Born Asleep Panorama

This programme contains some scenes which some viewers may find

upsetting. I feel anger over these stillbirths.

These are proper beautiful babies who should be alive. And if we can

do something, then we should be doing it now.

Britain has one of the highest levels of stillbirths in the

developed world. Every day in the UK nine apparently

healthy babies die in the womb. I was in a very bad place, thinking

my baby is dead, how can I give birth to him. This is supposed to be

a happy occasion. Tonight, on Panorama, we meet the doctors who

think they can save thousands of babies. We have the right treatment.

We have the right machinery to prevent many of the still bifrts

that we have now. It is -- stillbirths that we have now. It is

depressing we don't. They have been battling for years for the medical

establishment to take notice. . We believe this is a game changer.

We have saved over 500 stillbirths this year alone. That's ten a week.

But there is a lot more to go. But others say it is too soon. The

evidence just isn't there. If we have some great idea, if we

have some great new technique it is more important that we then generate

the evidence that will mean it is implemented. The NHS promotes

preventative medicine. Live-saving interventions are not being rolled

out with the momentum you might expect.

More than 750,000 babies are born each year in the UK.

For many of us, the greatest gift. The vast majority, like this little

one, arrive without complication. But during pregnancy, one in every

200 births encounter problems. Something that might not be detected

by the midwife or the expectant mother until it's too late.

This is where our kitchen area is going to be. Samantha hopes her

consultant has caught her problem in time. No-one is spared in lottery of

all of this - she is a nurse. Se is more than seven month -- she is more

than seven months pregnant and moving house. Uncertainty hangs over

everything. It has been stressful. We are having a baby and buying a

house at the same time. Was that planned? It was not going to be the

way it was. The baby has other ideas of when she will arrive, anyway. The

problem doctors have detected is that Samantha's baby is not getting

enough food and oxygen from her placenta. There's a chance her baby

will not be coming home. And they saw me at 28 weeks. That is

when it got scary. I asked, would I ever get to full term. Not a chance.

Whereas they might have said it differently. I can ask and because I

want to know the answers to the questions. It is the horrible

thought if she has died in my womb that I would have to give birth to

her. That is the horrible thought to give birth to a dead baby when you

look forward to an alive baby that is so much wanted and planned for.

Every year in the UK, over 3,000 babies die in their mother's womb.

This year, the figure is down slightly for the first time in two

decades. But experts in this programme say

they could save around half of all stillborn babies.

For the families involved, it is an intimate grief. Too painful to speak

of. There are no memories of their child

to mourn. But some find a way. At a peaceful

village hall in Leicester, on a spring day.

So, this is his little baby go that he went off to Nottingham in

straight off from the hospital. I have kept it. I have never washed

it. It is of coursely part of him. As you can -- of course, part of

him. As you can see it is dirty where I kept cuddling it. They make

memory boxes. Memories of children they never knew. There was a way to

find to print the pictures. Who do you ask? You cannot go and print

your picture like this. I did mine at ASDA. Like he is asleep. I didn't

think it would offend anybody queueing around me. There are

accounts of the final moments - they are heartbreaking. It was the night

before. I thought something didn't feel right. I had a cold glass of

Lucozade, like they say. I felt him move. I went to sleep happily. In

the morning when I woke up on the Saturday, something didn't feel

right in my heart. On the Thursday, I realised I hadn't

felt anything - no movements at all, which was very, very unusual. Louise

phoned me. I was at work. "I cannot feel the baby moving." I rushed

home, panicking. We went straight to the hospital.

They couldn't find the heart beat. First of all we saw a midwife who

tried to sort of strap me up to listen to the heart beat externally.

She couldn't... She didn't flap. She said, right, OK, let's get you

scanned. And then I don't really remember

very much. Then she went, I'll go and get the

consultant. That is when the penny dropped that something serious is

wrong. I didn't quite comprehend what the consultant said, so I had a

bewildered look on my face. I had to wait a few minutes for it to sink

in. Before that, you are so excited. You have so much hope. I was going

to be a stay-at-home dad. My life was about to change, for me in a

really positive way. And, you know, in a blink it had all gone. So,

absolutely devastating. I didn't look at the screen, but all

I remember is the sonography saying, "I am very sorry, guys." And that

was that. She said, "I am sorry Mrs Patel.

Your baby's dead." Reena Patel's baby, Mayan, could

have lived. At seven-and-a-half months he was perfectly formed, but

smaller than he should have been, because he had been starved of

oxygen and nutrients. It just wasn't spotted. It breaks my heart every

time I go to the graveyard to find another baby has been buried.

Every week or so, more baby coffins are brought down here and buried.

And it is the frequency that is so disturbing. There is a row here

where three babies died on consecutive days and another row

there, at the back, where three babies, all from different families,

died on the same day. There are shared baby graves like

this all over the country. More than half of hospitals use them.

You will think they must have been seriously ill with something

undetectable, something untreatable, but actually many of them were fully

formed, apparently healthy babies. You might be saying, surely it is

the same the world over - giving birth can be a risky business.

Actually, no, in the UK the figures for stillbirths are particularly

bad. In a study, out of 35 countries, Britain came 33rd.

Even though our stillbirth rate has reduced slightly in the last year,

that small decline has been out-performed in other countries.

Tonight, Panorama brings you three pioneering doctors with big ideas,

whose methods could change everything. Each is achieving

spectacular drops in the stillbirth rate. So, why are their methods not

being rolled out across the country, so that all can benefit?

To being rolled out across the country,

so that all can benefit? To some Degree the NHS is an oil

tanker. If you need to change practise, is not easy to do it. It

takes time. We are looking at the baby's head

down here. Even if I were to produce a study know to show we can make a

change, the evidence would suggest it would take 10-20 years before

practise changes. Britain is well known, in many

aspects of medicine and many aspects of science, for producing

pioneering, new developments. It is a sad day when the pioneers that are

producing the new evidence are not able to practise their discoveries

in this country. Obstetrician Professor Jason Gardosi

travels the world, from his base at the perinatal institute in

Birmingham. Today, he's on a mission on Scotland

to try and convince midwives and obstetricians to sign up to his

programme for reducing stillbirths in low-risk mothers, using a

low-tech and low-cost procedure. One of the main things that we were

up against when we started this a few years ago was that most

stillbirths were classified as unexplained. The implication of that

is unexplained equals unavoidable. For us, each stillbirth is a tragedy

which is like a plane crash and we wanted to investigate this as you

would in the airline industry. For us, the flight recorder, the

black box, was the case notes of the unfortunate mother.

Professor Gardosi and his team trawled through the case notes of

hundreds of stillbirths. They found that far from being unexplained,

many of the deaths were avoidable. And had come about as a result of a

failure in the mother's placenta. In the womb, the baby receives food,

nutrients and oxygen from the placenta.

If there is a problem and the blood flow is abnormal, the baby's growth

is likely to slow. The challenge is to spot which

babies are struggling and save them before it is too late.

Professor Gardosi tries to identify babies that are struggling, not

through invasive surgery or even through scans but through software

and something that most of us have in our own homes. A tape measure.

A mid-Wye, trained by Professor guard -- a midwife, trained by

Professor Gardosi talks us through the procedure. Sue is trying to

detect any problems with the growth of Ruby's baby, at 31 weeks. The

chart predicts the size a healthy baby should be. This is rub bi's --

Ruby's individualised chart. This chart has been developed using her

height, her weight, at the beginning of pregnancy. Her ethnic origin and

how many babies she has had. All that, including ethnic origin

dictates the size you expect the baby to be. Yes. If it falls outside

these contours, then what? We may see the baby's growth has slowed or

suddenly increase. If I saw any of these I would refer Ruby for a scan

in the main antenatal clinic. If a growth problem is detected the

mother is scanned to establish the cause. OK, so this is where it was

on the chart last time you were measured. And we are going to

measure again. Are you happy to be measured? Yes. Let's do it again. I

measure the bump to the symphysis pubis. Ruby is 31 weeks. We plot 29

sensy metres, which is on the 50th centile. On the middle.

Almost perfect. Professor Gardosi's charts have not won everybody over.

Despite the fact that hospitals which have adopted his methods in

the UK have seen their stillbirth rate drop by up to 22 2 2. About --

22%. He estimates it is only 50 p per pregnancy.

On BBC Radio Berkshire, it is Anne Diamond. Thank you. I am Anne

Diamond. A special programme for you today about stillbirths. Every year,

3,000 babies in this country are stillborn, making it one of the

highest rates in the developed world...

It's not the first time there's been a problem rolling out a potential

life saver for babies across the UK. One summer morning in 1991, TV

presenter Anne Diamond found her baby boy, Sebastien, dead in his

cot. I went into Sebastien's bedroom and I could see he was in his cot,

face down, one little arm sticking out between the bars of the cot.

Nothing unusual there, until I went over and felt his arm. It was stone

cold. I then went to pick him up and he was like a stiff little statuism

knew immediate -- statue. I knew immediately that he was dead and had

been dead for a few hours. Just four months old, Sebastien had succumbed

to cot death. There was already a study under way in New Zealand,

which found you could cut 50% of cot deaths by turning your baby on its

back. Even so, the British Government of the day never told

mothers. They were waiting for more data, more proof. The Department of

Health here said well, hang on, we don't really have the data to prove

it. We think it might work, but we can't prove it. I later found that

our professionals in this country did know what was going on in New

Zealand, but me, living in London, I didn't know that. Why not? I found

that the professionals in our country were obsessed with wanting

more and more evidence. How come me, as a mum, was left ignorant, when if

I'd happened to live in New Zealand my baby might still be alive? I

don't think I'll ever forgive the British Government. Anne went into

campaign mode, going on TV and radio to demand change. Cot death is

compare Tivoli rare but there are few things more She made her tragic.

Own advert and finally managed to sting the Government into action.

The Department of Health's new leaflet explains how anyone who

looks after a young baby can help reduce the risk of cot death. How

many babies' lives were saved? We reckon certainly within the first

few years, 15,000 babies' lives were saved. Incredible. It was Now she

wants incredible. To get involved again, this time with stillbirths.

She's invited Professor Gardosi onto her show to give his message to the

listeners of radio Berkshire. Are you able to tell, yet, how many you

can save? What sort of a difference will this make, in numbers terms?

We've done it in the West Midlands and then we've done it in several

other regions that have picked up the training programme. Overall, in

the whole country, we are estimating if everybody picked up this fairly

simple but standardised evidence-based method, we can save a

thousand stillbirths each year. That is unbelievable. Why aren't we doing

something about this? Why isn't every hospital - I mean, it's so

simple. It's easy to carry out. You can train the professionals to do

it... Back in London, Samantha, at 34 weeks pregnant, has arrived at a

specialist unit in St George's Hospital to see if the blood flow

into her placenta is worsening and putting her baby at risk. The

consultant who will examine her is Professor Basky Thilaganathan, one

of the country's leading obstetricians.

I hope you don't mind my sitting in on this? No, you're welcome. Good to

see you. This piece of equipment, available in most hospitals, can

visualise and measure the blood flow between Samantha's placenta and her

baby. It's called a doppler scan. Sam came along mid-pregnancy for her

routine scan. We found that the doppler assessment of blood flow to

the womb indicated the placenta hadn't formed as well as it should

have done. The placenta is struggling a bit. Often when the

placenta fails, it's towards the end of pregnancy, like with Samantha.

That means their baby can be delivered early, often by Caesarean,

without the need for intensive care. The problem is most hospitals only

use doppler scans on high-risk women because those are the national

guidelines. Professor Thilaganathan and his team at St George's think

that's wrong and give toplers to all first-time mothers as well, like

Samantha, at an additional cost of just ?15 per pregnancy.

Is it possible that this baby could have been lost, if he were being

delivered in another hospital? It's a difficult question to answer, but

I think it is entirely possible that this baby could have been lost in

another She was fortunate hospital. To be here? Because not many

hospitals do what you do. No, that's true. That went well, didn't it?

Yeah, definitely. Really happy today. Baby's put on some weight and

everything is stable. You could be giving birth this time in three

Could be, but days. Hopefully not. I'd like to go another week, if

possible. Hopefully. Fingers crossed. Brilliant. Offering topler

scans to all first-time mothers, as well as those at high risk, seems to

have yielded a remarkable result. Over the last two years, we've had a

50% drop in stillbirths. 50%? A lot of Trusts would love that figure. I

think you're right. We'd-to have that. -- We'd love to have that.

Like with cot death, the decision makers want more data, more

evidence, something Professor Thilaganathan is prepared for. It's

difficult for me to proffer that -- to prove that the interventions

we're doing on the ultrasound base add preach are the very reason for

the drop in stillbirth. We need to get on and do proper studies to

ensure that is really what's Aren't you being happening. A bit modest? A

lot of people would say this is down to you and your techniques? I'd like

to that I that this is our intervention that has changed the

stillbirth rate. However, one must be cautious. I need to be absolutely

certain it is my intervention that caused the reduction in stillbirths.

But others are confident there's enough evidence out there already on

the life-saving use on dopplers. How are you? OK. You are the man

responsible? I am. Professor Kypros Nicolaides works at Kings College

Hospital in London. Many regard him as the father of foetal medicine.

Today, he's in the procedure room to operate on unborn twins. The

mother's placenta is feeding too much blood to one, too little to the

other. Doctors come from around the world to study his techniques. Can

you see? Going down the Tube. Then we need to look at the blood

vessels. Can you see that? He believes the UK's stillbirth rate

could be reduced dramatically almost overnight, if the medical

establishment were willing. He favours a similar method to

Professor Thilaganathan, a doppler scan, but in his case, three of them

at 12, 22 and around 33 weeks. We have demonstrated through extensive

research that you can identify more than 90% of those cases from the

12th week assessment. Do you think you could avoid therefore more than

50% of the stillbirths? We can easily avoid them. We can do so

through very simple adjustment in the way we deliver antenatal care.

With the support of his hospital administrators, he offers care

beyond the national guidelines, three doppler scans to all pregnant

women. But consultants who've tried to implement the same programme in

other hospitals have met with resistance. They had to stop because

they were outside the guidelines. People will be surprised that if

there are individual consultants who believe they have an improvement to

the guidelines, they're sometimes pressurised not to implement it. But

that is the case. The Department of Health told Panorama it's asked

Professor Nicolaides to submit his research so it can be considered for

wider use in the NHS. The NHS is very, very good. Many countries are

jealous of the care that you provide for the whole population. It is

against this background that you are discussing the issues of

stillbirths, but it is critical that we continue to improve the care that

we provide the Opportunities are being patients. Missed being at the

moment? I think that we must speed things up. The medical establishment

is wary of speed, even when the intervention is low risk and

nonsurgical. Professor Gordon Smith is one of their champions. He

supports change, buffer only when based on rigorous scientific

testing. This is some of our storage facility for the samples we've

collected. In his fridges could be the answer everyone's looking for.

He is studying samples from more than 4,000 placentas. It's already

taken six years. I think if we want to impact in the care of hundreds of

thousands of women in the UK and potentially millions of women around

the world, you have to have this level of activity, this seriousness

and to generate the highest quality evidence. This is the route we have

taken. His work is part of a ?12 million Government-funded research

programme. But he's keeping an eye on the work at St George's and

King's and suspects they might be onto something. My personal hunch is

that scans almost certainly will work, doppler scans will work well,

better than just growth scans and combining growth, doppler and blood

tests we'll be able to identify high-risk babies. We don't change

the care of 800,000 women based on a hunch. We have to provide the

evidence that what we want to do is safe, effective and cost effective.

If you were to get that strong evidence, how significant do you

think it will be globally? It could be very significant. There are

800,000 women giving birth in the UK each year. There's four million

women in the United States. There's millions of women around Europe. The

NHS isn't going to fund a large-scale intervention that hasn't

clearly been shown to be safe and effective. Samantha, how are you?

I'm good, thank you. Congratulations. Thank you. That is

fantastic. Samantha's fortunate, her hospital in London provided a

doppler scan when they were not required to and baby Lettie was

delivered five weeks early by Caesarean. Is she doing a lot of

crying? No, she only cries when she wants I'm still holding feeding.

These - they're for you! Thank you. You've waited a long time for this,

haven't you? There was probably a time when you thought it might not

happen? Yeah, it felt like a long way. It's all worked out in the end.

Very happy, very pleased. You'd better take her and feed her.

Definitely or she'll stark squawking. Better go. Thank you so

much. Bye, Lettie. If Samantha can benefit from such a low-cost

intervention, which has the endorsement of some of our leading

practitioners, isn't it time to make the change for everyone? Every

single hospital in England has the experts, the expertise and the

machinery to offer a much higher standard of care for the pregnant

women of this country. But this year, just like every other year,

many hundreds of babies will die in the UK, when potential solutions are

out there. I think it's stunning, the

similarity between what happened to me 20-odd years ago. We seem to be

onle brink with stillbirths -- on the brink with stillbirths of having

found a solution of being able to save many, many thousands of lives.

The fact that we, as a society, don't see it as important losing aI

baby. It's almost -- losing a baby. It's almost a natural tragedy that

you have to accept. Why accept it? The Department of Health declined to

take part in our programme but told Panorama: "The NHS is a safe place

to give birth with women reporting high levels of trust and confidence

in staff." They added, they've reversed the historic decline in

midwife numbers with a record number in training.

For details of organisations which offer advice and support, go online

to bbc.co.uk/actionline. Or call the BBC Action Line to hear recorded

information.