Stillbirth - A Comprehensive Overview

Symptoms, Warning Signs, Causes, and Coping with Stillbirth

Pregnant Woman Smoking
What do you need to know about stillbirth? Check out this overview of the causes, risk factors, warning signs, and ways to cope. Brooke Fasani/The Image Bank/Getty Images

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? - Definition

A stillbirth (also called intrauterine fetal demise) is most often defined as the loss of a baby which 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.)

How Common are Stillbirths and When Do They Occur?

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 percent 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. Some risk factors associated with an increased risk of stillbirth include:

  • Maternal age greater than 35 or less than 20 - Women over the age of 35 are more likely to have unexplained stillbirths than younger women.
  • Health conditions in the mother, particularly high blood pressure and diabetes. Conditions such as lupus, kidney disease, some blood clotting disorders and other medical conditions also increase risk.
  • Pre-eclampsia (pregnancy induced hypertension.)
  • Obesity.
  • Multiple pregnancy (twins and more.)
  • Smoking.
  • Having a history of stillbirth, miscarriage, or neonatal death (death during the first 28 days of life.) Having a history of preterm birth, toxemia, or intrauterine growth retardation in a prior pregnancy may also raise risk.
  • Lack of prenatal care.
  • Race. Black women have a higher incidence of stillbirth than Caucasian women even when controlled for socioeconomic status.
  • Alcohol use or controlled drug use (both prescription and nonprescription) during pregnancy.
  • Abdominal trauma (related to motor vehicle accidents, falls, or domestic violence.)
  • Sleeping position - While it's still uncertain, some researchers believe that sleeping in a supine position (on your back) may be associated with a increased risk of stillbirth.
  • Intrauterine growth retardation.
  • Post-term pregnancies - Pregnancies which are overdue (beyond 41 - 42 weeks gestation) are thought to contribute to 14 percent of stillbirths.

Causes of Stillbirths

A variety of factors can cause babies to be stillborn, but some causes of stillbirth include:

  • Birth defects, particularly chromosomal abnormalities in the baby - Birth defects, for example, anencephaly are the cause of 14 percent of stillbirths.
  • 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 becomes compressed) or a cord which is tightly coiled around the baby's neck account for around 10 percent of stillbirths. Keep in mind that many babies have the cord around their neck at the time of birth (loosely) and this does not often cause problems.
  • 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 one percent of pregnancies. The risk of stillbirth depends on the degree of separation, with a separation of 50 percent or more often causing stillbirth.
  • Infections - Infections with bacteria, viruses, or protozoa are thought to be the cause of stillbirth up to 24 percent of the time in developed countries. The types of infections most commonly associated with stillbirth (and/or miscarriage) include bacterial vaginosis, group B strep, parvovirus B19 (fifth disease),  Listeria monocytogenes, cytomegalovirus, genital herpes (the first infection), syphilis, and many more. Infections are more likely to cause early stillbirths (20 to 28 weeks gestation) than late stillbirths (after 28 weeks.)

    Twenty-five percent to 60 percent of stillbirths are unexplained.

    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 percent of stillbirths, careful management of overdue pregnancy is essential.

    Early Symptoms and 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 an 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 abdominal or back pain and vaginal bleeding as this could mean a condition called placental abruption. Always err on the side of caution and call your doctor if you are concerned.

    What Happens When Doctors Discover That a Baby Has No Heartbeat?

    If it's found that your baby does not have a heart beat at a routine prenatal checkup, she will want to first 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 done 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 Opt to 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. She (or he) will likely have an idea what has helped the most with others facing a similar situation.

    What Should Parents 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 him or her. You may wish to review these thoughts on having a funeral after a stillbirth, as well as the pros and cons regarding a fetal autospy.

    How Can Parents Cope with Having a Stillborn Baby?

    If you have suffered 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. For moms, you might be struggling with issues like breast engorgement and postpartum depression, the healing and physical recovery after stillbirth, on top of your normal grieving.

    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." It is OK to grieve. These platitudes may seem meaningless at best, and cause you to feel angry at worst. It doesn't matter how old you are. The last thing on your mind right now is probably having another, and there is nobody who can say it wasn't meant to be. This was your baby and you not only lost your baby but all of the dreams and hopes you had for your baby.

    Communicating with 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 he doesn't express his feelings the same way. (Men and women often react very differently though at the heart of the matter they are feeling the same emotions.) He may be trying to put on a strong front to support you.

    For dads, try to be patient with your partner and have a ready shoulder and listening ear. Talking about the loss may be therapeutic for her (women often need to talk about things and not talking about it won't help her not think about it.) 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 with pregnancy loss as well. If you are whispering or if your child catches tiny snippets of conversation, she may become very anxious and think it is her fault. 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.

    For Those Who Wish to Get Pregnant in the Future

    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 than 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 her special place in your heart.

    Sources:

    Bakhbakhi, D., Burden, C., Storey, C., and D. Siassakos. Care Following Stillbirth in High-Resource Settings: Latest Evidence, Guidelines, and Best Practice Points. Seminars in Fetal and Neonatal Medicine. 2017 Mar 6. (Epub ahead of print).

    Lawn, J., Blencowe, H., Waiswa, P. et al. Stillbirths: Rates, Risk Factors, and Acceleration Towards 2030.. Lancet. 2016. 387(10018):587-603.

    Warland, J., Mitchell, E., and L. O’Brien. Novel Strategies to Prevent Stillbirth. Seminars in Fetal and Neonatal Medicine. 2017 Feb 2. (Epub ahead of print).

    Continue Reading