Opinion

Belfast Trust's stillbirth figures don't tell the whole story

Newton Emerson

Newton Emerson

Newton Emerson writes a twice-weekly column for The Irish News and is a regular commentator on current affairs on radio and television.

Stillbirths, including deaths within 28 days of birth, are over half as high again as the national average in the Belfast Health and Social Care Trust. Picture by Dominic Lipinski, Press Association
Stillbirths, including deaths within 28 days of birth, are over half as high again as the national average in the Belfast Health and Social Care Trust. Picture by Dominic Lipinski, Press Association Stillbirths, including deaths within 28 days of birth, are over half as high again as the national average in the Belfast Health and Social Care Trust. Picture by Dominic Lipinski, Press Association

BELFAST Health and Social Care Trust has the worst stillbirth rate in the UK, a University of Leicester study has found.

Stillbirths (including deaths within 28 days of birth) are over half as high again as the national average.

Of Northern Ireland’s other four health trusts, the two farthest from Belfast were ranked almost as badly, while the two nearest had rates below the national average.

The latter two are centred on Craigavon, an acute hospital with a full maternity service; and the Ulster, which serves part of Belfast.

What all this means is that the Belfast trust’s poor performance cannot be fully explained by public health in Belfast (which in any case is not the worst in the UK) or by having difficult births transferred to it from the rest of Northern Ireland. It has a standalone problem.

The Leicester study advised a review but Belfast has not conducted one. Instead, it has partly attributed its higher rate to Northern Ireland’s abortion laws, which result in more babies with severe congenital anomalies being carried to term.

This would be easy to prove with a statistical breakdown but the trust has not provided one. It has said “around 30 per cent” of deaths are due to “lethal abnormalities” but its stillbirth rate is 52 per cent above average, while lethal abnormalities also cause 10 per cent of stillbirths in Britain.

In other words, abortion law can only explain half the Trust’s discrepancy.

Given the apparent reluctance to supply evidence, I feel justified in supplying anecdote.

My wife and I have had three children in Belfast. In each case a caesarean section was required by medical necessity and professional guidelines but in each case we seemed to face alarming obstacles.

My first child, a daughter, was due to be delivered naturally but labour did not start. After 10 days - the maximum before a baby’s health deteriorates in the womb, according to the medical literature - my wife was admitted and repeatedly induced, to no avail, while the baby’s heart rate indicated increasing distress.

After two days of this my wife suffered a placental abruption and required a crash section to avoid bleeding to death. The baby was delivered not breathing, with the umbilical cord around its neck.

My wife is an aeronautical engineer and took the pilot’s view - any landing you can walk away from is a good one.

But she is also a doctoral student and rarely embarks on anything without reading the research. So when we went to arrange the birth of our next child, a son, we knew that official guidelines recommended another section.

Yet we were subjected to what I can only describe as a sales pitch for natural delivery. This included being told that caesareans increase the risk of type 1 diabetes (a confusion of cause and effect) and can accidentally cut the baby (demonstrated with a slashing motion made across our faces.)

None of the risks of a natural birth with my wife’s history were explained, as guidelines require. When we insisted on a caesarean, we were booked in a week after the due date instead of week 39, as is supposedly standard practice.

So we contacted the NHS Patient Advice and Liaison Service, who after further obstruction from the trust managed to transfer us to other clinicians - an option not everyone knows they have. We also made a written complaint to the trust, which was rebuffed.

By the time we were expecting our last child, also a son, we were aware of how politicised delivery methods have become and that Belfast will controversially advise a natural birth after multiple sections.

So we sought out a sequence of referrers from GP through to consultant, all of whom we knew would support a third caesarean.

How many people know they have the right to do that, let alone how to do it? We certainly had no idea the first time around.

As my wife waited in the pre-theatre ward for her final section, we overheard a midwife telling the woman in the next bed that it was not too late - minutes before surgery - to attempt a natural birth.

It felt like different parties were canvassing the cubicles.

Of course, I am only one of the 350,000 people in the Belfast Trust’s area. But in my experience, it is aggressively discouraging caesareans.

In my opinion, this is dangerous. If that does not explain its excess stillbirth rate, it may explain exactly what does.

newton@irishnews.com