What Is Stillbirth?

Symptoms, Warning Signs, Causes, and Coping with Stillbirth

What Is Stillbirth?

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

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

Symptoms

Stillbirth can occur without symptoms, but the main one is not feeling fetal movement. Doctors often instruct women who are past 28 weeks pregnant to track fetal kick counts at least once a day. A low, absent, or especially high kick count can be a cause for 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. An effective way to stimulate your baby and monitor movement is to drink juice and then lie down. Usually, a baby will respond with kicks over the next 30 minutes or more. Trust your instincts. If your baby feels less active to you, or in contrast, overly active, call your doctor.

A mother's intuition can't be underestimated when it comes to their baby's well-being.

In fact, a 2017 study found that a dramatic increase in vigorous activity reported by a mother was sometimes associated with stillbirth. At the same time, it's important to keep in mind that most changes in a baby's activity are completely normal, and becoming overly fixated on the possibility that something is wrong can be very stressful and unhealthy for you and your baby.

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

Causes

While 25% to 60% of stillbirths are unexplained, a range of known factors can cause babies to be stillborn, including the following:

  • Birth defects: Chromosomal abnormalities in the baby or birth defects, like anencephaly, cause 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 food poisoning, cytomegalovirus, genital herpes, 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 before the baby and gets compressed), or a cord tightly coiled around the baby's neck, account for around 10% of stillbirths. However, many babies are born with the cord loosely around their neck without causing problems.

Risk Factors

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 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, or those overdue beyond 41 to 42 weeks gestation
  • Pre-eclampsia (pregnancy-induced hypertension)
  • Race (higher incidence is found in Black women than White women regardless of socioeconomic status)
  • Sleeping in a supine (on your back) position
  • Smoking
  • Twin (and other multiple) pregnancies

However, many stillbirths are not explained by the above risk factors.

The majority of stillbirths that happen in countries with access to high-quality healthcare, like the United States, occur in women without established risk factors.

Prevention

In some cases, stillbirth may be prevented, and other times 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 and patient can sometimes take action to reduce the risk. This is why regular 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.

For an average-risk pregnancy, the best things you can do to prevent stillbirth are take care of your overall health and watch for signs of trouble with the pregnancy. This includes the following:

  • Try to get to a healthy weight before pregnancy.
  • Don't smoke, drink alcohol, or use recreational drugs during the pregnancy.
  • Monitor your baby's kicks, and tell your doctor if you notice any changes that concern you.
  • Sleep on your side rather than your back.
  • Avoid foods that could cause food poisoning, such as soft cheeses, unpasteurized dairy products, and undercooked meats.
  • Tell your doctor right away if you experience any unusual abdominal pain, itching, or vaginal bleeding.

However, in many cases, including cord accidents, placental abruption, chromosomal conditions, or other unforeseeable problems, a stillbirth can occur without warning and is rarely preventable.

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

Treatment

If it's discovered that your baby does not have a heartbeat at a routine prenatal checkup, your provider will need to confirm the absence of a heartbeat. An ultrasound is usually done first. If it's determined that the baby has died, there are several options for delivering the deceased baby.

One possibility is to schedule a medical induction of labor right away. You may also have a c-section if indicated or desired. Another option is to wait to see if you go into labor on your 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. Your doctor can help you decide what's best in your case.

Holding Your Baby

Deciding whether or not to hold your stillborn baby is a personal choice with no right or wrong answer. Some parents find that holding the baby is essential for the coping process, while others do not want to see the baby at all. Either way, the experience of delivering a stillborn baby is bound to be extremely heart wrenching.

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. Only they know how they feel and what may serve them as they process their grief.

The hardest part is that couples may not fully realize 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 may have an idea about what has helped the most with others facing a similar situation.

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. Some parents find having some kind of ceremony to honor their child's tragically short life—and their grief—therapeutic.

In some cases, parents also need to decide whether to have an autopsy done on the baby to determine the reason for the stillbirth.

Coping

If you have experienced a stillbirth, 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 experiencing breast engorgement, postpartum depression, and the physical recovery after stillbirth on top of your grief.

The most important thing you need to know is that it's OK to grieve as you heal physically and emotionally. There are several typical steps involved in the emotional recovery after stillbirth, but each woman (and their partner and loved ones) experience these in different ways and with different timing. Be patient and loving to yourself as you heal.

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. It is OK to grieve, but if you find yourself overwhelmed by negative thoughts, see help from loved ones, your doctor, and/or a counselor.

Healing Together

In dealing with your grief, aim to be sensitive to the feelings of your partner and other loved ones as you process your own. Understand that your partner is grieving also, even if they don't express their sadness the same way. They may be trying to put on a strong front to support you and you may be doing the same. Sharing your feelings while also giving each other space can help you heal together.

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

Finding Support

Everyone copes with pregnancy loss differently, but many women find that tactics such as keeping a journal or attending support groups can be therapeutic. No matter how loving your family and friends are, if they haven't had a stillbirth, they can't really know the magnitude of what you are feeling. It can help to be around those who have gone through a similar experience.

There are several wonderful pregnancy loss support organizations where 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.

Talking About Your Loss

If you have other children, you'll need to talk to them about your loss. It's important to use age-appropriate language to explain the pregnancy loss, but whatever you decide is best, it's key to recognize that children will need to cope with the loss of a sibling and may have big feelings to process.

If your child hears you whispering or catches tiny snippets of conversation, they may become very anxious and concerned. Also, 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.

For informing the adults in your life about the stillbirth, it may help to share a written message via email or social media or to have a friend or relative pass on the news for you to avoid repeated conversations that may be draining or re-traumatizing. It's OK to tell people you aren't ready to discuss it as well.

Additionally, if you need help, such as with meals, childcare for your other children, running errands, or just a shoulder to cry on, be sure to ask for it and take friends up on their offers.

A Word From Verywell

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, having a funeral, or something else meaningful to you. This process may help emotionally if you decide to become pregnant again. Remember, you are not replacing the baby you lost, rather, that baby will always have a special place in your heart.

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