Hospitals
and medical staff are not legally required to examine or explain the causes of
stillbirth, and coroners can only investigate the cause of death after life has
begun. Under Australian law, life begins when a baby takes its first breath.
But
every year, 2000 foetuses between 20 weeks and full term never make it that
far. And one in three of those dies for unknown reasons. The rate of
unexplained deaths rises to 80 per cent as the foetus approaches full term.
Now
a leading State Government medical adviser and SIDS and Kids Australia are
urging governments to allow the independent investigation of late-term
stillbirths.
Associate
Professor James King, chairman of the Victorian Consultative Council on
Obstetric and Pediatric Mortality and Morbidity, wants coroners' powers
extended. "I favour an extension of coronial authority to include
discretionary investigation of certain categories of stillbirth, particularly
where the death occurs shortly before or during the birth process,"
Professor King said.
Despite
advances in medicine, there has been no reduction in the incidence of
stillbirths in a decade.
Researchers
believe more stillbirths could be explained if clinicians counselled parents to
give their consent to autopsies. They believe medical staff's reticence to do
so comes from a combination of misguided compassion, undervaluing the benefit
to parents and the community of identifying the causes of stillbirth, and fear
of litigation.
The
call for action comes as the State Coroner investigates the death of William
Grant Keays, a baby resuscitated at birth who died 6½ hours later, on November
2, 2003. His mother, Karin Keays, has asked the Coroner to draw the public's
attention to the powerlessness of parents whose children are stillborn.
"Because
the Coroner does not have the power, there is no effective avenue for the
independent investigation of stillborn babies," Mrs Keays said. "It
is a terrible loophole in the law related to obstetrics.
"I
believe that laws regarding the conduct and accountability of obstetricians and
hospitals need urgent revision and sweeping changes.
"The
legal loophole which classes full-term or near-term babies as not being
'people' who would otherwise be entitled to the protection of the law, is
draconian and needs to be closed," she said.
"Authorities … seem to pussyfoot around
the subject of medical error and negligence in obstetrics for fear of upsetting
obstetricians.
"But
what about all the stillborn and neonatal deaths? What about the babies'
rights? They seem to have none.
"What
about the parents' rights to honesty and transparency of information from their
doctors and midwives?"
After
its success in reducing, through parental education, the rate of cot death from
500 a year to about 60 a year, SIDS and Kids Australia has expanded its focus
to stillbirth. Janet Carey, national executive of research and programs at SIDS
and Kids, said there was a lack of political and social focus on the issue
because it was emotional and difficult to discuss.
"This
is the same issue that faced parents 20 years ago after their child had died of
sudden infant death syndrome and there were no answers," Ms Carey said.
"Now
we hope to create some urgency about stillbirths and how many unexplained
deaths there are before birth."
Researchers
at Brisbane's
Mater Mothers' Hospital are collating the world's first large-scale study of
stillbirths.
"The
stillbirth rate in Australia
is just not going down," said Vicki Flenady, co-ordinator of the
hospital's perinatal mortality group.
Ms
Flenady said the reluctance of clinicians to push parents to consent to autopsy
was a major barrier to the further reduction of stillbirths.
