Ki ngā pēpi kua ngaro ki te pō, moe mai koutou.
To our precious ones who have disappeared into the night, rest in peace
~ Lisa Paraku, bereaved parent representative PMMRC member
The following information is about the babies and mothers who died in Aotearoa New Zealand during pregnancy, or shortly after childbirth, in 2018, and is published in the 14th annual report of the Perinatal and Maternal Mortality Review Committee (the PMMRC).
Every loss of life is mourned and acknowledged and the PMMRC continues to work towards its vision:
Te mahi tahi puta noa i te pūnaha kia kore rawa ai e mate, e whara ngā māmā me ā rātau pēpi, whānau hoki mai i ngā mate, wharanga rānei ka taea te ārai.
Working together across the system towards zero preventable deaths or harm for all mothers and babies, families and whānau.
About the Perinatal and Maternal Mortality Review Committee
Since 2007, the PMMRC has reported on the deaths of babies and mothers in Aotearoa New Zealand. The PMMRC is appointed by the Health Quality & Safety Commission.
- reviews the deaths of babies born from 20 weeks of pregnancy up until 28 days after birth
- reviews the deaths of all mothers who die at any stage during pregnancy, or in the six weeks after childbirth
- looks at information about the pregnancy and birth, and findings of medical tests to try and understand why a baby or mother died.
This incredibly important work is needed to support and improve how the maternity system works and the way things are done.
Babies who died during pregnancy or childbirth
In 2018, there were 59,258 births in Aotearoa New Zealand. Of those, 604 babies died after 20 weeks of pregnancy or within the first four weeks after birth. This means that 10 babies died for every 1,000 registered births. This rate is very similar for babies born in the UK and Australia.
This rate has gone down since 2007 when the PMMRC started reviewing these deaths. While it is encouraging that the rate has gone down, it has not decreased equally for everyone.
The rates of deaths of babies of Māori, Pacific, Indian, Other Asian and Middle Eastern, Latin American, or African (MELAA) ethnic groups have not decreased. It is unacceptable that no significant progress has been made to reduce these deaths and that this inequity of outcomes continues. These inequitable outcomes mirror the same inequities across other areas of our health system.
Urgent action, centred in equity, is required to help reduce the loss and grief that families and whānau are experiencing as a result of preventable death in Aotearoa New Zealand.
The causes of deaths of babies
Congenital anomalies continue to be the most common cause of death for babies.
Congenital anomalies are caused by the baby’s genetics or something in the baby's environment that has cause a difference in the typical development of the baby. The exact cause is not always known. Congenital anomalies are the most common cause of death for babies during pregnancy or in the first month of life.
In 2018, 162 babies died because of congenital anomalies. This accounts for over a quarter of deaths of babies.
Last year the PMMRC recommended that all bread should contain folic acid, which evidence shows is proven to support babies’ development in early pregnancy, reducing the number of babies with congenital anomalies. The Ministry for Primary Industries has begun reviewing the voluntary approach to adding folic acid to bread. However, this work was put on hold during the COVID-19 pandemic response and a decision is yet to be made whether there will be a change to the current law.
Premature labour was the second most common cause of death for babies in 2018. Premature labour is when a woman goes into labour or her waters break more than three weeks before the estimated due date. If a baby is born too early, their lungs and other parts of their body may not yet be fully developed. In 2018, 100 babies died due to premature labour.
Māori, Pacific and Indian babies are more likely to die from premature labour than any other ethnicity, which is an unacceptable outcome.
Bleeding (also known as haemorrhage) from the vagina can sometimes be a sign that there is a problem with the pregnancy. Bleeding from the vagina was common among women who lost a baby, even if the bleeding was not the direct cause of death. In 2018, 59 babies died because of bleeding from the vagina in pregnancy or labour. It is important that women seek medical guidance from their lead maternity carer (LMC), GP or or any other health care provider if they are bleeding during pregnancy.
Potentially avoidable deaths
In 2018, 79 deaths of babies were considered potentially avoidable. This is where one or more things were identified as contributing to the death. In the absence of these factors, these deaths could likely have been avoided. The most common factor was barriers to the woman getting the care she needed.
Do you always know why babies die during pregnancy?
Sometimes there is no explanation for why a baby died. In the PMMRC 14th report the terms used for this are unexplained antepartum death and no obstetric antecedent. For these babies there was no obvious medical problems with the baby or the mother that could explain why the baby died and/or there were no investigations done to try and find a cause of death. In 2018, just under 80 babies died from unexplained causes.
Around 30 percent of babies who died in 2018 had a full post-mortem (autopsy) examination afterwards. This investigation provides the fullest possible information for families and whānau about why their baby died.
There are other options available to parents who would like to investigate the reason their baby has died, including a partial autopsy and/or investigation of the placenta.
A study of decision-making by mothers after their baby had died found that no woman who chose for their baby to have a full post-mortem regretted her decision. Ten percent of women who declined, later regretted the loss of opportunity to understand more about their baby’s death.
Why mothers die during pregnancy and childbirth
The risk of death for mothers during pregnancy is low.
As the risk is so low, it can be difficult to measure whether there have been any changes over time. Each and every maternal death is a significant tragedy.
On average, 10 women die every year in pregnancy or within 42 days of the end of pregnancy. Often these women had pre-existing medical issues that were made worse by pregnancy. It is important that these women receive early and regular antenatal care. In 2018, there were 10 women who died.
Deaths of women from unrelated causes that happen to occur in pregnancy, such as a car accident, are not counted in these deaths.
Since the PMMRC began its reviews:
- 50 women have died from non-pregnancy related medical problems that were either pre-existing or begun during pregnancy, made worse by pregnancy
- 30 women have died from suicide
- 14 women have died from an amniotic fluid embolism around the time of childbirth. This is a rare pregnancy complication that occurs when the fluid that surrounded the baby during pregnancy enters the mother’s bloodstream and causes an allergic reaction.
What needs to change
The PMMRC has made approximately 120 recommendations since its first report in 2007. These recommendations have been made to government departments, health practitioners, researchers, colleges and regulatory bodies.
The PMMRC 14th report includes a list of its previous recommendations that still require further work. You can find these in Appendices B–F of the report.
There have been many improvements in the last 14 years, but greater priority must be given to putting previous recommendations into action.
The most urgent area where greater priority and improvement are needed, is reducing the deaths for the families and whānau for whom deaths are not reducing.
This includes whānau Māori, Pacific families, Indian families, mothers under the age of 20 years old, and those living in areas of high deprivation.
Improvements to systems and services must be decided and developed alongside groups and communities of people for whom the death rates have not changed to ensure the right decisions and changes are being made.
- Sands New Zealand (www.sands.org.nz) is an organisation that offers support for families and whānau whose baby has died. It has a lot of helpful information on its website.
- Wheturangitia (https://wheturangitia.services.govt.nz) is a website that has been created to have a single collection of up-to-date information and resources for people who have experienced the loss of a baby or child.
- PMMRC member Lisa Paraku and former member Dr Vicki Culling have created a short Postmortem for Babies in Aotearoa NZ video to explain post-mortem (autopsy) to families and whānau.
- The PMMRC has developed a pānui for post-mortem which includes information for parents who have had a baby die.
- If you had a miscarriage before 20 weeks there is useful information about miscarriage on the Ministry of Health’s website.
If you are pregnant, what can you expect?
There are multiple ways that health practitioners can support you and your baby during your pregnancy.
Firstly, www.findyourmidwife.co.nz is a good place to start to find an LMC. Your doctor or local district health board can also provide support for you to find an LMC quickly.
Your LMC will be able to answer your questions and help you through your pregnancy and birth of your child. Your LMC should also:
- offer tests that can check your baby and you are well. This includes screening for health conditions such as gestational diabetes, sexually transmitted infections and urinary tract infections
- arrange medical care if you already have a health condition or have had problems in a previous pregnancy. This will reduce the risks to your baby and you
- facilitate regular catch-ups. It is important that your LMC sees you regularly so any problems can be identified early
- provide stopping smoking advice and referral to stopping smoking groups if needed
- be on call for emergencies. Talk to your LMC, doctor or nurse straight away if you have any bleeding from your vagina, you notice your baby does not move as much or if you feel unwell
- provide information to keep you and your baby healthy, such as information on groups in your area that can support your nutrition or physical activity like the maternal green prescription
- ensure you have a safe sleep space for your baby, such as a bassinet, cot, wahakura or Pēpi Pod. District health boards can help with providing safe sleep spaces for those in need.