Save the ground floor first

Last week I attended a Study Group devoted to encouraging and prioritizing research into stillbirth.  I didn’t want to go – these things are often talking shops, and I was unsure whether stillbirth really needed money throwing at it.  But SANDS, the excellent Stillbirth And Neonatal Death Support group charity were behind the initiative, and the head of the group, my colleague Gordon Smith was persuasive.   I was glad I turned up. 

Gordon reminded us that death before, during or immediately after birth is far more common than later deaths in childhood, and potentially easier to prevent than childhood or prematurity related deaths.  He compared the billions we spend saving babies from the consequences of extreme prematurity, sometimes even after delivering them early, with the little or nothing we devote  to those term babies who die unexpectedly before birth. 

We might spend hundreds of thousands of pounds saving the life of a 24 week premature baby, often to leave them with long term handicap.  In contrast a simple labour induction costing a few pounds might convert a term stillbirth to a full life in perfect health.

Of course it’s not that simple.  We can’t reliably predict who will die, so we would have to induce many mothers to prevent one stillbirth, and we might end up causing extra Caesarean deliveries.  But perhaps it would be worth it.  Induction doesn’t increase Caesareans by all that much.  Maybe we could develop better induction methods.  Or we could develop better ways to predict who will die.   Whatever else we could be a bit less defeatist. 

Gordon drew a vivid analogy.  It would be crazy for firemen called to a burning high rise to set up ladders to free people trapped on the top floor before unlocking the ground floor to free the people trapped there.  Do the easy stuff first.

I agree.  It’s time to look for a way to unlock the term uterus and free those big healthy babies who are dying undelivered.  It can’t be that difficult.   

Jim Thornton