No parents-to-be should ever have to leave hospital without their baby, but sadly thousands of parents each year experience the indescribable heartache of losing a child to stillbirth or neonatal death.
While stillbirth rates have reduced in recent years, neonatal deaths have plateaued. But the life-long impact of knowing a stillbirth or neonatal death could have been avoided remains devastating and painful for families.
What is the difference between a stillbirth and neonatal death?
Stillbirth is where a baby dies in the womb after 24 weeks gestation; they are born without any signs of life - no heartbeat, no breath taken. The loss of a baby before 24 weeks is classed as a miscarriage. Neonatal death is where a baby is born alive but dies within the first 28 days of life.
One in 200 births are stillbirths – that’s around 3,000 a year or nine every day. A third of all stillbirths occur after 37 weeks gestation, so it is important for expectant mothers, particularly in the latter stages of the third trimester, to seek immediate advice from their community midwife if they are worried about anything or are experiencing reduced movements. Reduced movement is noticed in half of stillbirth cases.
By law, the difference between stillbirth and neonatal death is that a still born child and its mother are legally classed as one single entity. This means that the claim is brought as the mother’s claim. Whereas in a neonatal death case, there is not only a claim for the mother (or father) but there is also a claim for the estate of the deceased baby.
Why do stillbirths or neonatal deaths happen?
Not all stillbirths or neonatal deaths are preventable and a large proportion occur in seemingly healthy babies. However, around 100 babies a year are stillborn because of trauma or an event that was not well-managed or anticipated.
The main cause of stillbirth is complications with the placenta which links the blood supply between mum and baby. This may be placental abruption (where the placenta separates from the womb) or insufficient placenta (where blood supply between mother and baby is affected). It is hoped that more research into placenta complications will improve detection and result in better maternal care.
Other causes of stillbirth may be:
- Bleeding before/during labour
- Pre-eclampsia or high maternal blood pressure
- Umbilical cord problems, i.e., prolapse
- ICP liver disease
- Infection such as Group B Strep, E.coli, rubella, flu, listeria or sexually transmitted infections
- Birth defect
Causes for neonatal death can include:
- Complications in labour
- Failures in resuscitation post delivery
- Poor neonatal care
Will doctors be able to tell me why my baby died?
To find the cause of a stillbirth, many tests should be offered postnatally. These may be blood tests to check for pre-eclampsia or diabetes; urine samples or samples from the cervix to check for signs of vaginal infection; examination of the umbilical cord, placenta and membrane; thyroid checks; and genetic testing.
Sometimes a cause cannot be determined and around 60 percent of stillbirths are unexplained. A post-mortem may be offered, particularly in violent or unnatural circumstances or where cause of stillbirth is unknown. This cannot go ahead without the mother’s written consent. As things stand, currently there is no right to an inquest where a baby is stillborn. In neonatal deaths, a coroner may hold an inquest into the neonate’s death to determine the cause.
Are there any risk factors of stillbirth or neonatal death?
A baby not growing steadily should be a main concern for stillbirth, which is why attending antenatal check-ups is so important. A midwife will check the growth and wellbeing of a baby and if measurements trail off, it could be a sign there are complications with the placenta.
Other risk factors include twin or multiple pregnancies, smoking, alcohol consumption, or drug use during pregnancy. If a mother is aged over 35, obese (with a BMI over 30), or has pre-existing health conditions, her risk of stillbirth may increase.
How could I reduce my risk of stillbirth or neonatal death?
Along with stopping smoking, drinking alcohol and recreational drug use, you should limit caffeine consumption in pregnancy. These can all lead to a baby being born prematurely which increases the risk of complications before or shortly after birth.
To prevent stillbirth, it is also advised that you don’t sleep on your back after 28 weeks pregnant. Attending all of your antenatal appointments to monitor baby’s growth and having the flu vaccine when offered will also reduce your risk.
Infant mortality caused by clinical negligence
As previously highlighted, not all stillbirths are preventable. However, there are occasions where substandard medical practice results in a baby dying before birth. Common examples include:
- Failure to act on reduced movements – pregnant mothers should not be ignored or told not to worry if they experience a reduction in antenatal movements. Midwifery teams should monitor the baby in utero. There may also be failures regarding monitoring in hospital, particularly lack of foetal heart rate monitoring or incorrect interpretation of cardiotocography (CTG).
- Failure to identify growth restrictions – if it is presumed during regular antenatal check-ups that foetal growth has trailed off or slowed down, the mother should be regularly monitored and assessed with growth scans. Sometimes, there is a failure to measure the fundal height (the vertical height of your pregnant belly), or measurements are incorrectly plotted on the growth chart which can result in misdiagnosis. Towards the end of pregnancy, the only way to safely deal with growth restrictions is to induce labour and deliver the baby.
- Failure to detect placental abruption – if a pregnant woman is presenting pain (and possibly bleeding) caused by the placenta pulling away from the womb, there may be a failure to recognise these as signs of placental abruption, resulting in a delay to provide adequate care for her and her unborn child. There may also be a failure to recognise the risks of abruption, such as pre-eclampsia or growth restrictions.
- Failure to treat group B strep – this is a common bacterial infection found in the vagina and is normally harmless. But if it spreads to the baby during vaginal delivery, it can make them seriously ill. Sometimes it can be fatal. If GBS is suspected, antibiotics should be given before labour. There may be a delay or total failure to administer this, or results may not be followed up after birth.
- Mismanagement of high-risk mothers – mothers over 40, who have conceived via IVF or with conditions such as diabetes and pre-eclampsia should be closely monitored throughout their pregnancy. Often, they should not be allowed to reach 40 weeks before delivering their baby due to an increased risk of stillbirth after 37 weeks.
Can you claim compensation for stillbirth or neonatal death?
No amount of money will change what happened and no parents ever choose to make a medical negligence claim simply to compensate for the loss of their child. Most want answers as to what happened and why, and to ensure no other families go through the same harrowing experience.
However, any monies that are recovered through a medical negligence claim for stillbirth or neonatal death can be used in a positive way, such as to pay for private counselling for psychiatric injuries or grief.
If you are making a claim for the loss of a baby due to stillbirth, it is important to note that the claim will be by the mother for her injury. This will usually be compensation for the pain and suffering of a psychiatric injury caused by the death of her unborn child, as well as loss of satisfaction of bringing a pregnancy to conclusion. Secondary victims, such as the other parent, may also be able to claim for psychological injuries. Because stillbirth legally classes a mother and her unborn child as a single entity, statutory compensation for bereavement is not awarded. However, a stillbirth claim can account for financial losses such as funeral expenses, money spent preparing for the pregnancy (i.e., essentials such as cot, pram etc), counselling, fertility treatment for future pregnancies, loss of earnings for time off work due to grief and even the costs of having another child delivered at a private hospital.
For neonatal death claims, the claim is for the mother and the estate of the deceased child. A fixed sum bereavement award is given which is £12,980 for deaths before 1 May 2020, and £15,120 thereafter. This statutory award is available either to the mother or to the parents of the deceased child (split equally between the two parents). Again, financial losses as above can be claimed including compensation for psychological harm for secondary victims like the baby’s father or close relative, such as a grandparent who witnessed the traumatic events.