I recently had the privilege of presenting at the Star Legacy Foundation’s Stillbirth Summit 2014, here in Minneapolis. I presented on using energy psychology, including EMDR and clinical hypnosis, to heal trauma after a stillbirth. Being part of the remarkable international faculty was amazing and humbling. I learned a great deal. Here are six crucial recommendations to prevent stillbirth in the future:
1) Elective Delivery Before 39 Weeks Can Prevent Stillbirth
In 2013, the American College of Obstetricians and Gynecologists (ACOG) and the Society for Maternal-Fetal Medicine (SMFM) strongly recommended against elective delivery prior to 39 weeks gestation, unless there is a valid medical reason or indication. Valid medical indications including preeclampsia/eclampsia, HELLP syndrome, fetal growth restriction, placental abruption, multiple fetuses, and poorly controlled diabetes. Having a large baby is no longer considered a reason to induce or deliver by cesarean before 39 weeks.
The “39 Week Rule” was instituted in response to the rise in C-sections and NICU admissions in the United States. These are incredibly important issues. However, the unintended consequence is a dramatic rise in the number of stillbirths. Multiple physicians and researchers from the United States, England, Australia, and New Zealand agreed strongly that the rate of stillbirth can be reduced by inducing labor before 39 weeks of pregnancy. Many said that placentas have an ending point and “run out of gas” at the end of pregnancy.
2) Babies do not slow down at the end of pregnancy. Be aware of fetal movement, not just kicks
Every presenter talked about the crucial importance of being aware of fetal movement late in pregnancy. This means kicks and other movements. Women should use their intuition and call or go to their medical providers immediately if fetal movement is different than the baby’s normal pattern. All of the presenters dispelled the myth that babies slow down at the end of pregnancy. They do not.
3) End Membrane Stripping
There was an urgent recommendation AGAINST membrane stripping to induce labor. There was deep concern about how membrane stripping can introduce unnecessary, rapid infections that often result in stillbirth.
4) Sleep on the left side during pregnancy
Most presenters at Stillbirth Summit 2014 strongly urged pregnant women to sleep on their left side to prevent stillbirth. Back sleeping was strongly discouraged as it restricts blood flow. Sleeping on the right side has not been studied as much as the left but presenters acknowledged that it is fine to do.
5) Rule out or treat sleep apnea during pregnancy
Sleep disordered breathing (sleep apnea and chronic snoring) are implicated in pre-eclampsia, and a drop in fetal heart rate. A fascinating secondary question was brought up at the Summit: should all women with PCOS (polycystic ovarian syndrome) be worked up for sleep apnea?
6) Babies that are smaller or larger for gestational age are at higher risk for stillbirth
Don’t assume that all is well if a baby is smaller or larger than expected. Researchers suggested that the size of the baby is giving data about the health of the placenta.