Abstract
The Confidential Enquiry into Stillbirths and Deaths in Infancy (CESDI) has been investigating stillbirths and infant deaths for almost ten years. It seeks clinical and individual causes, through examination of clinical evidence, post mortem studies (Persad et al, 1996) and the effects of certain at risk behaviours on biological processes (CESDI, 1996; 1997; 1998; 1999). However, epidemiological evidence suggests that perinatal and infant mortality are more closely linked to structural factors, poverty, deprivation and poor environments. Against these, clinical medicine has little impact, yet CESDI frequently blames clinical practice, including midwifery services. Our Healthier Nation (Department of Health, 1999) recommends a move away from secondary measures and towards public health and primary care. Epidemiology not laboratory medicine supports these approaches, identifying models of susceptibility that can underpin the development of more effective and primary care orientated midwifery services. This article considers the epidemiology of perinatal mortality and how it supports the public health model of primary care rather than the ‘futile’ efforts of CESDI.
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