Canada’s silent crisis: A patchwork approach to stillbirth reporting and care
Health06.01.2025
When a family loses a child during pregnancy, the grief is profound. Yet, the silence surrounding it can often deepen the pain.
Unfortunately, there’s another kind of silence that looms over this issue in Canada — the lack of a national system to support parents or collect and analyze data on stillbirths.
Unlike our global counterparts such as the U.S., UK, Australia, or New Zealand, where standardized frameworks can spot patterns or provide insights on stillbirths, Canada is grappling with a fragmented provincial approach that leaves gaps in our understanding of the causes of stillbirths and hinders our ability to take preventative national action.
This patchwork approach is prompting groups like the Society of Obstetricians and Gynaecologists of Canada (SOGC) to call for change.
“Right now, there are just so many holes in our approach, and we’re not getting good data. That’s putting us seven or eight steps behind other countries, and leaving a lot of grieving parents without answers,” said Dr. Lynn Murphy-Kaulbeck, President of the SOGC. “I always say, until someone has gone through this, they have no idea what impact it has.”
So what is Canada’s current approach, and why is it failing?
To put it bluntly, said Murphy-Kaulbeck, there isn’t a system.
Since healthcare falls under provincial jurisdiction, each province can decide how to collect stillbirth data and what information it records. We rely on the provinces to classify and record these losses independently because we have no national data bank – and, therefore, no standardized approach.
For example, by definition, a stillbirth is recognized as the loss of a baby after the 20-week mark of pregnancy, or at a weight of more than 500 grams.
Until more recently, some provinces followed more limiting criteria for classification, and, as Murphy-Kaulbeck points out, the “and/or” approach of how we define a stillbirth can also lead to discrepancies in how a loss is recorded by a practitioner.
By leaving it up to the provinces, we are in a grey zone when it comes to data, she explained. Without apples-to-apples data – or in some cases like the Yukon, where we have no reported data for the last five years – we don’t have a proper national view of how we care for or prevent stillbirths.
“If you’re going to talk about prevention, then you need to have really good data on the cause, or potential cause,” said Murphy-Kaulbeck. “We know that about 40-50 per cent of the time there will be no cause found. But we also know that a large percentage of stillbirths occur during labour and delivery – and those are likely preventable.”
The reporting disparity is also evident within a province itself, depending on if you’re in a rural or urban area and what level of resources are available.
That also trickles down to the support level for parents dealing with a loss.
While it can be a difficult and emotional conversation to have with parents, there are options such as autopsy or tissue samples that can be done to help better understand the cause of the loss. Still, these are often not explored by care providers or are unavailable in remote regions. The same can be said for support groups or grief counselling.
“It takes skill and training to have those conversations with parents, but we have to remember that it’s not just about getting data, this is someone’s child,” she said. “If you can take them through what happened or you have a cause, that can often provide a lot of closure. It can also give them reassurance during a future pregnancy if you can look back on their file and say, ‘Here’s what happened last time, and here’s how we can get you into a good place this time.’”
A call to action
For Murphy-Kaulbeck, this issue remains deeply personal.
Decades of caring for women who have dealt with stillbirths has left an indelible mark on her, she said, as well as her own lived experience and knowing what these women will go through.
“As difficult as it is, working with these women has been incredibly rewarding, and they’ve taught me so much,” she said. “I feel that by caring for them, I can make a difference in how they’ll go through it. There’s still a lot of stigma around it… it’s a very silent grief. But I think how we deal with it as a country and how we support women and families when it’s happening can have a long-term impact.”
While Canada’s healthcare structure mainly contributes to this breakdown in data gathering and prevention, there is another underlying elephant in the room that Murphy-Kaulbeck said we can’t ignore in this conversation.
“Women’s health, gynecology, maternal health… it’s just not a priority,” she said. “So that’s kind of what we’re up against; it is just a lack of will to address these issues. It can be incredibly discouraging.”
As organizations like the OSGC remain vocal advocates for change, she said it will take other health professionals like herself to keep rattling the chains.
And, as Canada’s stillbirth rate continues to rise – Alberta recorded its highest number of stillbirths in 2023, showing 454 on record – the time for national action is now.
“We need to keep telling people why this is so important. To the women out there, you have a voice and your voice means something,” she said. “If we move the needle even a bit, that’s more than where we are now. And if we can prevent something as tragic as losing a child, then we absolutely need to do that.”
