A Comprehensive Overview of a Stillbirth

Symptoms, Warning Signs, Causes, and Coping with Stillbirth

If you're looking for information about stillbirth, you may be feeling sad and frightened. We will share a bit about the symptoms, warnings signs, and causes, but most importantly we will talk about what may help you best cope at this difficult time.

What Is a Stillbirth?

A stillbirth (also called intrauterine fetal demise) is most often defined as the loss of a baby that occurs after the 20th week of pregnancy in which a baby dies before being born. (A loss which occurs before 20 weeks is usually considered a miscarriage.)

Unfortunately, stillbirths occur far too often, in roughly 1 in 160 pregnancies. In the U.S., there are roughly 26,000 stillbirths each year, with 3.2 million worldwide. Around 80% of stillbirths are preterm (occurring before 37 weeks gestation), with half of all stillbirths occurring prior to 28 weeks.

Risk Factors for Stillbirth

As with most other pregnancy losses, stillbirths often occur without any identifiable risk factors, however, some risk factors associated with an increased risk of stillbirth include:

  • Abdominal trauma related to motor vehicle accidents, falls, or domestic violence
  • Alcohol use or controlled drug use (both prescription and nonprescription) during pregnancy
  • History of preterm birth, toxemia, or intrauterine growth retardation in a prior pregnancy
  • History of stillbirth, miscarriage, or neonatal death (death during the first 28 days of life
  • Intrauterine growth retardation
  • Lack of prenatal care
  • Maternal age greater than 35 or less than 20
  • Maternal health conditions, particularly high blood pressure and diabetes, along with lupus, kidney disease, and some blood clotting disorders
  • Obesity
  • Post-term pregnancies, overdue beyond 41 to 42 weeks gestation (thought to contribute to 14% of stillbirths)
  • Pre-eclampsia (pregnancy-induced hypertension)
  • Race (higher incidence in Black women than White women regardless of socioeconomic status)
  • Sleeping position, some researchers believe that sleeping in a supine position (on your back) increases risk
  • Smoking
  • Twin (and other multiple) pregnancies

Causes of Stillbirths

While 25% to 60% of stillbirths are unexplained, there are a range of known factors that can cause babies to be stillborn. These may include:

  • Birth defects: Chromosomal abnormalities in the baby or birth defects, like anencephaly, cause of 14% of stillbirths.
  • Infections: In developed countries, up to 24% of stillbirths (and/or miscarriages) are related to infections, like bacterial vaginosis, group B strep, parvovirus B19 (fifth disease), Listeria monocytogenes, cytomegalovirus, genital herpes (the first infection), and syphilis. Infections are more likely to cause early stillbirth (20 to 28 weeks gestation) than stillbirth after 28 weeks.
  • Placental abruption: When the placenta separates prematurely from the uterine wall, the condition is known as placental abruption. Some degree of placental abruption occurs in 1% of pregnancies. The risk of stillbirth depends on the degree of separation, with a separation of 50% or more often causing stillbirth.
  • Umbilical cord accidents: Umbilical cord accidents, such as a knot in the cord, a prolapsed cord (when the cord comes out of the vagina first and gets compressed), or is tightly coiled around the baby's neck, account for around 10% of stillbirths. Many babies are born with the cord loosely around their neck without causing problems.

Can Doctors Prevent Stillbirth?

There are some times when a stillbirth may be prevented and other times when prevention isn't possible. As part of prenatal care, doctors watch for early signs of problems in the mother and the baby. When risk factors exist, such as high blood pressure, a doctor can sometimes take action to reduce risk. This is why seeking prenatal care is so important.

For women who are at increased risk of stillbirth, consultation with a perinatologist or an obstetrician who specializes in high-risk pregnancy should be considered. A number of factors are currently being studied for their role in reducing the risk of stillbirth.

From probiotic supplements to sleeping position, it's important to find a physician who can help you learn about the latest research concerning anything you can do to decrease your risk. In the case of cord accidents, chromosomal conditions, or other unforeseeable problems, however, a stillbirth can occur without warning and thus is not always preventable.

Since prolonged pregnancies are thought to contribute to 14% of stillbirths, careful management of overdue pregnancy is essential.

Early Warning Signs of a Possible Stillbirth

Stillbirth can occur without symptoms, but doctors often instruct women who are past 28 weeks pregnant to track fetal kick counts at least once a day. If the kick count causes concern, your doctor may want you to come in for a test called a non-stress test (NST) that checks whether your baby is safe.

Just like adults, babies have days when they are more active than others. Trust your instinct. If you baby feels less active to you, or in contrast, overly active, trust your gut and call your doctor. A woman's intuition can't be underestimated when it comes to her baby's well-being.

In fact, a 2016 study found that a dramatic increase in vigorous activity reported by a mother was sometimes associated with stillbirth. At the same time, stress isn't good for anyone, and it's important to keep in mind that most changes in a baby's activity are completely normal.

Other possible warning signs include severe abdominal or back pain and vaginal bleeding as this could signal placental abruption. Always err on the side of caution and call your doctor if you are concerned.

What Happens When a Baby Has No Heartbeat?

If it's found that your baby does not have a heartbeat at a routine prenatal checkup, your provider will want to confirm the absence of a heartbeat. An ultrasound is usually done first. If it's determined that the baby has died, a woman has a few options.

She may be scheduled for a medical induction of labor right away (or have a c-section, if indicated) or may choose to wait to see if she goes into labor on her own within a week or two. There are some risks to waiting (such as blood clots), so it is important to understand the risks and benefits of these options thoroughly.

Should Parents Hold Their Stillborn Baby?

If you're wondering whether or not you should hold your stillborn baby, the answer is that there is not a right or wrong, only what is best for you. Some parents find that holding the baby is essential for the coping process, while others do not want to see the baby at all.

The research is mixed on whether holding the baby is therapeutic (some research suggests that holding the baby may possibly increase the risk of clinical depression), but the decision should be made by the parents alone.

The hardest part is that couples may not know their preferences until it's too late. Some parents who do not hold their babies end up regretting it later. If you're not sure what you want to do, talk to your obstetrics nurse. They will likely have an idea about what has helped the most with others facing a similar situation.

Things to Know About Hospital Procedures

Parents usually have the option of taking photos and keeping a lock of hair from their stillborn baby. In stillbirths, as opposed to miscarriages, there is also the option of holding a formal funeral and/or cremation, and parents should inquire about hospital policies in that area. In some cases, parents also need to decide whether to have an autopsy done on the baby to determine the reason for the stillbirth.

These are very difficult decisions to face when you are mourning your baby, and all you had hoped for them.

How to Cope With Having a Stillborn Baby

If you have experienced a stillbirth, you already know that coping is easier said than done. You may be facing feelings of self-blame (even though the loss was likely not your fault) or be struggling to understand what happened. You might be struggling with issues like breast engorgement and postpartum depression, the healing and physical recovery after stillbirth, on top of your grief.

The most important thing you need to know is that it's OK to grieve. There are several steps involved in the emotional recovery after stillbirth but each woman (and her partner) experience these in different ways and with different timing.

Many parents feel a deep bond with their babies long before birth, and to have that bond suddenly broken through stillbirth is understandably traumatic. You do not have to justify your grief; well-meaning but ignorant friends and relatives may pepper you with comments like "You're young; you'll have another," or "It just wasn't meant to be." These platitudes may seem meaningless at best, and cause you to feel angry at worst. It is OK to grieve.

Communicating About Stillbirth Your Family

In dealing with your grief, try to be sensitive to your partner. For moms, understand that your partner is grieving also, even if your partner doesn't express their feelings the same way. They may be trying to put on a strong front to support you.

For partners, try to be patient and have a ready shoulder and listening ear. Talking about the loss may be therapeutic. Try to be on the lookout for signs of postpartum depression in your partner and suggest she see a doctor or talk to a counselor if you are concerned.

Everyone copes differently with stillbirth, but many women find that tactics such as keeping a journal or attending support groups can be therapeutic in coping with pregnancy loss. No matter how loving your family and friends, if they haven't experienced a stillbirth, they can't really know what your are feeling.

There are several wonderful pregnancy loss support organizations through which you may connect with others to get the support you need. A few of these organizations are designed exclusively to help parents cope following a stillbirth.

If you have other children, you may be wondering how to talk about your loss. We have some age-appropriate tips for talking to children about pregnancy loss, but whatever you decide is best, it's important to recognize that children can suffer from pregnancy loss as well.

If you are whispering or if your child catches tiny snippets of conversation, they may become very anxious and concerned. Only you know what is best for your child, so you'll want to make sure that the well-meaning people in your life respect how and when you choose to talk to your child about your family's loss.

Getting Pregnant in the Future After Stillbirth

Chances are, you don't want to hear about getting pregnant again and may wish to stop here. If and when you reach that point, you may wish to learn about getting pregnant after stillbirth, how long you should wait, and what the risks may be. For now, you need to grieve in your own way and in your own time.

While you are grieving and recovering you may wish to find a special way to memorialize your baby, whether that means planting a memorial garden or something else meaningful to you. This may help if you decide to become pregnant again; you are not replacing the baby you lost, rather, that baby will always have a special place in your heart.

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