Mystery behind parents' heartbreak

Matt and Vanessa Postle's baby girl, Charlie, was born with dark brown hair and perfectly formed fingers and toes. The only indication that something was not right was her skin, which was tinged blue.

Charlie had died suddenly, and without explanation, a day earlier in her mother's womb.

''She looked like any other child,'' Matt says. ''If you didn't know better, you'd just expect her to start moving.''

Vanessa, a midwife at Royal Prince Alfred Hospital, had had a normal pregnancy. ''There were no problems,'' she says.

But on her due date Vanessa could not feel her baby move. When she arrived at hospital Charlie was pronounced dead.

The Postles, from Burwood, don't know why their first child was stillborn.

In a world where unborn babies can be tested for genetic mutations and it is possible for parents to choose their child's sex, the cause of more than a third of all stillbirths remains a mystery.

And while science and public health interventions have significantly reduced the number of children who die from conditions such as sudden infant death syndrome, the rate of stillbirths in Australia, around seven per 1000 live births, has remained largely unchanged for two decades.

But recent Australian research looking at the causes of stillbirth has made discoveries that could help reduce the number of them - more than 2000 a year.

Several studies have shown a foetus's movements during pregnancy, an expectant mother's sleeping position and in utero infections may play a role in the risk of a mother having a stillborn child.

In Australia, a child who dies after 20 weeks or weighs more than 400 grams is considered stillborn, while babies lost before 20 weeks are termed miscarried.

Neonatal specialist Dr Adrienne Gordon says the rate of stillbirths a year is more than 20 times higher than cot death. ''It is a lot more common than people think.''

Gordon, who works at Royal Prince Alfred Hospital, has completed a study comparing the pregnancies of 100 women who had stillborn babies with 200 control women who had healthy babies.

Her team found the movement of babies in the control mothers was much more likely to increase in frequency or strength during the later months of pregnancy.

Gordon says this finding debunks the common perception that a baby slows down as it grows.

''Most of the women who lose a baby have known there is something wrong, but they don't present because they're falsely reassured and told not to worry about it,'' she says.

Gordon found a proportion of the mothers who had stillborn children had been falsely reassured about their concerns something was wrong, or sent home from hospital. ''It's not something that is well listened to by healthcare providers,'' she says.

New clinical guidelines, issued by NSW Health last week, stipulate any woman who reports decreased foetal movement during the third trimester of her pregnancy must receive further assessment within 12 hours. If she reports no movement she must have further assessment, including heart monitoring, inside two hours.

Gordon's study, funded by a research grant from the Stillbirth Foundation, also confirmed stillborn babies are often smaller than their healthy counterparts.

But what causes growth restrictions in the womb often remains unknown, and in many cases doctors struggle to remedy the situation. ''We found quite a proportion [of doctors] do know the babies are small, they just don't know what to do about it and the baby has still died,'' says Gordon, who will submit the study to an academic journal.

A baby that was not growing could be delivered early, but there are risks involved, she says.

As part of another study, which reviewed state-based health data, Gordon confirmed smoking, diabetes and high blood pressure were risk factors for stillbirth.

And for the first time in Australia she found maternal age also increased an expectant mother's chance of having a stillbirth, especially as the pregnancy moves into the final few weeks.

''The risk of stillbirth for all women goes up beyond 40 weeks of pregnancy,'' she says. ''That's one of the reasons women don't get left if they go post date, they get induced.''

But for older women, especially mothers who are older than 40, having their first child, the risk of a stillbirth goes up at about 39 weeks gestation, rather than 41 weeks for younger mothers. ''People should be being counselled about that sort of risk,'' Gordon says.

Delivering older mothers a week early was a possible solution, she says. ''We are not saying that everyone needs to be delivered earlier, but these risks are as high as some of the chromosomal problems that people get counselled about,'' Gordon says.

The role of infections in causing stillbirth is also being explored by Australian scientists.

''We know some infections cause death in utero, but we don't know what the proportion is,'' Professor Bill Rawlinson, an infectious disease clinician and virologist, says.

A study of 130 babies who had died in utero found 15 per cent of babies were infected with cytomegalovirus, a strain of the herpes virus and the most common cause of congenital malformation in the country. The virus, passed through urine, sexual contact and saliva, can cause hearing and mental impairment or death in unborn children.

''The situation I see in my clinics all the time is women [who] have their first baby have not had CMV. They then get pregnant and their first baby goes to childcare and probably about one in 10 to one in five of those children are shedding CMV in their urine. The mother gets infected and then that spreads to her unborn baby,'' Rawlinson says.

The study, published in the Journal of Infectious Diseases, suggests the proportion of stillborn babies with the virus may be higher than reported.

Rawlinson, a professor at the University of NSW, believes mothers should be screened for the virus during their first doctor's visit. ''It is a well-established test, it doesn't cost that much,'' he says.

An intravenous treatment for the virus, being trialled in the United States, is showing promising results, he says. ''And if a women has never been infected with CMV, you can tell her that she is at risk and she will do things like washing her hands, taking care with an older child, that studies have shown will reduce her risk of getting CMV during pregnancy by half.''

The role an expectant mother's sleeping position plays in their risk of stillbirth is also being investigated. A study by a New Zealand obstetrics professor, Lesley McCowan, investigated the sleeping positions of mothers the night before giving birth and found that women who slept on their left side had an approximate 50 per cent reduction in the risk of having a stillborn child compared with those who slept on their right side or back.

The researchers suggest sleeping in those positions may restrict the blood flow to the baby, but they stress further research is needed before conclusions can be drawn.

Several Australian scientists, including Gordon and her PhD supervisor, obstetrician Professor Jonathan Morris, are putting together a proposal to conduct a follow-up study in Australia. ''Without research it will be harder to make a difference,'' Morris says.

While scientists are slowly piecing together the causes of stillbirth, it remained largely unstudied until a few years ago.

The work of the Stillbirth Foundation, which funds a large proportion of Australia's research in the area, and has the former NSW premier Kristina Keneally as its patron, has raised the profile of the condition.

Keneally, whose second child, Caroline, had a birth defect that meant she could not survive outside the womb, says with six babies stillborn each day in Australia, stillbirth was a public health problem.

''It would be fair to say it has not been on the radar of governments at state and federal level,'' Keneally says.''Foetal movement monitoring, potentially how an expectant mother sleeps at night, the role of viruses and infections - these are all areas of research that sound promising, but until we have the money and the will to follow them up, we are not in a position to be providing the right information to Australian women.

''When Caroline died, so many people said to me: 'I didn't realise stillbirths still happened in Australia.' I understand that. We don't talk about it very easily as a society.''