Maternal smoking, obesity and timely booking to an ante-natal clinic or a midwife during pregnancy are all areas which could be improved, according to the first detailed study of the deaths of babies during labour.
It analysed 81 intrapartum foetal deaths from 2011 to 2014 as well as 36 unexpected neonatal deaths from 2012 to 2014 where the baby died within seven days of birth. The report found major congenital malformation accounted for 36 deaths of the foetus in labour, while a bacterial infection, chorioamnionitis, was responsible for 18 deaths.
Over half of all neonatal deaths were due to hypoxic ischaemic encephalopathy — a condition of the brain being starved of oxygen. The report said a country’s intrapartum death rate was reflective of the care received by mothers and babies during labour.
The report, carried out by a team of researchers headed by Karen McNamara, a consultant at Cork University Maternity Hospital, also found that over a fifth of the mothers of the babies who died made a booking with a hospital or midwife late during their pregnancy or not at all.
“These three areas have all been previously associated with all types of stillbirth including intrapartum foetal death and adverse pregnancy outcome,” said Dr McNamara. “Despite ongoing efforts to improve antenatal education, unless there is engagement from the public, as well as acceptance of the risks associated with these lifestyle choices, these efforts will be futile.”
The report called for greater public health awareness programmes to highlight the benefits of healthy eating, exercise, obesity modification and quitting smoking in pregnancy for potential future parents.
The study found a fifth of normally formed infants in the study had a very low weight at birth for their gestational age which, in the vast majority of cases, had gone undetected in antenatal clinics.
“We were unable to identify reasons from the dataset as to why growth restriction was missed so frequently,” said Dr McNamara.
The report said it was unable to identify if any of the deaths could have been prevented.
The research team said its inability to conduct a root cause analysis of all deaths strengthened a recommendation by the National Perinatal Epidemiology Centre at UCC that all such cases should undergo a confidential enquiry process.
“Development of a confidential enquiry system into intrapartum foetal deaths and unexpected neonatal deaths would provide learning at both local and national levels and might also help improve the poor public perception of the Irish maternity services.”