care to meet the needs of all our mothers, but particularly our Indian and Pacific mothers.’
The report shows that the leading cause of perinatal-related death continues to be physical abnormality present from birth.
The report has a number of recommendations for the government and health sector. These include:
– funding of specific maternal mental health services, to improve maternal mental health with the flow on benefit to family/whānau and the community
– developing a consistent recommended way to support women/families/whānau when they have had a bereavement with a national perinatal bereavement pathway
– mandatory fortification of bread with folic acid to reduce preventable death and serious illness from neural tube defects
– improving the quality of ethnicity data in the National Maternity Collection so we can more clearly understand differences in care
– monitoring data by ethnicity related to maternity (for example, registration with lead maternity carer, preterm birth and induction of labour) to identify variation between ethnicities and work to improve those areas.
The report says bereavement care for families and whānau is inconsistent across DHBs.
Lisa Paraku, a consumer advisor to the committee, says bereaved parents, families and whānau are pleading for a national bereavement pathway ‘in the hope our grief journey can be as gentle as it can be’.
Currently, information for bereaved families and whānau, counselling and follow up care can differ widely depending on locality and circumstances. She says it’s time to be brave and create a system that serves all peoples, where, when and how they need it.
Mr Tait says the report highlights a number of other areas of concern.
‘There are significant lifelong health issues and risk of death to babies from neural tube defects, however there is strong evidence that mandatory fortification of food with folic acid reduces the prevalence of neural tube defects – and this is what the report calls for.
‘Until bread and flour fortification is implemented, folic acid should be provided for free. The benefits of this outweigh any potential adverse effects,’ he says.
The report says a system change for Māori mothers, babies and their whānau is urgently needed.
‘Māori women living in the poorest communities in Aotearoa experience the greatest loss from perinatal related deaths, though these inequities burden Māori whānau irrespective of their socioeconomic status.
‘It is also unacceptable that suicide is the leading cause of maternal death, with Māori mothers more than twice as likely to die as NZ European mothers.
‘PMMRC continues to see inequities in perinatal and maternal mortality and morbidity in New Zealand. It is increasingly acknowledged that racism is a determinant of health and a key driver of health inequities that disadvantage some groups and advantage others.
‘We will continue to highlight the need to raise awareness of, and employ strategies to eliminate both conscious and unconscious bias and institutional racism throughout our system,’ he says.
Maternal Morbidity Working Group annual report
The Maternal Morbidity Working Group also released its annual report today. The working group addresses systemic factors that may contribute to illness in pregnant or recently pregnant women and identifies opportunity for improvement.
The two conditions of focus in the report are peripartum hysterectomy and hypertensive disorders in pregnancy, such as pre-eclampsia.
Arawhetu Gray, co-chair of the working group, says this report is about real lives and making a difference for mothers and their whānau.
‘Women who bravely shared their experiences of being very unwell when pregnant have helped inform the working group’s recommendations. We are immensely grateful for their gift of personal narratives.’
The report shows Māori and Pacific women were over-represented in pregnant or recently pregnant women admitted to a high dependency unit and/or intensive care unit compared with non-Māori, non-Pacific women.
The report also provides updates on the maternal morbidity review toolkit and the maternity early warning system.
Ms Gray says they are looking forward to seeing how these quality improvement initiatives will be implemented to ultimately improve outcomes for mothers, babies and their families and whānau.
– A maternal death is the death of a woman while pregnant or within 42 days of the end of pregnancy.
– A perinatal death is the death of a baby from 20 weeks’ gestation (pregnancy) up to 27 days after birth. This includes stillborn babies. A neonatal death is the death of a live born baby from 20 weeks’ gestation (pregnancy) up to 27 days after birth.
– A stillbirth is a baby who is born from 20 weeks’ gestation (pregnancy) without any signs of life.
– A peripartum hysterectomy is a major operation where a woman’s uterus is removed during or immediately after delivery.
– Hypertensive disorders in pregnancy are characterised by high blood pressure and, often proteinuria (protein in urine). Approximately 5-10 percent of pregnancies in New Zealand are affected by hypertensive disorders in pregnancy.
Key findings, recommendations, and frequently asked questions attached.
Read the PMMRC report here: https://www.hqsc.govt.nz/our-programmes/mrc/pmmrc/publications-and-resources/publication/3823/.
Read the MMWG report here: https://www.hqsc.govt.nz/our-programmes/mrc/pmmrc/publications-and-resources/publication/3837/.