panorama.s2014e35.born.asleep.repack
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00:00Tonight, the toll of stillborn babies that shames Britain.
00:07I feel anger over these stillbirths.
00:10These are proper beautiful babies who should be alive,
00:14and if we can do something, then we should be doing it now.
00:19Britain has one of the highest levels of stillbirths in the developed world.
00:24Every day in the UK, nine apparently healthy babies die in the womb.
00:30I was in a very bad place, thinking, you know, my baby's dead,
00:34how can I give birth to him? It's supposed to be a happy occasion.
00:38Tonight on Panorama, we meet the doctors
00:41who think they can save thousands of babies' lives.
00:45We have the right equipment, we have the right machinery
00:49to prevent many of the stillbirths that we see.
00:53Many of the stillbirths that we have now, it is depressing that we don't.
00:58They've been battling for years for the medical establishment to take notice.
01:04We believe that this is a game-changer.
01:07We've saved over 500 stillbirths this year alone.
01:11That's ten a week, but there's a lot more to go.
01:15But others say it's too soon, the evidence just isn't there.
01:20If we have some great idea, if we have some great new technique,
01:23it's actually even more important that we then generate the evidence that it's implemented.
01:28The NHS promotes preventative medicine,
01:31yet life-saving interventions are still not being rolled out
01:35with the momentum you might expect.
01:51More than three-quarters of a million babies are born each year in the UK.
01:57For many of us, the greatest gift.
02:03The vast majority, like this little one, arrive without complication.
02:10But during pregnancy, one in every 200 births encounter problems,
02:16something that might not be detected by the midwife or the expectant mother until it's too late.
02:27This is where our kitchen, dining, family area is going to be.
02:32Samantha hopes her consultant has caught her problem in time.
02:37No-one spared in the lottery of all this.
02:40Samantha is a nurse.
02:42Right now, she's more than seven months pregnant and moving house.
02:46Uncertainty hangs over everything.
02:49It has, unfortunately, been a bit stressful with having a baby and buying a house at the same time.
02:54Was that planned?
02:55Well, it wasn't quite going to be the way it was,
02:57but, unfortunately, the baby's got other ideas of when she's going to arrive anyway.
03:01The problem doctors have detected is that Samantha's baby
03:05is not getting enough food and oxygen from her placenta.
03:09There's a chance her baby won't be coming home.
03:13And they saw me again at 28 weeks. That's when it got really quite scary.
03:17I asked, would I ever get to full term? No, not a chance.
03:21Whereas they may have, you know, said it a bit differently.
03:24But, do you know what I mean? I can ask and I can...
03:26Because I want to know the answers to the questions.
03:28It's the horrible thought that if she has died inside my womb,
03:31that I'd have to give birth to her then.
03:33I think that's a horrible thought, then, to give birth to a dead baby
03:36when obviously you're so much looking forward to having an alive baby
03:39that's so much wanted and planned for.
03:44Every year in the UK, over 3,000 babies die in their mother's womb.
03:51This year, the figure is down slightly for the first time in two decades.
03:57But experts in this programme say
03:59they could save around half of all stillborn babies.
04:06For the families involved, it's an intimate grief.
04:09Too painful to speak of.
04:12There are no memories of their child to mourn.
04:17But some find a way at a peaceful village hall near Leicester on a spring day.
04:28So, this is his little baby grow that he went off to Nottingham in,
04:32straight from the hospital.
04:34And I've kept it, I've never washed it, because that's obviously part of him.
04:39But as you can see, it's quite dirty where I keep cuddling it.
04:45They make memory boxes, mementos of children they never knew.
04:50There was a struggle, actually, to find a way to print the pictures,
04:54because who do you ask?
04:56You cannot go and print your picture anywhere like this.
04:59I did mine at Asda.
05:00Just like he's asleep, I didn't think it would offend anybody
05:03that he was queuing around.
05:07Their accounts of the final moments are heartbreaking.
05:12It was the night before, and I thought, something didn't feel right,
05:15so I had a cold glass of Lucozade, like they say, and I felt him move.
05:19So I went to sleep, happily went to sleep,
05:21and in the morning, when I woke up on the Saturday,
05:24something just didn't feel right in my heart.
05:27On the Thursday, I realised I hadn't felt anything,
05:31no movements at all, which was very, very unusual.
05:35Louise phoned me, I was at work.
05:37I can't feel the baby moving.
05:39So I rushed home, panicking.
05:43We went straight to the hospital.
05:48They couldn't find the heartbeat.
05:50First of all, we saw a midwife who tried to sort of strap me up
05:55to listen to the heartbeat externally, and she couldn't.
05:59She didn't flap.
06:01She said, right, OK, let's get you scanned.
06:05And then I don't really remember very much at that point.
06:11And then she goes, I'll go get the consultant,
06:13and that's when the penny dropped that something serious is wrong.
06:17I didn't quite comprehend what the consultant said.
06:22So I had a bit of a bewildered look on my face
06:26and I had to wait a few moments for it to sink in,
06:29and I still didn't believe it.
06:31Before that, you're so excited, you've got so much hope.
06:34I was going to be a stay-at-home dad with Katie.
06:37So my life was about to change in, for me, a really positive way,
06:43and in a blink, it had all gone.
06:48So absolutely devastating.
06:57I didn't look at the screen,
06:59but all I remember is the sonographer saying,
07:02I'm very sorry, guys.
07:06And that was that.
07:10She said, I'm sorry, Mrs Patel, your baby's dead.
07:20Reena Patel's baby, Mayan, could have lived.
07:24At seven and a half months, he was perfectly formed,
07:27but smaller than he should have been,
07:29because he'd been starved of oxygen and nutrients.
07:32It just wasn't spotted.
07:34I mean, it breaks my heart every time I go to the graveyard
07:37to find another baby's been buried.
07:46Every week or so, more baby coffins are brought down here and buried.
07:51And it's the frequency of it that's so disturbing.
07:54There's a row here where three babies died on consecutive days,
07:59and another row there at the back where three babies,
08:02all from different families, died on the same day.
08:08There are shared baby graves like this all over the country.
08:12More than half our hospitals use them.
08:15You'd be thinking they must have been seriously ill
08:18with something undetectable, something untreatable.
08:22But actually, many of them were fully formed,
08:25apparently healthy babies.
08:27So you might be saying, surely it's the same the world over.
08:31Giving birth can be a risky business.
08:34But actually, no.
08:36In the UK, the figures for stillbirths are particularly bad.
08:40In a study out of 35 countries, Britain came 33rd.
08:47Even though our stillbirth rate has reduced slightly in the last year,
08:51that small decline has been outperformed in other countries.
08:57Tonight, Panorama brings you three pioneering doctors with big ideas
09:02whose methods could change everything.
09:05Each is achieving spectacular drops in the stillbirth rate.
09:09So why are their methods not being rolled out across the country
09:13so that all can benefit?
09:16To some degree, the NHS is a bit of an oil tanker,
09:19which, if you need to sort of change practice, is not easy to do.
09:24It takes time.
09:26OK, so we're looking at the baby's head down here.
09:29Even if the baby's head is down,
09:33Even if I were to produce a fantastic randomized controlled study now
09:38to show that we can make a change,
09:40the evidence would suggest that it takes something like 10 to 20 years
09:44before practice changes.
09:46See that white line? That bit is done.
09:49Britain is well known in many aspects of medicine
09:52and many aspects of science
09:54for producing pioneering new developments.
09:59It is a sad day when the pioneers that are producing the new evidence
10:04are not able to practice their discoveries in this country.
10:20Obstetrician Professor Jason Gardossi travels the world
10:24from his base at the Perinatal Institute in Birmingham.
10:33Today, he's on a mission in Scotland
10:36to try to convince midwives and obstetricians
10:39to sign up to his programme for reducing stillbirths in low-risk mothers
10:44using a low-tech and low-cost procedure.
10:48One of the main things we were up against
10:51when we started this a few years ago
10:54was that most stillbirths were classified as unexplained.
10:58The implication of that is unexplained equals unavoidable.
11:05For us, each stillbirth is a tragedy, which is like a plane crash.
11:10And we wanted to investigate this
11:14as you would do in the airline industry.
11:17For us, the flat recorder, the black box,
11:20was the case notes of the unfortunate mother who had this outcome.
11:29Professor Gardossi and his team
11:31trawled through the case notes of hundreds of stillbirths.
11:35They found that, far from being unexplained,
11:38many of the deaths were avoidable
11:40and had come about as a result of a failure in the mother's placenta.
11:46In the womb, the baby receives food, nutrients and oxygen from the placenta.
11:53If there's a problem and the blood flow is abnormal,
11:56the baby's growth is likely to slow.
12:00The challenge is to spot which babies are struggling
12:03and save them before it's too late.
12:10Professor Gardossi tries to identify babies that are struggling,
12:14not through invasive surgery or even through scans,
12:18but through a clever piece of software
12:21and something that most of us have in our own homes.
12:24A tape measure.
12:28A midwife trained by Professor Gardossi
12:31takes us through how his procedure works.
12:34Sue is trying to detect any problems
12:37with the growth of Ruby's baby at 31 weeks
12:40and the chart predicts the size a healthy baby should be.
12:45This is Ruby's individualised growth chart
12:48that was produced at the beginning of her pregnancy
12:51and this chart has been developed using her height,
12:54her weight at the beginning of pregnancy,
12:57her ethnic origin and how many babies that she's had.
13:00Because all that, including ethnic origin,
13:03dictates what the size you expect the baby to be?
13:06Absolutely, yes.
13:07And if it falls outside these contours, then what?
13:10We may see the baby's growth has slowed,
13:12it could stay the same or possibly suddenly increase.
13:15If I saw any of these, I would be referring Ruby
13:18for a scan in the main antenatal clinic.
13:21If a growth problem is detected,
13:23the mother is scanned to establish the cause.
13:27OK, so this is where it was on the chart last time you were measured
13:31and we're going to measure her again.
13:33Are you happy to be measured? Yes.
13:35Right, well, let's do it then.
13:37I take my tape measure and I measure her bump
13:40to the symphysis pubis and I take that measurement,
13:44which on here is 29 centimetres.
13:47So Ruby is now 31 weeks, so we plot 29 centimetres,
13:52which is nicely just about on the 50th centile.
13:55It's right in the middle, isn't it? It is.
13:57Almost perfect. Almost perfect.
14:01Professor Gardos' charts haven't won everybody over,
14:05despite the fact that hospitals which have adopted his methods in the UK
14:09have seen their stillbirth rates drop by up to 22%.
14:14His results were peer-reviewed
14:16and published in a specialist medical journal.
14:19But still, about a third of British hospitals
14:22haven't signed up to his growth assessment protocol,
14:25despite the low cost.
14:28He estimates it's only 50p per pregnancy.
14:38BBC Radio Berkshire, it's Anne Diamond.
14:41Thanks very much indeed. Yes, I'm Anne Diamond.
14:43Special programme for you today about stillbirths.
14:46Every year, 3,000 babies in this country are stillborn,
14:50making it one of the highest rates in the developed world...
14:54It's not the first time there's been a problem
14:57rolling out a potential lifesaver for babies across the UK.
15:03One summer morning in 1991, TV presenter Anne Diamond
15:08found her baby boy, Sebastian, dead in his cot.
15:14I went into Sebastian's bedroom and I could see he was in his cot,
15:18face down, one little arm sticking out,
15:21between the bars of the cot.
15:23Nothing unusual there until I went over and felt his arm
15:27and it was stone cold.
15:29And I then went to pick him up and he was like a stiff little statue.
15:33And I knew immediately that he was dead
15:36and had been dead for a few hours.
15:41Just four months old, Sebastian had succumbed to cot death.
15:47There was already a study underway in New Zealand
15:50which found you could cut 50% of cot deaths
15:53by turning your baby on its back.
15:56Even so, the British government of the day never told mothers.
16:00They were waiting for more data, more proof.
16:04The Department of Health here at the time said,
16:07well, hang on, we haven't really got the data to prove it.
16:10We think it might work but we can't prove it.
16:12Well, what I later found was that
16:15our professionals in this country did know what was going on in New Zealand
16:19but me, living in London, I didn't know that. Why not?
16:22And I found that the professionals in our country
16:25were obsessed with wanting more and more evidence.
16:28How come me, as a mum, was left ignorant
16:31when if I'd happened to live in New Zealand, my baby might still be alive?
16:35I don't think I'll ever forgive the British government.
16:39Ann went into campaigning mode,
16:42going on TV and radio to demand change.
16:47Cot death is comparatively rare but there are few things more tragic.
16:52She made her own advert
16:54and finally managed to sting the government into action.
16:58The Department of Health's new leaflet
17:00explains how anyone who looks after a young baby
17:03can help reduce the risk of cot death.
17:06How many babies' lives were saved?
17:08Well, we reckon that certainly within the first few years,
17:1115,000 babies' lives were saved.
17:13Incredible. It was incredible.
17:15Now she wants to get involved again, this time with stillbirths.
17:20She's invited Professor Gardosi onto her show
17:24to give his message to the listeners of Radio Berkshire.
17:27Are you able to tell yet how many you can save?
17:30What sort of a difference will this make in numbers terms?
17:34We've done it in the West Midlands
17:36and then we've done it in several other regions
17:38that have picked up the training programme.
17:40Overall, in the whole country, we are estimating
17:43if everybody picked up this fairly simple
17:46but standardised evidence-based method,
17:49we can save 1,000 stillbirths each year.
17:52That is unbelievable. Why aren't we doing something about this?
17:55Why isn't every hospital...?
17:57I mean, it's just so simple.
17:59It's easy to carry out.
18:01You can train the professionals to do it.
18:05Back in London, Samantha, at 34 weeks pregnant,
18:09has arrived at a specialist unit in St George's Hospital
18:13to see if the blood flow into her placenta is worsening
18:16and putting her baby at risk.
18:20The consultant who will examine her is Professor Baski Filaganathan,
18:24one of the country's leading obstetricians.
18:29Hi, Baski. How are you? I'm good, thank you.
18:32I hope you don't mind me sitting in on this.
18:34No, you're welcome. Good to see you. Come and have a seat.
18:37This piece of equipment, available in most hospitals,
18:40can visualise and measure the blood flow
18:43between Samantha's placenta and her baby.
18:46It's called a Doppler scan.
18:49When Sam came along in mid-pregnancy for her routine scan,
18:53we found that the Doppler assessment of blood flow to the womb
18:57indicated that the placenta hadn't formed as well as it should have done.
19:01So the placenta is struggling a little bit.
19:04Often, when the placenta fails,
19:06it's towards the end of pregnancy, like with Samantha.
19:10That means their baby can be delivered early, often by caesarean,
19:14without the need for intensive care.
19:18The problem is that most hospitals only use Doppler scans on high-risk women
19:23because those are the national guidelines.
19:27Professor Filaganathan and his team at St George's
19:30think that's wrong and give Dopplers to all first-time mothers as well,
19:34like Samantha, at an additional cost of just £15 per pregnancy.
19:41Is it possible that this baby could have been lost
19:44if it were being delivered in another hospital?
19:47It's a difficult question to answer, but I think it is entirely possible
19:50that this baby could have been lost in another hospital.
19:52So she was fortunate to be here?
19:54Because not many hospitals do what you do.
19:56No, that's true.
20:00Well, that went well, didn't it?
20:02Yeah, definitely. Yeah, really happy today.
20:04Baby's put on some weight and everything's stable, so that's good.
20:07You could actually be giving birth this time in three days, couldn't you?
20:09Could be, but hopefully not. I'd like to go another week if possible.
20:12Hopefully. Fingers crossed.
20:14All right. Brilliant. We'll give you that.
20:18Offering Doppler scans to all first-time mothers,
20:21as well as those at high risk, seems to have yielded a remarkable result.
20:27Over the last two years, we've had about a 50% drop in stillbirths.
20:3150%? A lot of trusts would love to have that figure, wouldn't they?
20:35I think you're right. I think we'd love to have that.
20:39But, just like with cot deaths,
20:41the decision-makers want more data, more evidence,
20:45something Professor Thalaganathan is prepared for.
20:49It's difficult for me to prove that the sort of interventions we're doing
20:53on an ultrasound-based approach are the very reason for that drop in stillbirth.
20:57And I think we need to get on and do proper studies
21:00to ensure that that's really what's happening.
21:03Aren't you being a bit modest, though?
21:05A lot of people would say, this is down to you and your techniques.
21:08I'd like to think that it is our intervention that has changed the stillbirth rate.
21:13However, one must be cautious.
21:15I need to be absolutely certain that it is my intervention
21:18that caused the reduction in stillbirths.
21:24But others are confident there's enough evidence out there already
21:29on the life-saving use of Dopplers.
21:32How are you? OK.
21:34And you are the man responsible? I am.
21:37Professor Kipros Nikolaidis works at King's College Hospital in London.
21:41Many regard him as the father of foetal medicine.
21:47Today he's in the procedure room to operate on unborn twins.
21:53The mother's placenta is feeding too much blood to one, too little to the other.
22:00Doctors come from around the world to study his techniques.
22:05Can you see?
22:08See, we're going down the tube that you already have inside.
22:11And then you need to look at those blood vessels.
22:14Can you see those blood vessels? OK.
22:17He believes the UK's stillbirth rate could be reduced dramatically,
22:21almost overnight, if the medical establishment were willing.
22:25He favours a similar method to Professor Thiller-Ganathan, a Doppler scan,
22:30but in his case, three of them, at 12, 22 and around 33 weeks.
22:36We have demonstrated through extensive research
22:39that we can identify more than 90% of those cases
22:45from the 12-week assessment.
22:48Do you think you could avoid, therefore,
22:50more than 50% of the stillbirths in this country?
22:53I think we can easily avoid them,
22:55and we can do so through very simple adjustment
22:59in the way we deliver antenatal care.
23:02With the support of his hospital administrators,
23:05he offers care beyond the national guidelines,
23:08three Doppler scans to all pregnant women.
23:12But consultants who've tried to implement the same programme
23:15in other hospitals have met with resistance.
23:19They had to stop because they were outside the guidelines.
23:23People will be surprised that if there are individual consultants
23:27who believe they've got an improvement to the guidelines,
23:30they're sometimes pressurised not to implement it.
23:34But that is the case.
23:38The Department of Health told Panorama
23:41it's asked Professor Nikolaidis to submit his research
23:44so it can be considered for wider use in the NHS.
23:49The NHS is very, very good.
23:51Many countries are jealous of the care that we provide
23:54for the whole population.
23:56It is against this background
23:58that we are discussing the issues of stillbirths.
24:02But it is also against the guidelines
24:05of stillbirths.
24:07But it is critical that we continue to improve
24:10the care that we provide to the patients.
24:12Opportunities are being missed, aren't they, at the moment?
24:15I think that we must speed things up.
24:18The medical establishment is wary of speed,
24:21even when the intervention is low-risk and non-surgical.
24:25Professor Gordon Smith is one of their champions.
24:28He supports change,
24:30but only when based on rigorous scientific testing.
24:33So this is some of our storage facility
24:36for the samples we've collected.
24:39In his fridges could be the answer everyone's looking for.
24:44He's studying samples from more than 4,000 placentas.
24:48It's already taken six years.
24:53I think if we want to impact on the care of hundreds of thousands
24:56of women in the UK and potentially millions of women around the world,
25:00you have to have this level of activity, this seriousness,
25:03and to generate the highest quality of evidence.
25:05So this is the route we have taken.
25:10His work is part of a £12 million government-funded research programme.
25:16But he's keeping an eye on the work at St George's and King's
25:20and suspects they might be on to something.
25:25My personal hunch is that scans almost certainly will work.
25:28Doppler scans will work well, better than just growth scans,
25:31and that combining growth, Doppler and blood tests
25:34will be able to identify high-risk babies.
25:37But we don't change the care of 800,000 women based on a hunch.
25:41We have to provide the evidence that what we're wanting to do
25:44is safe, effective and cost-effective.
25:46If you were to get that strong evidence,
25:48how significant do you think it would be globally?
25:51It could be very significant.
25:53There are 800,000 women giving birth in the UK each year.
25:56There are 4 million women in the United States.
25:58There are millions of women around Europe.
26:00The NHS isn't going to fund a large-scale intervention
26:04that hasn't clearly been shown to be safe and effective.
26:11Samantha, how are you?
26:13I'm good, thank you. Congratulations.
26:15Thank you. That is fantastic.
26:17Samantha's fortunate.
26:19Her hospital in London provided a Doppler scan
26:22when they were not required to,
26:24and baby Letty was delivered five weeks early by Caesarean.
26:28Is she doing a lot of crying?
26:30No, she's a good girl. She only cries when she wants feeding.
26:33I'm still holding these. These are for you. Thank you.
26:36You've waited a long time for this, haven't you?
26:38There was probably a time when you thought it might not even happen.
26:41Yeah, it did feel like that. It did feel like a long, long way.
26:44But it's all worked out well for the end.
26:46We're very happy, very pleased.
26:48You'd better take her off her feeder.
26:50Yeah, definitely. She'll start squawking in a minute, so let her go.
26:53All right. Thank you so much.
26:55Thank you. Bye, Letty.
26:59If Samantha can benefit from such a low-cost intervention,
27:02which has the endorsement of some of our leading practitioners,
27:06isn't it time to make the change for everyone?
27:12Every single hospital in England has the experts,
27:16the expertise and the machinery
27:19to offer a much higher standard of care
27:22for the pregnant women of this country.
27:26But this year, just like every other year,
27:29many hundreds of babies will die in the UK
27:32when potential solutions are out there.
27:37I think it's stunning, the similarity
27:39between what happened to me 20-odd years ago.
27:42We seem to be on the brink with stillbirths
27:45of having found a solution,
27:48of being able to save many, many thousands of lives.
27:51I think the fact that we as a society
27:54don't see it as important, losing a baby,
27:57it's almost as if it's one of those natural tragedies
27:59that you have to accept.
28:01Why accept it?
28:03The Department of Health declined to take part in our programme,
28:07but told Panorama the NHS is a safe place to give birth,
28:11with women reporting high levels of trust and confidence in staff.
28:16They added they've reversed the historic decline in midwife numbers,
28:21with a record number of over 6,000 in training.
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