Stillborn babies are ‘the collateral damage of the pandemic’

Stillborn babies are ‘the collateral damage of the pandemic’

According to new research, Melbourne mothers were more likely to have a preterm stillbirth during lockdowns than they were in the previous two years.

This is a unique finding, as the Victorian state government has imposed on Melbourne the longest, and arguably harshest, lockdown restrictions in the world; yet there have been minimal cases of pregnant mothers contracting Covid-19; and no mothers or babies dying as a result of Covid, for those who did contract it. 

This unique set of circumstances allowed researchers to assess the impact of lockdowns without needing to account for the impacts of the disease itself on pregnancy.

The reason for the uptick in stillborns is linked to disrupted maternal services. 

Changes made to Melbourne pregnancy care included more telehealth calls rather than face-to-face care, larger gaps between in-person visits, shorter in-person appointments, and changes to gestational diabetes screening and fetal growth monitoring.

These measures resulted in pregnant mothers spending less time in care and receiving a lower quality of care. As a consequence, health concerns, which would normally be picked up, were missed.

Specialist in midwifery at the University of South Australia in Adelaide, Jane Warland, says “What we’ve done is cause an unintended spike in stillbirth while trying to protect [pregnant women] from COVID-19”.

A recent survey of close to 3000 women by the Australian College of Midwives, asked women about “their experiences of maternity care during COVID-19”.

Associate Professor Jane Warland, University of South Australia international researcher and midwife, says that “The feedback has been telling”. 

“Women – first time mums particularly – are voicing their concerns about not being seen, forgotten, ignored and scared that their baby might be at risk without regular health checks.These comments mean that women are not receiving the kind of care they are entitled to in a country which prides itself on a first-class health system.”

Globally

But it isn’t just Melbourne that has seen an increase in stillbirths. Across the world, in countries rife with Covid-19 cases, there has also been an increase. Once again, the reasons are being attributed to reduced care for pregnant women due to lockdowns, rather than Covid-19.

There are those who might argue that the impact of Covid-19 on the healthcare system would have caused the same increase in stillbirth (irrespective of whether or not lockdowns were occurring); or even that the stillbirth rate would have been worse had there been no lockdowns to reduce the impact of Covid-19 on healthcare. 

However, the rates of stillbirth were the most dramatic, not when Covid cases became out of control, but when lockdowns were at their strictest.

The Lancet Global Health published the largest study to date on the rise in the stillbirth rate. The data examined 20,000 pregnant women across Nepal.

“It reported that stillbirths increased from 14 per 1,000 births before the country went into lockdown to stop the spread of the coronavirus in late March, to 21 per 1,000 births by the end of May — a rise of 50 per cent. The sharpest rise was observed during the first four weeks of the lockdown, under which people were allowed to leave their homes only to buy food and receive essential care.

“Pregnant women might have been unable to travel to health facilities for lack of public transport; in some cases, antenatal appointments were reportedly cancelled. Others might have avoided hospitals for fear of contracting SARS-CoV-2, the virus that causes COVID-19, or had consultations by phone or Internet. Disruptions brought about by the pandemic have also been linked to a rise in deaths from heart disease and diabetes.”

Ashish K.C., a perinatal epidemiologist at Uppsala University, Sweden says that “Nepal has made significant progress in the last 20 years in health outcomes for women and their babies, but the last few months have de-accelerated that progress”.

A similar trend can be observed in London. At St George’s Hospital there was “a nearly fourfold increase in the incidence of stillbirths...from 2.38 per 1,000 births between October 2019 and the end of January this year, to 9.31 per 1,000 births between February and mid-June.”

Asma Khalil, an obstetrician at St George’s, University of London, calls this “the collateral damage of the pandemic”. Saying that during lockdown, pregnant women may have developed undiagnosed complications but been hesitant to go to hospital because of Covid-19, and would therefore only seek treatment at the advanced stages of a problem, when less medically could be done.

India and Scotland have also observed an increase in the rate of stillbirths during the pandemic.

It’s clear that we’re starting to see the unintended consequences of lockdowns on health. Whilst governments around the world have tried to protect the health of their citizens, they have also inadvertently hurt people’s health; in this case some of the most vulnerable pregnant women and their unborn children.

Unfortunately, not enough notice was taken of those medical professionals and community members who raised a flag about the potential impact of lockdowns on other areas of health. 

Sadly, we’re at the stage where we will have to learn the lessons after the fact, and suffer the consequences of the impacts of lockdowns. The tragedy is that a portion of that burden will fall on the pregnant women who lost their babies.