Every day in the UK around 13 babies die before, during or soon after birth. That is, of course, a shocking statistic.

Losing a baby at any stage of pregnancy is a devasting experience. Too often the subject of baby loss is kept quiet or avoided as people find it difficult to talk about the loss of baby through a miscarriage, stillbirth, or neonatal death.

Whilst babies can die for a number of different reasons concerns remain as to why these tragedies continue to happen in such large numbers and what can be done to avoid them.

We do not want to worry parents-to-be unnecessarily. Most pregnancies proceed smoothly. However, having acted for many parents who have lost their babies as a result of different problems in pregnancy – infections such as group B Strep, failure to recognise fetal growth restriction, gestational diabetes, hypertension, placenta praevia and preeclampsia – we would really like to see these terrible statistics improving.

There are two main themes that seem to arise in most of the cases we deal with. Our clients who suffered baby loss, like my client Chyril have told us either they;

1. were unaware that their symptoms they had were concerning, or
2. attended hospital with a strong instinct that something was wrong but their worries were not taken seriously enough and were dismissed

Given the first issue above, one way of trying to reduce the number of baby deaths is to ensure that advice is available on the possible risks within pregnancy and when to seek further help and advice.

We set out below some of the risks in pregnancy that sadly our clients have experienced and which the expert obstetricians and midwives who help us with our cases, the Royal College of Obstetrics and Gynaecology (“RCOG”) and baby loss charities SANDS and Tommys have suggested mean you should call your maternity unit or to be seen straightaway:

A Change in Baby’s Movements

Baby’s movements can start any time between 16 – 24 weeks and as the baby grows both the number and type of movements will change and a patten will start to develop. Getting to know your baby’s normal pattern of movements is crucial.

The RCOG provides the following information about baby's movements

• If your baby’s movements have changed, slowed down or stopped you should phone your maternity unit. The midwife at the unit should advise you what to do and often may ask you to come into to be monitored.
• If you are unsure whether your baby has moved then RCOG advise that you should take the time to lie down on your left side and focus on your baby’s movements for up to 1 hour. If you are worried, call your midwife for advice.
• The RCOG also  advise not  relying on hand held monitors to check your baby’s heartbeat. Even if you detect a heartbeat that doesn’t mean your baby is well and you may be falsely reassured.

Vaginal Bleeding

Some spotting or light bleeding in early pregnancy is quite common. However, the RCOG? Confirms that vaginal bleeding after 12 weeks can be a sign of premature labour or a problem with the placenta. It is therefore important that if you have vaginal bleeding you phone your midwife or midwifery unit straight away. It is not advisable to wait until your next antenatal appointment.

Itchy Skin

Many women find their skin itches during pregnancy. Whilst this is normal for most women, occasionally it’s a sign of intrahepatic cholestasis of pregnancy (ICP), a liver disorder.

Itching with ICP usually affects the hands and feet and can be mild or severe. If untreated ICP increases the risk of stillbirth it can also affect the pregnancy and lead to premature labour.

A blood test is available for ICP so diagnosis and treatment is straightforward. If you have itchy skin you should call your midwife within 24 hours and get the blood test.

The charity ICP Support has a lot of information about ICP symptoms, risks and treatment for women and health professionals.

Severe Headache and/or Changes in Vision (blurring, flashing lights, difficult focusing) and/or Obvious Swelling

The RCOG provides useful information about pre-eclampsia

The following are symptoms of pre-eclampsia:

• Severe headaches that won’t go away and are sometimes accompanied by vomiting
• Problems with vision including blurring, flashing lights or spots or problems focusing
• Swelling that develops over hours or days. The hands, face and /or upper body become swollen

Pre-eclampsia is a condition that needs careful monitoring. Although pre-eclampsia is usually mild, in some pregnancies it can lead to life-threatening problems for both mother and baby.

If you have one or more symptoms of pre-eclampsia then the RCOG advise that you should phone your GP or maternity unit straightaway.

Watery Fluid/Discharge

In pregnancy it is normal for your waters to break shortly before or during labour. This could be a slight leak or strong gush of fluid. The fluid should be clear.

Sometimes your waters break early (before 37 weeks) and this might mean labour is starting early. If you don’t go into labour it is important to reduce the risk of infection.

If the vaginal discharge is coloured or blood stained and/or smells strange it may be a sign of infection and you should contact your maternity unit for immediate advice.

The RCOG have produced information about what to do if your waters break early, before you go into labour

Gestational Diabetes

Gestational diabetes is diabetes that develops in pregnancy. Most women who have gestational diabetes have healthy pregnancies and healthy babies.

Occasionally gestational diabetes can lead to complications in pregnancy or during birth, especially if it goes unrecognised or is not well controlled.

If you have been diagnosed with gestational diabetes, the chances of having problems during your pregnancy can be reduced by keeping your glucose levels in the target range. The RCOG advice this can be done by:

• eating a healthy diet
• exercising for at least 30 minutes every day
• managing your weight gain during pregnancy
• taking medication, if necessary.

If you are given a diagnosis of gestational diabetes you should be closely monitored during pregnancy and labour to check if treatment is working and for any problems.

For further details, please see the RCOG information on Gestational Diabetes

Luckily, many mothers do not experience any of these problems, but I hope that by highlighting these risks I am helping to ensure that more expectant parents are fully informed of what symptoms and signs to be concerned about in pregnancy and what to do if they suffer any of these symptoms .

For more information on the conditions mentioned above do read the information published by the RCOG and baby loss charities Tommys and SANDS. However, the main message from all of them is if you have any unusual signs or symptoms or have any concerns at all do contact your maternity unit or GP and if you remain concerned do not be afraid to keep asking for help.