What is stillbirth?
Stillbirth is a common term for death of a fetus after 20 weeks of pregnancy.
What causes stillbirth?
The cause of stillbirth in not always known. Known causes may include:
- Placental problems including poor blood flow, abruption (early separation of placenta), twin-to-twin transfusion (when twins share a placenta)
- Poor fetal growth
- Genetic or chromosomal abnormality in the fetus
- Infection in the mother or in the fetal tissues
- Rh disease. A blood incompatibility problem between the mother and fetus.
- Cord problems such as knots, tightened cord, cord wrapped around the body or neck, cord prolapse
Who is at risk for stillbirth?
Most pregnancies are at low risk for stillbirth. You may be at higher risk for stillbirth if you:
- Are African American
- Are obese
- Are having your first pregnancy
- Are older than 35
- Are pregnant with twins or more
- Have high blood pressure
- Have diabetes
- Have a thyroid disorder
- Have kidney disease
- Have a blood clotting disorder
- Have a long-term (chronic) condition such as lupus
- Had a stillbirth in the past
- Smoke, drink, or use drugs
- Have poor or no prenatal care
- Are a victim of intimate partner violence
What are the symptoms of stillbirth?
These are the most common symptoms of stillbirth:
- Your developing baby stops moving and kicking
- You have spotting or bleeding from your vagina
Other symptoms may or may not be linked to stillbirth. The symptoms of stillbirth may look like other health conditions. Always see your healthcare provider for a diagnosis.
How is stillbirth diagnosed?
See your healthcare provider right away if your developing baby stops moving or if the movements slow down. Also see your provider right away if you have spotting or bleeding. Your provider will listen with a special stethoscope or sound waves for the baby's heartbeat. If the provider does not hear a heartbeat, you will need a follow up ultrasound to make the final diagnosis.
How is stillbirth treated?
Treatment of stillbirth depends on many things. This includes the number of weeks of pregnancy, the size of the fetus, and how long since the fetal heartbeat stopped. Treatment may include:
- Waiting until you go into labor on your own
- Stretching open (dilating) the cervix and using instruments to deliver the fetus and tissues
- Inducing labor with medicines. This opens the cervix and makes the uterus contract and push out the fetus and tissues.
What are the complications of stillbirth?
Stillbirth is very difficult for parents and other family members. It’s sometimes harder than an earlier miscarriage. This is because it happens when the fetus has developed and you have felt movement. Often, the baby is fully formed and is delivered just as any baby. It may be very hard emotionally for you to go through labor, yet not have a baby to take home. Counseling is important for all parents with a stillbirth. This helps them understand their feelings and start the work of grieving.
Depending on the cause of the stillbirth, you may have an increased risk for stillbirth with a future pregnancy. Your healthcare provider may recommend genetic counseling for you and your partner if you want to get pregnant again after a stillbirth.
Can stillbirth be prevented?
The cause of many stillbirths cannot be determined. These are called unexplained stillbirths. But you can take steps to help reduce the risk for stillbirth. These include:
- Get good prenatal care.
- Take folic acid supplements before and during pregnancy.
- Quit smoking if you smoke.
- Know if your pregnancy is high risk.
Coping with stillbirth
Mementos of the baby often help in the grieving process. Holding and touching the baby are important steps. In a private room, a nurse or counselor brings the baby to you wrapped in a blanket. This helps you understand that the baby has really died and gives you and your partner a real, not imagined memory. Seeing the baby is especially helpful when a baby has a birth defect. Often your imagination of the defect is much worse than the real problem. Photographs of the baby may be helpful, too, as well as a lock of hair or footprints. Many parents want to remember their baby with a memorial or funeral service. This can also help friends and other family members understand the loss that you have had.
Some parents may want to learn more about the cause of their baby's death. This is especially true if there are no clear factors. An autopsy or special genetic and chromosome testing is often available. The healthcare provider can share the test results with you and your partner several weeks afterward. An autopsy does not prevent you from being able to see or hold the baby. The autopsy can be done before a funeral.
When should I call my healthcare provider?
Call your healthcare provider right away at any point during your pregnancy if you notice that your baby's movements or kicks have slowed or stopped. Also call your provider right away if you have bleeding or spotting.
After a stillbirth, call your healthcare provider if you have trouble dealing with your grief, have depression, or other emotional or physical symptoms.
Key points about stillbirth
- Stillbirth is a common term for death of a fetus after 20 weeks of pregnancy.
- Symptoms of stillbirth include stopping of fetal movements or kicks, and vaginal bleeding or spotting.
- Stillbirth is very difficult for parents and other family members.
- Counseling is important for all parents with a stillbirth. This helps them understand their feelings and start the work of grieving.
Tips to help you get the most from a visit to your healthcare provider:
- Know the reason for your visit and what you want to happen.
- Before your visit, write down questions you want answered.
- Bring someone with you to help you ask questions and remember what your provider tells you.
- At the visit, write down the name of a new diagnosis, and any new medicines, treatments, or tests. Also write down any new instructions your provider gives you.
- Know why a new medicine or treatment is prescribed, and how it will help you. Also know what the side effects are.
- Ask if your condition can be treated in other ways.
- Know why a test or procedure is recommended and what the results could mean.
- Know what to expect if you do not take the medicine or have the test or procedure.
- If you have a follow-up appointment, write down the date, time, and purpose for that visit.
- Know how you can contact your provider if you have questions.
- Bowers, Nancy, RN, BSN, MPH
- Freeborn, Donna, PhD, CNM, FNP