What is a Stillbirth?

A stillbirth is when a fetus dies after the mother’s 20th week of pregnancy. The baby may have died in the uterus weeks or hours before labor. Rarely, the baby may die during labor. Although prenatal care has drastically improved over the years, the reality is stillbirths still happen and often go unexplained.

A stillbirth is classified as either an early stillbirth, a late stillbirth, or a term stillbirth. Those types are determined by the number of weeks of pregnancy:

. Early stillbirth: The fetus dies between 20 and 27 weeks.

. Late stillbirth: The fetus dies between 28 and 36 weeks.

. Term stillbirth: The fetus dies the 37th week or after.

Who is at risk of having a stillbirth?

A stillbirth can happen to pregnant women of any age, background, or ethnicity. They can be unpredictable – 1/3 of cases go unexplained. There are some ways you can reduce your risk, though. You’re more likely to have a stillbirth if you:

. Smoke, drink alcohol, or use recreational drugs.

. Are an older mother (age 35 or older).

. Have poor prenatal care.

. Are malnourished.

. Are African-American.

. Are having multiple births (twins or more).

. Have a preexisting health condition.

. Are obese (body mass index above 30).

What’s the difference between a stillbirth and a miscarriage?

Like a stillbirth, a miscarriage is also a pregnancy loss. However, while a stillbirth is the loss of a baby after 20 weeks of pregnancy, a miscarriage happens before the 20th week.

What causes a stillbirth?

The cause of the stillbirth is vital not only for the healthcare providers to know, but for the parents to help with the grieving process. The cause is not always known (1/3 of stillbirths cannot be explained), but the most likely causes include:

. Problems with the placenta and/or the umbilical cord. Your placenta is an organ that lines your uterus when you’re pregnant. Through it and the umbilical cord, the fetus gets blood, oxygen and nutrients. Any problems with your placenta or umbilical cord and the fetus will not develop properly.

. Preeclampsia. Preeclampsia is high blood pressure and swelling that often happens late in the pregnancy. If you have preeclampsia, you have twice the risk of placental abruption or stillbirth.

. Lupus. A mother who has lupus is at risk of having a stillbirth.

. Clotting disorders. A mother who has a blood clotting disorder like hemophilia is at a high risk.

. The mother’s medical conditions. Other illnesses can sometimes cause stillbirths. The list includes diabetes, heart disease, thyroid disease, or a viral or bacterial infection.

. Lifestyle choices. If your lifestyle includes drinking, using recreational drugs and/or smoking, you’re more likely to have a stillbirth.

. Birth defects. One or more birth defects are the cause of about 25% of stillbirths. Birth defects are rarely discovered without a thorough examination of the baby, including an autopsy (an internal examination of the baby’s body).

. Infection. An infection between week 24 and week 27 can cause a fetal death. Usually, it’s a bacterial infection that travels from your vagina to the womb. Common bacteria include group B streptococcus, E. coli, klebsiella, enterococcus, Haemophilus influenza, chlamydia and mycoplasma or ureaplasma. Additional problems include rubella, the flu, herpes, Lyme disease and malaria, among others. Some infections go unnoticed until there are serious complications.

. Trauma. Trauma such as a car crash can result in a stillbirth.

. Intrahepatic cholestasis of pregnancy (ICP): Also known as obstetric cholestasis, this is a liver disorder that includes severe itching.

What physical symptoms does the mother have after stillbirth?

If you have a fever, bleeding, chills, or pain, be sure to contact your healthcare provider right away because these may be signs of an infection.

Will I lactate after a stillbirth?

After the delivery of the placenta, the milk-producing hormones may be activated (lactation). You might start to produce breast milk. Unless you have preeclampsia, you can take medicines called dopamine agonists that may stop your breasts from producing milk. You can also choose to let the lactation stop naturally.

Does stillbirth cause infertility?

No. A stillbirth does not cause infertility and it doesn’t indicate that there is a problem with it.

How is the diagnosis made?

Usually, you’ll notice that your baby isn’t as active as it used to be. An ultrasound will confirm if the baby has passed.

How can I find out what caused my stillbirth?

To discover the cause, your healthcare provider will perform one or more of the following tests:

. Blood Tests. Blood tests will show if you have preeclampsia, obstetric cholestasis or diabetes.

. Examination of the umbilical cord, membranes and placenta. These tissues attach to your fetus. An abnormality could prevent your baby from receiving oxygen, blood and nutrients.

. Tests for infection. Healthcare providers will take a sample of your urine, blood, or cells from your vagina or cervix to test for infection.

. Thyroid function test. This test will determine if there’s something wrong with your thyroid gland.

. Genetic tests. Your healthcare provider will take a sample of the umbilical cord to determine if your baby had genetic problems such as Down’s syndrome.

Your healthcare provider will also review medical records and the circumstances surrounding the stillbirth. With your consent, an autopsy can be performed to determine the cause of your baby's death. An autopsy is a surgical procedure performed by a skilled pathologist. Incisions are made carefully to avoid any disfigurement, and the incisions are surgically repaired afterward. You have the right to limit the autopsy to eliminate any incisions on your baby that are uncomfortable for you. Be sure to write these requests on the autopsy permission form.

Some hospitals do not perform autopsies, so your baby may have to be transported to another hospital. Be sure you feel comfortable with where your child is being taken. You also have the right to deny an autopsy, if that is your wish.

An autopsy may be legally required in some cases, including when:

. A baby died within 24 hours of a surgical operation.

. A healthcare provider cannot certify the cause of death.

. A baby was alive and then died suddenly.

Management and Treatment

What happens after a stillborn baby passes away?

If your baby passes away before you’re in labor, you have three options:

  1. Induced labor.
  2. Natural birth.
  3. Cesarean section.

. Induced labor. Healthcare providers recommend induced labor as the best option after a stillbirth. It should be done immediately if the mother:

. Has severe preeclampsia (high blood pressure).

. Has a serious infection.

. Has a broken amniotic sac (the bag of water around your baby).

. Has any clotting disorder.

The labor is induced using medicine dispensed in one of five ways:

. A tablet inserted into your vagina.

. A gel inserted into your vagina.

. A swallowed tablet.

. A drip into a vein.

. A Foley bulb. A mechanical balloon that widens the cervix.

. Natural birth. Waiting for birth to happen naturally is an option but, as time goes by, your baby’s body may deteriorate in the womb. The baby may look different than you expect. The deterioration also makes it more difficult to determine the cause of death.

. Cesarean section. A cesarean section is not recommended because it’s not as safe as a natural birth or induced labor.

What happens after a stillborn baby is delivered?

You will be able to hold your baby, and your healthcare providers will allow you as much time as you need to spend with your child. You may feel uncomfortable with this idea at first.

You may want to ask for any mementos and keepsakes of your child, such as a blanket, a lock of your child’s hair, the hospital ID bracelet, etc. You can take pictures. This may also be uncomfortable, but it may be a cherished possession at a later time and may help you during your grieving process. Most hospitals will issue the family a birth certificate, but make sure you ask and request that it include the baby's handprints and footprints.

Can a stillbirth be prevented?

Usually, a stillbirth cannot be prevented. It often occurs because the baby's development was not normal. Helping improve the mother’s health, including managing preexisting conditions and lifestyle choices, improve the chances of a successful pregnancy. You’re also less likely to have a stillbirth if, when you know you’re high-risk, you’re carefully monitored through routine ultrasounds and/or fetal heart rate monitoring. If your healthcare provider finds a problem, they can have your baby delivered early if necessary.

How can I reduce my risk of having a stillbirth?

Because the reason why a stillbirth occurs is not always understood, it is difficult to prevent. However, there are some steps you can take to increase your chances of having a healthy baby:

. Avoid recreational drugs, smoking and drinking alcohol.

. Contact your healthcare provider if there’s any bleeding during the second half of your pregnancy.

. Do what’s called a daily “kick count.” Around 26-28 weeks, familiarize yourself with your baby’s movements. Figure out what’s normal for your baby. Then, if they stop acting normally, contact your healthcare provider.

. Before you get pregnant, get to a healthy weight. If you’re already pregnant, talk with your healthcare provider about diet and exercise options.

. Protect yourself against infections.

. Avoid certain foods including some types of fish and some types of cheese. Also, double-check to make sure that any meat or poultry you eat is thoroughly cooked.

. Report any stomach pain, itching, or vaginal bleeding immediately.

. Sleep on your side, not your back. If you’ve been pregnant for 28 weeks or more, sleeping on your back can double the risk of stillbirth. It’s not completely clear why that makes a difference, but experts suspect that it has something to do with the flow of blood and oxygen to your baby.

. Get routine tests, including your blood pressure and urine. These will help your healthcare provider see if there are any illnesses or conditions that may affect the health of your baby.

Can the food I eat prevent stillbirth?

Unfortunately, eating or avoiding a specific food can’t guarantee you won’t have a stillbirth. However, there are some foods you should stay away from to improve the chances of a healthy pregnancy in general. Avoid the following:

. Mold-ripened soft cheeses and soft blue cheeses.

. Unpasteurized milk and unpasteurized milk products.

. Raw or undercooked meat.

. Liver products.

. Pâté.

. Game meats.

. Raw or partially cooked eggs.

. Duck, goose or quail eggs.

. Swordfish, marlin, shark and raw shellfish.

. Limit caffeinated drinks and herbal teas.

Outlook / Prognosis

When should I see my healthcare provider after the natural birth or induced labor?

You’ll likely have a follow-up appointment with your healthcare provider a few weeks later. At that time the post-mortem and test results will be discussed and you can voice concerns about future pregnancies.

Can I get pregnant after I've delivered a stillborn baby?

Yes. Most women who deliver stillborn babies go on to have normal pregnancies and births. If the stillbirth was caused by a birth defect or umbilical cord problem, the chances of another stillbirth is slight. If the cause was an illness the mother has or a genetic disorder, the risk is somewhat higher. The chance that a woman's next pregnancy will result in stillbirth is about 3%, which means that most post-stillbirth pregnancies result in healthy babies.

How long after a stillbirth should I get pregnant again?

Discuss the timing of your next pregnancy with your healthcare provider to make sure you are physically ready to begin a new pregnancy. Some healthcare providers recommend waiting a certain amount of time (from six months to one year) before trying to conceive again. Some studies have shown that women who wait at least one year to conceive may have less depression and anxiety during a later pregnancy.

Statistics show that about 60% of couples take up to six months to conceive after delivery of a stillborn baby, and another 30% take up to 12 months. Don't be surprised if things don't happen quickly.

Is a funeral necessary after a stillbirth?

After the death of your baby, one of the first decisions you will be faced with is whether or not to need to arrange a funeral.

The type of arrangements you make may play an important role in the grieving process. It is a decision that only you and the other parent can make together. You may find that you need time to make your decisions and arrangements. It is quite common for families to take up to a week (and sometimes longer) to make arrangements. This is okay.

No matter what your choice is, you have the right to change your mind. Be sure you ask whoever is carrying out your arrangements about how long you have to make any changes.

How should I communicate with my other children after a stillbirth?

You may find your children are a comfort, a worry, or just too hard to deal with. These are normal reactions. Take time to grieve and say goodbye to the child you lost. You will eventually feel normal feelings for your living children again, and the bond you have with them may possibly become stronger.

No matter how much you may want to shelter your children from pain, they can sense the emotion around them. Honesty is the best way to help your children cope with this painful experience. Children have a different understanding of death at different developmental stages.

What can I do to cope with a stillbirth?

Take as much time as you need to heal physically and emotionally after a stillbirth. Regardless of the stage of pregnancy during which your loss occurred, you are still a parent and the life you nurtured was real. It is completely normal for you to experience depression and post-traumatic stress disorder (PTSD). Above all, don't blame yourself. Give yourself time to cope, grieve and accept your devastating loss.

Counseling is available. Pregnancy loss support groups may also be a good resource for both parents. Ask your healthcare provider for more information about counseling and support groups.





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