Nearly a quarter of all stillbirths in the United States are fully preventable, according to a new study exploring why the country has seen its declines in the stillbirth rate stall compared to other highly developed nations.
Since World War II, the number of stillbirths in America has dropped dramatically — from roughly 25 deaths per 1,000 live births 75 years ago to just under six deaths per 1,000 live births in 2013. But in the last decade, the U.S. rate has largely flatlined while other wealthy countries, from the Netherlands to the United Kingdom, continue to see further declines.
The new findings were published last week in the journal Obstetrics & Gynecology. “We’ve essentially plateaued relative to other high-income countries with similar demographics,” study author Dr. Robert Silver, a professor of obstetrics and gynecology at the University of Utah Health Sciences Center, told HuffPost.
The declining progress in preventing stillbirths in the U.S. is part of a broader failure to make strides on maternal and childhood health, despite enormous medical innovations. The U.S. has the highest maternal mortality rate in the developed world, and children born in America have a 70 percent greater chance of dying in childhood than those born in peer countries.
In their research, Silver and his team first set out to define the highly subjective notion of a “preventable” stillbirth. While some stillbirths remain unavoidable due to congenital defects, the researchers opted for what they saw as a reasonable benchmark by which better outcomes for improving stillbirth declines could be achieved.
Ultimately, they identified a number of preventable causes of death before or during childbirth, using diverse and representative data from the Stillbirth Collaborative Research Network. Those stillbirth deaths were most frequently due to maternal health disorders, problems during labor, complications due to multiple births, prematurity and problems with the placenta.
Though stillbirth is generally defined as fetal death after 20 weeks, the authors opted not to include babies born before 24 weeks or those with major fetal abnormalities. They said nearly one-quarter of the stillborn deaths in the U.S. were due to one or more of those preventable causes, and that the single biggest preventable cause was “placental insufficiency.”
The placenta provides the fetus with oxygen and nutrients, as well as performing other vital tasks. If the placenta does not develop normally, or is damaged, then a baby may not get the nutrition or oxygen it needs to thrive — and in severe cases, may die as a result.
There are tests to screen for minor and major complications with the placenta during pregnancy, but Silver argued they are not as sensitive as they should be.
Part of the issue, Silver said, is that doctors lack the advanced tools to screen women for potential complications.
“The problem, right now, is that our methods for screening for the placenta not working are relatively crude,” he said. “And they’re not very precise ... so what we have to do is focus on developing better tests.”
There are other preventable causes of death that can be addressed immediately, without developing new tests or technologies, the study authors found. Babies should not be dying as a result of maternal health complications like high blood pressure and diabetes, Silver argued, yet nearly half of the potentially preventable stillbirths in the U.S. were tied to maternal medical complications or hypertensive disorders of pregnancy.
Likewise, nearly 8 percent of the preventable stillbirths happened during labor and delivery, the research found.
“The three that are the lowest hanging fruit — in other words, the three that there are really, really good treatments that we know about today, but due to access or implementation we aren’t doing enough — are intrapartum stillbirth (so during labor); hypertensive disorders of pregnancy; and medical complications of pregnancy,” Silver said.
According to the study’s authors, the problem of stillbirths in the U.S. is also heavily impacted by inequality among women and families, particularly with regard to healthcare access.
According to the most recent estimates, the stillbirth rate for black women is more than twice that of white and Asian women — just as black women in the U.S. are at least three times more likely than white women to die during childbirth. In Silver’s study, preventable stillbirth was more common in poor women with public health insurance.
Those differences in access can partially explain the differences between the U.S. and its peers, who also have racially and economically-diverse populations. For example, the stillbirth rate in the Netherlands dropped by nearly 7 percent and the U.K. decreased by 1.4 percent from 2000 to 2015. During the same period, the U.S. only saw a 0.4 percent decline.
“A lot of it has to do with access,” Silver said. “I think that our ceiling is higher than a some other countries, but our floor is lower as a consequence of our health care system. So we can do a lot of really awesome things that other people can’t do, like heart transplants and stuff like that, but then we also have people with no or limited access who end up falling through the cracks.”
