Saving a baby’s life is worth any cost

A sudden unexpected death, whatever its cause, is a devastating event for the patient’s family. It is distressing enough if it is the final episode after a long life but, in my opinion, the most upsetting is a stillbirth. It is not difficult to imagine a crueller end to forty weeks of increasing excitement, pleasurable anticipation and forward planning than a totally unexpected dead baby.

I have often been told by older women who have successfully borne healthy children that memories of their and their family’s misery after a stillbirth is the dominant thought when they review their life.

These feelings of despair and anger will not have been eased by recent research at two universities. It has shown that 80 per cent of the stillbirths they studied could have been prevented by improved midwifery or obstetric care. In Britain, it would not be surprising if the baby’s family doesn’t relate their own anguish to the news this year that the reputation of our obstetric services – once so high – now ranks near the bottom of the Western league table.

This research only covers the worst cases, where the baby has actually died. It doesn’t deal with all those cases in which the baby survives but never fully recovers from the battering it and its mother received during the delivery. Recently, research has shown that many, possibly most, cases of brain damage can be traced to a difficult delivery.

Nearly sixty years ago, I started in general practice. With the help of a recently appointed, local senior consultant obstetrician, I was able to read the records of many relatively disadvantaged children. It was appalling how many had had a shambles of a delivery and a subsequent, dicey, postnatal early life. Bad decisions during a pregnancy or delivery can and often will cause not only death but, for the survivors, evidence of lasting intellectual and/or physical disadvantage.

Several years ago, the wife of a young but successful executive at a firm I worked for went in to a well-known London teaching hospital. During a long labour, the baby started to show signs of foetal distress. Although all the modern scientific diagnostic aids were set up and working, the midwife failed to realise that they showed the baby was in dire trouble.

The baby’s distress was only recognised when the junior hospital doctor paid a routine visit. The baby was so knocked out by the delivery that it never fully recovered. When the baby was eventually discharged from the hospital, the parents were told he would never sit up unaided, never walk, never swallow easily and would be unlikely to talk intelligibly.

The old-style, extremely strict regime included a multitude of visits to the antenatal clinic to see a doctor and to meet the midwives, as well as a large number of physical tests. This was routine when I was a junior hospital doctor, but it has now been trimmed. As more cynical doctors take note of the way in which the rating of our maternity services is tumbling in comparison with other Western countries, they are bound to wonder if the currently less demanding routine is not being introduced at the cost of excellency.

Women who are at an increased risk of having a difficult birth must be treated differently. Diabetic women, and those with a raised blood pressure and heart or renal troubles, are usually closely supervised. Lesser indications of potential difficulties – such as being appreciably overweight, unusually short, older than 35 or having had previous obstetric troubles – increase the chances of having a stillbirth.

When comparing the risks of caesarean sections to vaginal deliveries, not enough regard has been given as to whether the caesarean was planned or an emergency – carried out because mother or baby was distressed, or someone had miscalculated the ease with which the baby’s head would go through the mother’s pelvis. The absurd acceptance of a long, distressing labour can lead to disaster.

The Treasury may fear the cost of an increased caesarean rate, but this can never be too high if it reduces the chance of a stillbirth.

‘They were told their child would never walk and would be unlikely to talk’