Our beautiful baby daughter Anabelle was born sleeping June 2010.
Blessed with the screaming arrivals of our gorgeous rainbow sons,
Alexander October 2011, Zachary November 2013 and Lucas July 2016.

After Anabelle - Raising Rainbows
Heartbreak. Joy. Death. Life. But most of all Love.

Saturday, 28 May 2011

The UK verses Finland

In the UK a baby is considered stillborn if born with no signs of life after 24 weeks gestation.  In other countries the limit ranges from 20-28 weeks gestation. To allow a comparison the Lancet report studied stillbirths across 193 countries after 28 weeks.  In the Lancet report (summary from Sands here)   the UK was ranked 33rd, one of the worst in rate amongst the 35 rich nations examined; France and Austria coming behind us. Since Thursday I've been thinking a lot about the stillbirth rate in the UK verses the stillbirth rate in the country identified as the least per 1000 births - that country was Finland.  Finland records stillbirths from 22 weeks gestation.

  • The UK's officially recorded rate of stillbirth (after 24 weeks) is 5.1 per 1000 births, (after 28 weeks as reported in the Lancet - 3.5 per 1000) or 1 every 200. 
  • Finland's officially recorded rate of stillbirth (after 22 weeks) is 3.3 per 1000 births, (after 28 weeks as reported in the Lancet - 2 per 1000)  or 1 every 330. 

For the purpose of this blog I've looked at the national statistic pages for the UK and Finland using figures from 2009.

The UK page (here) records that in 2009 there were 706,248 live births in England and Wales and 3,688 stillbirths. Additionally 1,715 babies died in the seven days after their birth and a further 3,312 babies died before reaching their first birthday.    So for the 709,936 babies born during 2009 a total of  8,715 never came home or died during their first 12 months. 

During 2009 there were 60,430 live births in Finland and 205 stillbirths were recorded. Additionally 95 babies died in the seven days after their birth and another 282 babies died before reaching their first birthday.   So for the 60,635 babies born during 2009 in Finland, a total of 583 never came home or died in their first 12 months. (Finland's stats pages here and here)

My maths ability isn't great, so please forgive me if there is some error; but on my calculations (with some help from Jon!), the comparative percentage difference is: 
  • Of the total babies born in the UK in 2009; 1.2% died. 
  • Of the total babies born in Finland in 2009; 0.9% died. 
Yes, comparatively argued in the UK, 8,715 of over seven hundred thousand babies is a low mortality rate but Finland's is lower. As I stated Thursday, each of those lost babies (in whatever country figures) represent a devastated family, each of those babies count and matter as much as the babies that lived.  The difference compared as a percentage between the UK and Finland isn't huge, granted, but there is a difference; especially as Finland's figure include babies 2 weeks younger in gestation than the UK. 

As I said in Thursday's blog, the UK needs to aspire to that 0.9% stillbirth and mortality rate. Or better. I say again, even one baby's death should be considered too many. What are Finland doing differently to us? 

I know that there are regional variations in what you can expect from antenatal care around the UK, but based on my experience of antenatal care for a first baby in my area is as follows; 
  • A booking appointment with community midwife around 8-10 weeks. Fill in the green pregnancy notes. 
  • Dating scans around 12 weeks and booking bloods taken checking haemoglobin levels, blood group, antibodies, rubella immunity status, hepatitis B status syphillis and HIV status.  Sickle cell and Thalassaemia is also checked in women of other ethnic groups. 
  • A nuchal fold scan is also offered in my area, I've declined in both of my pregnancies. 
  • 'Triple' blood test offered at 16 weeks to screen for Down's syndrome. Again I've declined this test in both of my pregnancies, but have visited midwife for a general checkup instead. 
  • Anomaly scan offered around 20 weeks. 
  • Further routine antenatal visits offered with community midwife at 25, 28, 31, 34, 36, 38, 40 and 41 weeks of pregnancy. During these visits the baby's heartbeat is listened too on a doppler and bump measured to assess baby's growth. 
  • Further blood tests at 28 weeks are offered to check haemoglobin levels. 
It is interesting to also note that in some areas, for a second baby with no complications on your first, less antenatal visits are offered. Because Anabelle died I am having far more antenatal appointments for Bow with my consultant and community midwife than would routinely offered for even a first baby. So far I've had eight appointments, so on average seeing somebody fortnightly. As we progress further into this pregnancy I will see my community midwife weekly, with additional consultant appointments as well. But frequency of my appointment in this specific pregnancy is another topic for another post I think. 

From the information regarding antenatal care I can find about Finland's services an expectant mother would meet with her healthcare providers 11-15 times throughout her pregnancy. This is not too dissimilar to UK practice. In Finland it is currently recommended that a scan is offered around 11-12 weeks to date pregnancy and number of babies. Another scan is offered around 20 weeks. Similar blood tests are also offered. (See here)

I hope to be back with further information regarding Finland's pregnancy care a little later, but what astounds me, that if as far as my limited findings on Google can see, is that if similar routine tests and a number of visits being offered in both countries, why  is there the discrepancy in stillbirth and infant death rates? Answering that question would take a far more skilled researcher than me, someone with far more time and obviously take into account other innumerable variables. (e.g. environmental conditions, food sourcing, water quality, genetic factors etc. etc. etc.)  

I don't know what the answer is or how we can lower the stillbirth and neonatal death rate in the UK. 17 babies a day is heartbreakingly far too many.  I hate that my daughter is part of the figures that will be released for 2010, she should be here with me.  It would make sense that the finer details and general set up of the Finnish healthcare system were closely compared to ours and steps taken to adopt some of their systems when caring for pregnancy women and unborn babies. Despite the similarities I've so far found on Google they must be doing something better than us. (Finland Health Care History)

Sands funds research (info here) into the causes of stillbirth and improving antenatal care so problems are detected before a baby dies. I don't know what they could change. Maybe additional routine scans in later pregnancy, maybe something else. In our case, an extra scan did nothing to save Anabelle. She was scanned 8 days before she died and no problems were detected, no distress found. Maybe the sonographer missed something, maybe there was nothing to miss - this is something I'll never know, although the question buzzes around in my head constantly.

But for a huge proportion of stillbirths maybe, just maybe, an extra scan in the 3rd trimester could've saved the baby's life. Even on a hope of a 'maybe',  I feel this is something that should be worth pursuing. Even one baby's life saved would make it worthwhile. 

I hope the recommendations in the Lancet report are pursued and addressing the number of stillbirths made one the UK's national health priorities. Surely in a country where our cot-death rates have been reduced by 70% since the 'Back to Sleep' campaign we can also do the same to reduce our stillbirth and neonatal death rates. 

Additional Links:


Abi said...

I know there are links with socioeconomic background and stillbirth. Maybe Finland is better off economically? And that affects things like diet and then weight etc. Not sure about the smoking, drinking rates in pregnancy either. Also, teen mums are more likely to go into prem labour or suffer stillbirth. I'd bet we have higher numbers of teen mums (since we're worst in W. Europe)! So I guess that pushes our stats up.

- Abi

Maria said...

do you know where I can see all of the countries stillbirth and death rates? I would like to know where Italy ranks.


Caz said...

Abi do you know why being a teen mum increases the risk? I know this was just a very basic comparison - and that there are hundreds of other factors that would have to be considered too. I guess the question I always come back to is why me? At 25 I was supposed to be in the "safer" age bracket, of course I never smoked or drunk during my pregnancy, I have no other health concerns and I wasn't already overweight. I know I'll never know, but it infuriates me that I don't belong to any of the high risk groups - it would be nice to know what percentage of stillbirths are people who don't fit in anywhere else.

Maria I've no idea sorry, I just googled birth rate/stillbirth rates in the countries I was interested in.

Maria said...

ok thank you!

Sara said...

Hey Caz,

You may have seen this already but as you have many more followers than me it'd be great if you could put it in your blog. It's to the UK government to try and get more research into preventing stillbirth.


Sending love for Anabelle's birthday.

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After Anabelle - Raising Rainbows. I'm Caz, Mummy to beautiful angel Belle and my wonderful rainbow boys, Xander, Zachy and Luc. Wife to Jon. Twitter @cazem Instagram @cazzyem
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