#EndStillbirths: Counting mixed blessings

I am no fanatical supporter of the NHS. I do not support it blindly and without qualification as I am keenly aware of where it gets things wrong and some of the more corrosive aspects of its culture.

Equally I do not shy away from celebrating where it does get it right and supporting the people that are fighting from within to change the culture and improve both health and patient care.

Reading the recent Lancet research papers on the costs of grief made me keenly aware that for all its many faults the existence of the National Health Service (NHS) means that I am grateful for a system where I am not charged for tests.

It’s difficult as I had already purchased all the baby items and then had additional tests to pay for.
I wouldn’t have minded [the tests] if my child had lived but having to pay for them after he died was difficult and a constant reminder as the bills kept coming (Australia)

I am also grateful that I could focus on my family and grieve without the added worry of how we could afford the hospital stay and treatment.

Together with sustained difficulties in paying the hospital bills, this strained relations with family members from whom funds had been borrowed (Benin)

The financial difficulties illustrated above are often compounded by the reduced earnings or inability to return to work mentioned in my previous post. All this is in addition to the grief of losing a child and the bewildering array of artificial constraints on grieving.

The test point was highlighted by a recent article by a mother contrasting her maternity experience in Chile with that of America.

Because my desire for reassurance does not qualify as a medically necessary part of prenatal wellness, I would have had to pay out of pocket for a heartbeat check—not a sustainable option over the course of a pregnancy

We know from the MBRRACE research that regular monitoring is essential for improving the chances of reduced stillbirth and I frequently exhort parents to follow instincts to get checked when they feel something is not right or reduced movements.

This is easy for me.  I live in a country that has a system of health care free at the point of use.  I don’t have to weigh up the risk of not getting checked out with the cost of extra scans or doppler checks because there isn’t a direct cost to us other than fuel and parking.

The research has shown that this is far from a universal offering and there are parents that do have to make that horrible cost benefit calculation when they encounter the heart stopping, breath quickening moment when the kicks aren’t coming as frequently or at all.

They have to weigh the life of their child with the prospect of tests they may not be able to afford and just hope that the kicks start again and that the baby is just sleeping or getting ready to come out and say hello.

I am grateful that I did not have to make these calculations and angry that others do and at such terrible cost.

Best estimates available show that a relatively modest sum of spending on prevention ($2000) is enough to generate more than a three-fold return on investment. The economic costs of a stillbirth to a health service far outstrip those of a healthy live birth in terms of more costly interventions and subsequent costs during the next pregnancy and psychological support.

This doesn’t even take into account the savings in terms of what it means to the staff involved.

The psychological toll of having to be involved in that most intimate of times and the terrible professional, moral and legal fear of having been responsible or that maybe had you acted faster or been more attentive or had the time to really listen it could have all been different…can’t be and should not be underestimated.

It is a mixture of everything, rage, oppression, impotence…(Spain)

It shook me to my core (USA)

You’ve got anger, huge anger, especially when a mistake has been made or something has been missed. (Ireland)

If you…lose a mother or a baby, you will lose your licence, your income, your work (USA)

Medical professionals need more support and training to handle these situations so that they can help the bereaved and be supported too.

…they do not teach you the necessary strategies to provide support in these situations (Spain)

…I had to cut off my emotions just to make it through (USA)

…we need to support each other and not tear each other down (USA)