Learning Objectives: At the end of this activity, you will be able to:

• Explain why stillbirth is a complex problem involving many factors
• Discuss the benefits of seeking input from the community

Description: Solving the challenge of a high stillbirth rate in Scotland is not simply about getting obstetricians to improve. “It’s a multidisciplinary problem,” says Jason Leitch, National Clinical Director in the Scottish Government Health Department and former IHI Fellow. “So we’ve brought together social workers, teachers, housing officers, prison officers, and criminal justice people. With the family in the center of the conversation, we’ve tried to find whatever the solutions are [together].” Teaching moms about practical concepts such as fetal movement and smoking cessation has contributed to an 18 percent reduction in stillbirth rate in three years. “We’re still not at the average,” Leitch says. “There’s still much to do.”

Discussion Questions:

• What were some of the factors affecting stillbirth rates that you heard in the video? Why couldn't obstetricians solve the problem on their own?
• Do you think it would be hard to convince staff and patients to participate in multidisciplinary rounds after a stillbirth? Why might people resist this, and how might you address their concerns?
• What other health care problems might be improved by addressing factors outside of health care, for example, living conditions?