New Zealand has one of the highest rates of stillbirth among developed countries and an expert says many more babies would survive if the country quit smoking and reduced its obesity.

France has the highest stillbirth rate among high-income countries, followed by Austria. New Zealand and Britain share third place, with 3.5 stillbirths per 1000 births, and Australia's rate is 2.9, according to a series of articles published today in British medical journal The Lancet.

In New Zealand, around 210 babies a year are stillborn after 28 weeks' gestation, the international measure - but more than 300 a year on the country's own definition of after 20 weeks.

The journal says the global toll was 2.6 million babies. Internationally nearly half these deaths occur during childbirth, mainly from obstetric emergencies, but this is much more a problem in poor countries than in the West, where the greatest scope for improving survival lies in improving women's health, detecting and managing women at risk of stillbirth, and improving maternity care.

Obesity, alcohol, tobacco, having had a caesarean and being aged over 35 are listed as risk factors for stillbirth.

"Any smoking during pregnancy raises the risk of stillbirth by 40 per cent, although the authors suggest this is likely to be a conservative estimate, with some high-quality data suggesting a doubling of the risk," the journal says.

Auckland University's head of obstetrics and gynaecology, Professor Lesley McCowan, said yesterday it was fantastic The Lancet was giving so much attention to stillbirth.

"Many of us have been trying to raise awareness for decades. It affects one in 300 families [a year]. It is 10 times the rate of cot death. It needs to be much more of a research priority."

But Professor McCowan objected to the journal's rankings because New Zealand's rate might vary from 2.8 to 3.8 per 1000 births between years and statistically these rates were about the same.

"I'm really disappointed [the journal] has ranked countries, because you really can't separate 2.8 from 3.8.

"New Zealand's rate ... is very comparable to other countries with a similar model of maternity care, like the Netherlands and the UK and we are not dissimilar from Australia."

Professor McCowan said her research had found the risk factors for stillbirth among Auckland women included being overweight, exposure to tobacco smoke, the pregnancy being a woman's first, having a fourth or subsequent baby, and infrequent attendance for antenatal care.


Maria Ramsay would be aged 5 now if she had survived. She was stillborn.

Her mother, Alana, spoke yesterday of her family's loss of their second baby.

"It changed our lives. It's like there's a hole in our family now. There isn't a day that goes by that we don't think about her, what she would be like, what our family would be like, if she had lived."

Mrs Ramsay, husband Angus, and children Joel, aged 8, and Julia, 4, celebrate Maria's birthday each year.

"We hang things on our Christmas tree for her at Christmastime as well."

Maria and her placenta didn't grow properly in the womb, but the reason for that wasn't known, she said.

An Auckland co-ordinator for Sands, a pregnancy and baby loss support group, Mrs Ramsay said, "We encourage people to try and do meaningful things to make memories because the life of their baby is so small, so short, we really think it can help people in their grieving if they can do memory-making things."

She said it was especially important for couples to spend some time with their baby, forming memories, before they held a funeral.

The Lancet journal says there is a stigma associated with stillbirth, a perception that the mother has somehow failed, and that affected women face a high risk of depression, anxiety and post-traumatic stress disorder.

Mrs Ramsay said New Zealanders didn't know how to respond to someone who had had a stillbirth.

"People think you should get over it, that six weeks is enough to get over it. I don't think life ever goes back to what it was before."

She said there was no free counselling available for parents who had a stillbirth, but hospitals now cared well for affected families.

Factors that can increase the risk of a woman having a stillbirth:

* Being overweight.
* Tobacco smoke.
* Alcohol consumption in pregnancy.
* Being aged over 35.
* Being pregnant for the first time.
* Having a fourth or subsequent baby.
* Previous caesarean birth.
* Lack of antenatal health care.