What Can We Do To Reduce The Number Of Babies Dying Before, During Or Soon After Birth?

There were more than 700 fetal and neonatal deaths in 2021, that’s a rate of 11.2 per 1000 births according to the Perinatal and Maternal Mortality Review Committee’s (PMMRC) 16th Annual Report released recently.

In the latest Briefing from the Public Health Communication Centre, Dr Rose Elder and co-authors describe the key findings in the PMMRC Report and encourage a robust conversation about what needs to be done.

The committee has recommended prevention, optimisation and preparation in the management of preterm birth would lower neonatal and perinatal mortality, especially if equity of outcomes is addressed.

Preterm birth is one of the leading causes of fetal and neonatal death, and many of these deaths are preventable according to Dr Rose Elder, Subject Matter Expert for the PMMRC.

“If someone has risk factors for preterm birth then with access to scanning, the opening of the uterus (cervix) can be monitored in early pregnancy and treatment to support the cervix to stay closed if needed can lower the risk of early birth.” She lists other measures including the recognition and treatment of health issues that contribute to preterm birth, screening for and treating infection, providing smoking cessation support, providing education around signs of labour, and easy and fast navigation into services once preterm labour is suspected. Also, preparation for preterm birth if expected or required.

Dr Elder says this is made so much easier when maternity providers have the resources, time and skills to engage with pregnant people early and in a way that is acceptable to the person.

The PMMRC also warns in its report that inequity remains a major issue. Indian, Māori and Pacific women and birthing people, experience a higher burden of perinatal mortality.

“Overall Indian whānau are the most likely to lose a baby, followed by Pacific then Māori whānau. These populations are overrepresented in rates of preterm rupture of membranes, perinatal infection, hypertension, antepartum haemorrhage and maternal conditions.”

Other factors revealed by the report are that pregnant individuals with confirmed Covid-19 infection in pregnancy were 7.4 times more likely to experience perinatal death.

Suicide remains the leading cause of maternal mortality accounting for over 40% of direct maternal mortality events. Wāhine Māori have over three times the suicide rate of NZ Europeans. “Suicide is often multifactorial with many contributing factors such as experience of physical or sexual violence, poverty, relationship stress and previous mental health service engagement. In the current environment, the risk of social complexity is high and mental health services can be challenging to access” says Dr Elder.

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