Preventing stillbirths and the role of the midwife during the preconception and antenatal period

Preventing stillbirths and the role of the midwife during the preconception and antenatal period

Elena Fernández García (1), Ana Fernández García (2), Mª Jesús Gutiérrez Martín (3), Maria Rives Molina (4), Yolanda del Campo Sanz (5), Soraya Varona Iglesias (6), Laura García Calvo (7), Koon Loong Chan (8)

(1) Midwife, Ramón y Cajal University Hospital, Madrid, Spain, (2) General Practitioner Registrar, Clinico University Hospital, Valladolid, Spain), (3) Academic Head of Midwifery Teaching Unit and Midwife, Río Hortega University Hospital, Valladolid, Spain, (4) Clinical Governance Midwife, Saint Mary’s Hospital, Manchester, UK, (5) Midwife, Río Hortega University Hospital, Valladolid, Spain (6) Midwife, Laredo Hospital, Ladero, Spain (7) Obstetric Registrar, La Paz Hospital, Madrid, Spain (8) Consultant Obstetrician and Subspecialist in Fetal and Maternal Medicine, Saint Mary’s Hospital, Manchester, UK

Background
Perinatal mortality rates are crucial indicators of public health wellbeing, as they reveal the effectivity of healthcare strategies. There are unjustified variation rates in stillbirths in normally formed singleton pregnancies across Europe which indicates that decreasing the number of antenatal fetal deaths is possible.

Research methods
A traditional narrative review of the literature available was undertaken to uncover research into the midwifery role which related to stillbirth prevention during the preconception and antenatal periods. The PEO strategy has been used due to its qualitative nature for this traditional literature review.

Results
The midwife’s public health role and practice involvement is key in reducing stillbirths. Midwives need to understand and respond to women’s and their family needs and wishes, because preconception and prenatal health are crucial periods to ensuring life-long health. The multi-faceted approach of low-cost, effective and evidence-based midwifery interventions, before and during pregnancy, includes personalised screening programs, obesity reduction, smoking/alcohol cessation, acknowledgement of reduced fetal movement , sleeping on one side from 28 weeks and correctly identifying fetal growth restriction.

Conclusion and Recommendations
After examining the literature, it is concluded that midwifery care impacts on the prevention and reduction of stillbirths. Midwives have a privileged position to educate, empower and support women to modify health habits by applying the best evidence-based practice whilst caring for them and their babies. However, in the UK and Spain, barriers have been identified such as a national shortage of midwives and lack of continuity of care. Both features are key to improving women’s and babies’ health by providing women-centred care and greater informed-choice. From an international perspective, strong leadership is needed to target stillbirths. Reports, audits and clear evidence-based guidelines/protocols should be designed to promote healthy and safe pregnancies.

Ethics statement
The authors declare that they have no conflict of interest. No patients were involved. No institutional consent required.

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