Stillbirth is a topic that U.S. obstetrical clinicians don’t discuss enough. It’s like the elephant in the room that everyone likes to ignore. Unfortunately it can’t be ignored because it affects 6 out of every 1,000 pregnancies.

As we move further into the 21st century, there will be a large emphasis on wellness and prevention by insurance plans and policy holders for primary care patients. However, the same initiative should apply to pregnant women. My biggest criticism is that obstetricians don’t do enough to warn patients about potential problems and look for problems aggressively. This was the reason for the birth of The Smart Mother’s Guide to a Better Pregnancy.

The Society for Maternal-Fetal Medicine (a group of high risk pregnancy doctors) reported the findings of a Norwegian study that suggested older pregnant women are at risk for stillbirths. Stillbirths are defined as fetal death after 20 weeks. According to this study, women over 35 have a risk five times greater than a woman under 25 of having a stillbirth and of course, this number increases dramatically for women who are pregnant and over 40.

So what should be done? One of the best ways of preventing stillbirth is to watch both mother and unborn baby during pregnancy by a method called fetal surveillance (FS). FS involves performing a Non-Stress test and ultrasound once or twice a week to make certain the baby’s heart rate, movement and breathing pattern are normal. Yet, this test is not routinely done for women over 35 and it should be according to the study. Yet, that endeavor might be easier said than done because of cost-saving measures by insurance companies. The present U.S. healthcare system pays physicians for services based on a diagnosis. Does this mean that older pregnant women (also known as Advanced Maternal Age) should be considered a high-risk condition? The answer is a resounding “yes.”

The study states that the risk of a stillbirth increases after 38 weeks for women over 35. Therefore, fetal surveillance should be considered at this time or at least discussed with your midwife or obstetrician.

Remember, a healthy pregnancy doesn’t just happen. It takes a smart mother who knows what to do.