Losing a baby in pregnancy through miscarriage or stillbirth is still a taboo subject worldwide, linked to stigma and shame. Many women still do not receive appropriate and respectful care when their baby dies during pregnancy or childbirth.
Miscarriage is the most common reason for losing a baby during pregnancy. Pregnancy loss is defined differently around the world, but in general a baby who dies before 28 weeks of pregnancy is referred to as a miscarriage, and babies who die at or after 28 weeks are stillbirths.
Every year, 2.6 million babies are stillborn, and many of these deaths are preventable. However, miscarriages and stillbirths are not systematically recorded, even in developed countries, suggesting that the numbers could be even higher.
Around the world, women have varied access to healthcare services, and hospitals and clinics in many countries are very often under-resourced and understaffed. Women who lose their babies are made to feel that should stay silent about their grief, either because miscarriage and stillbirth are still so common, or because they are perceived to be unavoidable.
All of this takes an enormous toll on women. Many women who lose a baby in pregnancy can go on to develop mental health issues that last for months or years — even when they have gone on to have healthy babies.
There are many reasons why a miscarriage may happen, including foetal abnormalities, the age of the mother, and infections, many of which are preventable, though pinpointing the exact reason is often challenging.
General advice on preventing miscarriage focuses on eating healthily, exercising, avoiding smoking, drugs and alcohol, limiting caffeine, controlling stress, and being of a healthy weight. This places the emphasis on lifestyle factors, which, in the absence of specific answers, can lead to women feeling guilty that they have caused their miscarriage.
As with other health issues such as mental health, around which there is tremendous taboo still, many women report that no matter their culture, education or upbringing, their friends and family do not want to talk about their loss. This seems to connect with the silence that shrouds talking about grief in general.
Stillbirths happen later in pregnancy, and 1 in 2 stillbirths occur during labour, many of which are preventable. Around 98% of stillbirths take place in low- and middle-income countries. Providing better quality of care during pregnancy and childbirth could prevent over half a million stillbirths worldwide. Even in high-income countries, substandard care is a significant factor in stillbirths.
There are clear ways in which to reduce the number of babies who die in pregnancy. Integrating the treatment of infections in pregnancy, foetal heart rate monitoring and labour surveillance, as part of an integrated care package could save 1.3 million babies who would otherwise have been stillborn.
How women are treated during pregnancy is linked to their sexual and reproductive rights, over which many women around the world do not have autonomy.
Putting women at the centre of their care is vital to a positive pregnancy experience – biomedical and physiological aspects of care need to be joined with social, cultural, emotional and psychological support.
To read some stories from around the globe, visit https://bit.ly/2TMLYG2