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My baby was put in a shared grave

Years after losing her son through hospital blunders, Alvina Carrington discovered a new horror
Denis Campbell, health correspondent
Sunday December 2, 2007
The Observer

In late 2004, on a visit to her son's grave, Alvina Carrington was surprised to find fresh flowers. 'I knew I hadn't put them there, so I thought it was odd,' she recalls. But Alvina assumed a friend or member of her family had brought them, and was touched someone had made the journey to Alperton cemetery on the north-west fringes of London to remember Luke, who had been stillborn at seven months.

After his death in October 2003 Alvina's life fell apart. She had lost the first child she desperately wanted and had spent six years trying for. An appalling series of blunders by doctors and midwives meant her pre-eclampsia went unidentified, with fatal consequences. Amid the shock, grief and anger, her relationship broke up. Previously very sociable, the 33-year-old became introverted and virtually housebound. She gave up her job, unable to stop crying every night after she got home. Alvina thought she had reached the lowest point of her life.

But more than a year after that trip to the cemetery, in early 2006, she suffered another heartbreak. In the course of asking what sort of headstone she could put on Luke's grave, Alvina discovered that what she thought was her son's final resting place also contained the bodies of several other babies. The flowers were for one of them, not Luke.

'I'd rung the cemetery, told them Luke was buried there, given them the plot number and asked them what size of headstone I could erect. I'd decided that I was going to have gold lettering saying "Blue: in our hearts always", because that was the nickname I'd given him, and then 'Luke' underneath.

'That would have been the final act. But the cemetery people explained to me that it wasn't my property, that it belonged to Brent Council, that I'd need to get their permission for the headstone and that there were other babies in the grave,' says Alvina. 'I was devastated. I thought it was Luke's grave and only Luke's grave, and that it was my property. I thought the cemetery had got it wrong. But they said to me: "It should have been explained to you that the grave belongs to the council and that other babies are there."

'I wanted to know how many other babies were in there beside Luke, and whether they were on top of each other or side by side. I wanted to know if there was another baby on top of Luke.'

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Half of Stillbirths Related to Placental Pathology

Thanks to Niobe for sending in this article

Interview with Dr. Gordon Smith, MD
November 16, 2007 - Insidermedicine

Most stillbirths occur as a result of a failing placenta, and understanding placental development and functioning may hold the key to identifying those at high risk for stillbirth early on, according to research published in The Lancet.

According to the Antepartum Fetal Surveillance Guidelines put forth by the American College of Obstetricians and Gynecologists (ACOG):

• Women with high-risk factors for stillbirth should undergo antepartum fetal surveillance using the nonstress test (NST), contraction stress test (CST), biophysical profile (BPP), or modified BPP. Testing should be initiated at 32 to 34 weeks for most pregnancies and at 26 to 28 weeks for very high risk women.
• An abnormal NST or modified BPP usually should be further evaluated by either a CST or a full BPP. Subsequent management should then be predicated on the results of the CST or BPP, the gestational age, the degree of oligohydramnios (if assessed), and the maternal condition.
• In the absence of obstetric contraindications, delivery of the fetus with an abnormal test result often may be attempted by induction of labor with continuous monitoring of the fetal heart rate and contractions. If repetitive late decelerations are observed, cesarean delivery generally is indicated.

In an effort to better understand why stillbirth rates have remained the same or even risen slightly over the past several decades, the investigators reviewed the literature on this condition dating back as far as 1997. They discovered that the standard screening technique, consisting of measuring the height of the uterus with a tape measure, has not changed in four decades. While other more high tech screening procedures have been tried, none has been shown to improve outcomes.

We had a chance to speak with Dr. Gordon Smith from the University of Cambridge about his findings, and what must be done in the research community to address stillbirth.Most cases of stillbirth can be linked to a failing placenta, including premature detachment from the uterus, failure to provide the fetus with adequate oxygenated blood, and problems associated with pre-eclampsia.

When the placenta fails late in a pregnancy it typically failed to develop properly in the first place. As a result, a stillbirth that occurs late in pregnancy may be the result of improper placental development occurring very early on in the pregnancy.Today's research highlights the role of the developing placenta in stillbirth. One way of reducing the rate of stillbirth may be to further investigate how the placenta develops and functions. Such research may provide important insight into how to develop screening tools that identify those at highest risk for stillbirth.

For Insidermedicine in Depth, I'm Dr. Susan Sharma.