A stillbirth is any fetal loss after 20 weeks of pregnancy. Stillbirth is more common than you may think, affecting about 1 in 175 births in the United States.
The term stillbirth refers to a fetal death that occurs during or after week 20 of pregnancy (gestation). If loss occurs before week 20 of pregnancy (gestation), it’s called a miscarriage.
While specific definitions of stillbirth can vary from country to country, most fall within these guidelines that refer to the age of the fetus and the length of pregnancy:
- Early stillbirth: 20 to 27 weeks of gestation
- Late stillbirth: 28 to 36 weeks of gestation
- Term stillbirth: after 37 weeks of gestation
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Pregnancy and labor complications
Certain circumstances can cause complications and death for the baby before delivery. Some of these include:
- preterm labor, likely caused by complications in the pregnancy
- changes in the placenta
- placental abruption
- pregnancy lasting more than 42 weeks
- carrying multiples
- accident or injury during pregnancy
Pregnancy and labor complications and placental abruptions are
Placenta problems
The placenta provides the baby with oxygen and essential nutrients, so anything that interferes puts the baby at risk. Problems with the placenta may include things like poor blood flow, inflammation, and infection. Another condition is placental abruption, which occurs when the placenta separates from the uterine wall before birth.
Genetic, structural and developmental conditions in the baby
About 14% of all stillbirths have one or more prenatal condition. These can include:
- fetal growth restriction
- genetic conditions
- Rh incompatibility
- structural changes
Genetic conditions are present at conception. Other prenatal developmental changes may be due to environmental factors, but the cause isn’t always known.
Serious developmental issues or structural changes can make it impossible for the baby to survive.
Infection
An infection in the mother, baby, or placenta can lead to stillbirth. Infection as the cause of stillbirth is
Infections that can develop include:
Umbilical cord problems
If the umbilical cord becomes knotted up or squeezed, the baby can’t get enough oxygen. Umbilical cord problems as a cause of stillbirth are
Maternal health
The mother’s health can contribute to stillbirth. Health conditions that affect pregnancy may lead to stillbirth, such as:
Unexplained stillbirth
Nearly
Stillbirth can happen to anyone, but risk factors may include a mother who:
- has a health condition, such as high blood pressure or diabetes
- has obesity
- is Black
- is a teenager or older than 35
- had a previous stillbirth
- experienced trauma or high stress in the year before delivery
- lacks access to prenatal care
You may not experience any signs or symptoms at all, especially early on. Some signs and symptoms are cramping, pain, or bleeding from the vagina. Another sign is that your baby stops moving.
By the time you reach the 26th to 28th week, you can start a daily kick count. All babies are different, so you’ll want to get a feel for how often your baby moves.
You’re looking to time how long it takes your baby to get to 10 movements. Here’s how:
- It’s important to do a kick count at the same time each day.
- Count movements (like kicks, flutters, swishes, or rolls).
- Hiccups don’t count.
- Stop counting when you reach 10, and note the time.
- After each session, compare that time (how long it takes) and strength (how the kicks felt) with past sessions.
Go to a hospital immediately if you notice a change in your baby’s strength of movements or how long it takes to reach 10 movements. Since hospitals are available 24/7 for you and can provide immediate care if needed, they are the best place for your baby to get checked. It’s important not to put off getting checked until the next day and not to wait until your next scheduled appointment.
It’s not necessary to use handheld monitors, dopplers, or phone apps to check your baby’s heartbeat. Even if you detect a heartbeat, this doesn’t mean your baby is well, and using these devices of methods may delay getting the care you and your baby may need.
It’s important not to waste time trying to get your baby to move by drinking cold water or eating something sugary. Seek care immediately so you and your baby can be checked by healthcare professionals as soon as possible.
Your doctor can perform a nonstress test to check for a fetal heartbeat. Ultrasound imaging can confirm that the heart has stopped beating and your baby isn’t moving.
If your doctor determines your baby has died, they will discuss your options and next steps with you. One option your doctor or healthcare professional may present is to do nothing to start labor and to wait instead. If you choose this option, labor will likely start on its own within a few weeks.
Another option is to induce labor. A doctor may recommend inducing labor right away for several reasons, such as if you have a chronic condition or other health concerns. You may also discuss the need for a cesarean delivery.
You may have options after delivery as well. You may want to think about what you’d like to do following the delivery. You might want to spend time alone or with your partner holding your baby. Some families want to bathe and clothe the baby or take photos.
These are very personal decisions, and you can take the time you need to consider them. Hospitals also have social workers and clergy available if you feel that talking with them might help.
Your doctor, midwife, or other healthcare professionals can help guide you through your options and help you decide what you would like to do and feels best for you.
You don’t have to rush into decisions about whether or not you want a service for your baby. But it’s important to let your healthcare team know you’re considering what you want to do next.
Determining the cause
While your baby is still in your womb, your doctor may perform amniocentesis to check for infection and genetic conditions. After delivery, your doctor will perform a physical examination of your baby, the umbilical cord, and the placenta. An autopsy may also be performed if necessary.
Your doctor or healthcare professional will discuss the next steps with you so you know what to expect.
Physical recovery time depends on several factors, but it generally takes 6 to 8 weeks. There is a lot of variation in this, your individual experience may be different. Your doctor, nurse midwife, or other healthcare professional can help you understand what to expect and the care you may need.
Delivery of the placenta will activate your milk-producing hormones. You may produce milk for 7 to 10 days before it stops. If this is upsetting to you, talk with your doctor about medications that stop lactation.
You’ve experienced an unexpected, significant loss, and you’ll need time to grieve. It’s impossible to predict how long it will take to work through your grief.
It’s important not to blame yourself or feel the need to “get over it.” Grieving is different for everyone, and it’s OK to grieve in your own way and in your own time. Sharing your feelings with loved ones and those you trust may help.
Journaling your feelings may also help. If you feel like you’re having a hard time or think it may help you cope, ask your doctor, nurse midwife, or healthcare professional to recommend a grief counselor.
You can also talk with your healthcare professional about symptoms of postpartum depression, such as:
- daily depression
- loss of interest in life
- lack of appetite
- inability to sleep
- relationship difficulties
Support following a stillbirth
Joining a pregnancy loss support group may also help. Ask your doctor if they can recommend an in-person group. You may also be able to find an online support group through Facebook or other social networks or forums.
Here are some other support groups you may be interested in:
How to help someone after stillbirth
It’s important not to minimize the loss or feed the person’s feelings of guilt in any way. They’re grieving the baby they lost. Talking about future pregnancies isn’t helpful – unless they bring it up first.
What they need right now is compassion and support. Offer sincere condolences as you would to anyone who has lost a loved one — because that’s what has happened. Don’t try to change the subject. Let them express their feelings as many times as they need to and in a way that they choose.
Encourage them to eat well, get plenty of rest, and keep their doctor appointments. In the first few weeks, offer to help with household tasks. Basically, just be there for them.
Yes, you can have a successful pregnancy after a stillbirth.
While you’re at a higher risk for complications than someone who hasn’t had a stillbirth, the chances of a second stillbirth are only about 2.5%.
Your doctor will tell you when you’re physically ready to get pregnant again, but only you’ll know when you’re emotionally ready.
You may also decide another pregnancy isn’t right for you, and that’s all right, too. You may decide to look into adoption, or you may choose not to expand your family.
Many causes and risk factors are out of your control, so stillbirth can’t be completely prevented. But there are some things you can do to lower the risk:
Have a checkup before you get pregnant again. If you have any risk factors, such as diabetes or high blood pressure, work with your doctor to manage and monitor them during pregnancy.
If the cause of a previous stillbirth was genetic, you can meet with a genetic counselor before getting pregnant again.
Don’t smoke or use alcohol, cannabis, or other drugs while pregnant. If you have a hard time quitting, talk with your doctor.
One of the more important things you can do is to get good prenatal care. If your pregnancy is considered high risk, your doctor will monitor you more frequently.
Seek medical help right away if you experience bleeding or other signs of trouble during pregnancy.
If your baby shows signs of distress, emergency measures, such as early delivery, may be able to save your baby’s life.
What to do if you notice your baby is moving less
Go to the hospital immediately. Hospitals are available 24/7 to help. Don’t put off getting checked until the next morning, the next day, or until your next scheduled appointment.
Call your provider to let them know you’re going to the hospital. You don’t need their permission to go in or to get checked, but it’s a good idea to let them know. Decreased movements cannot be checked from home. You need to go to the hospital immediately.
A change in movements can sometimes be the ONLY warning sign that your baby needs help. Decreased movement can be an early sign of trouble. If you seek care immediately, there is a window of opportunity in which the baby’s life may be saved. Some examples of a change include less movement, weaker movements, or an unusually rapid increase in movement. Trust your gut instincts.
Stay at the hospital until you’re happy with your baby’s movements. Don’t go home if you’re not feeling reassured.
Don’t use handheld monitors, dopplers, or phone apps to check your baby’s heartbeat. Even if you detect a heartbeat, this doesn’t mean your baby is well.
Physical recovery may take a few months. Women who experience stillbirth can go on to have healthy children. Be patient with yourself as you work through the stages of grief.