Shaping healthcare guidelines to prevent and reduce stillbirths

Research conducted at The University of Manchester into risk factors associated with stillbirths has influenced UK and international health policy, helping to educate parents and save lives.

Gaps in addressing the risk factors associated with stillbirths 

In 2010, stillbirth rates in the UK were higher than most other high-income countries. There were gaps in antenatal care and variability in the services available for bereaved parents across the country. As a result, NHS England declared its aim to halve stillbirths in the UK by 2025.

In 2014, NHS England launched the Saving Babies’ Lives Care Bundle, an action plan to identify and manage risk factors for stillbirth and save lives. The bundle was published in 2016 and updated in 2019 when the implementation of it became mandatory for all NHS maternity units in England. Two of the four elements in the bundle were based on research led by Professors Alexander Heazell and Ed Johnstone at The University of Manchester. 

Identifying and managing stillbirth risk factors 

The team at Manchester investigated a range of factors influencing stillbirth risk:

• focused on understanding pregnancy complications where the baby does not get the oxygen and nutrients it needs from the placenta;  
• identified risk factors such as fetal growth restriction (FGR), when the baby is smaller than expected or the baby’s growth slows or stops during pregnancy, and perceived reduction in fetal movements (in general, feeling the baby move is a sign that they are well);  
• investigated the impact of better screening and care in these areas;
• demonstrated an association between maternal sleep position and late stillbirth. 

The findings on FGR and reduced fetal movements were used in the Saving Babies’ Lives Care Bundle; between 2015 and 2017 the number of stillbirths reduced by 20% in the 19 NHS Trusts where the care bundle was adopted. 

Raising awareness and informing
antenatal guidance   

Researchers worked with NHS England and Tommy’s Baby Charity to improve both parental awareness and the clinical care required to prevent stillbirths.  

Since 2018, the team has worked with Tommy’s to raise awareness among mothers that sleeping on their side in later pregnancy (after 28 weeks) reduces the risk of stillbirth. The campaigns #sleeponside and #movementsmatter reached an estimated 2.5 million women globally and sleep position was included as a recommendation in NICE’s antenatal guidelines, published in August 2021.

The guidelines also recommend the use of the care bundle when carrying out a risk assessment for FGR. The care bundle is now used across NHS Trusts in England.   

As the NHS moves towards digital delivery of care, a project to provide an online version of the FGR element was developed in partnership between Tommy’s, The University of Manchester, Manchester University NHS Foundation Trust (MFT) and the Greater Manchester Strategic Clinical Network. The online version called ‘Tommy’s Toolkit’ was launched into clinical service across all three MFT maternity sites in January 2022 and will be freely available across the NHS the same year.   

Changing international care 

The University’s work was also critical to the development of the Australian Safer Baby Bundle, launched in 2019. Euan Wallace, Victoria’s Secretary for the Department of Health and Human Services explained: “We would not have been able to develop the Safer Baby Bundle without the resources and insights from Saving Babies Lives care bundle, generously shared by Professors Heazell and Johnstone.”

Initial evaluation showed that the bundle was associated with a 27% reduction in stillbirth in 21 of the state’s maternity services. 

Creating a care centre for families 

Following the researchers’ review of women and families’ needs in pregnancies after a previous stillbirth, they set up the Rainbow Clinic in Manchester in 2013 to provide care for these families. By 2021, the centre had treated more than 900 families. A 2016 review showed that Rainbow Clinic care helped to reduce preterm birth by 11% and low birth weight by 9%.

There are now 28 satellite Rainbow Clinics in the UK delivering this model of care, with a further two in development. The team are also working with care providers in Australia, Canada and the US to adopt the model.