The term stillbirth is sometimes used to describe fetal death later in pregnancy (at 20 weeks of gestation or more). The rate of fetal death—the spontaneous death of a baby in the uterus—in the United States is considerable. According to the National Center for Health Statistics, about one million fetal deaths occur at any gestational age in the United States each year, including almost 26,000 a year at 20 weeks of gestation or more. By comparison, about 25,000 infant deaths occur per year.
Preterm births and stillbirths can occur in pregnant women of any age, although women of a certain age may be at increased risk for stillbirth. A stillbirth can even occur in a mother who has had state-of-the-art prenatal care. More than one third of these deaths are never explained.
Stillbirth is an unexpected tragedy. The impact on affected families is significant and long-lasting. In one study, women who had experienced stillbirth reported that their grief was not socially recognized, that the cheery environment of the labor and delivery setting was painful, and that physicians’ well-intentioned attempts to offer comfort often had the opposite effect (BMC Pregnancy Childbirth, 2012). This study highlighted the need for greater support for affected families, and the importance of reversing the stigma that surrounds stillbirth.
Signs of Stillbirth
You may suspect that something is wrong when you don’t feel your baby moving for several hours or more. You may have spotting or bleeding. Your doctor may not be able to find a heartbeat. The symptoms of stillbirth may resemble those of other medical conditions.
Causes of Stillbirth
The majority of stillbirths are caused by pregnancy-related or birth-related complications, including preterm labor and premature rupture of the membranes. Abnormalities of the placenta (most commonly placental abruption) are the next most common cause, followed by birth defects and infection. In some instances, infection may go undetected in the mother or fetus because of a lack of symptoms. Umbilical cord accidents and maternal chronic disease, in particular high blood pressure, are other well known, less common causes. In rare cases, injury and sudden severe blood loss (hemorrhage) in the mother or fetus can also cause stillbirth.
Risk Factors for Stillbirth
- Four or more prior pregnancies
- Pregnancy with twins or multiples
- African ethnicity
- History of drug addiction
- Maternal age over 35 years
Young teenage girls who get pregnant may be at higher risk for stillbirth. This may be due to the less favorable socioeconomic conditions often faced by pregnant teenagers, or it may be due to their biological immaturity. Obesity may also increase a woman’s risk of stillbirth.
Diagnosis of Fetal Death
Fetal death that occurs before delivery can be confirmed by an ultrasound examination that shows no heartbeat in the fetus. If your pregnancy ends in fetal death, your healthcare provider may want you to undergo blood testing to help determine the cause of death. This testing may include fetal karyotype and bacterial culture.
Coping After Stillbirth
Coping with stillbirth or miscarriage is very difficult. A period of sadness and grieving is normal, and helpful for recovery. Support from your partner, family, and friends is important. The healing process is different for every woman. For some women, trying to conceive again is a good way to move on. For others, joining a support group or seeing a counselor can be beneficial.
Loss during the later stages of pregnancy can be traumatic for the mother and her family, especially if they have made preparations in anticipation of their new baby. Fetal death is difficult for everyone involved, the parents as well as the physician and medical staff. Those affected may experience strong emotions, such as shock, numbness, denial, deep sadness, guilt, anger, and depression. Extra support at this time can help families recover from their loss.
Treatment Options Following Stillbirth
After intrauterine fetal death, the uterus may expel the fetus on its own, with the mother going into labor usually within two weeks after the fetus dies. In other instances, immediate delivery of the fetus is necessary for medical reasons. Your healthcare provider will discuss the options available to you for delivering the fetus. Some couples may want to have labor induced rather than waiting for it to occur naturally. If labor has not begun after two weeks, your doctor may induce labor because there is a small risk of developing dangerous blood clots after this time. A Cesarean delivery is usually unnecessary unless there are problems with labor and delivery.
Testing Following Stillbirth
Test results often do not reveal the cause of stillbirth. However, they can be useful in helping couples plan a future pregnancy. Your healthcare provider will examine the fetus, placenta, and umbilical cord to determine the cause of death. Testing for common chromosomal defects and specific disorders or infections is often recommended. An autopsy is probably the most important test to consider after a stillbirth. However, it can be costly and making the decision to have an autopsy performed can be difficult for couples who are suffering the loss of their baby.
Prevention of Stillbirth
There is not much a pregnant woman can do to prevent a stillbirth. You can make sure you are providing the best environment for your baby by taking care of yourself by eating healthy and resting, and by not smoking, drinking alcohol, or abusing drugs, and by avoiding activities associated with the risk of infection (e.g., foreign travel). Going to all your prenatal doctor appointments and immediately reporting any new symptoms or concerns to your healthcare provider can help prevent many pregnancy complications, including stillbirth.
Despite its impact, less is known about fetal death than about infant death, which is where most research and public concern is focused. Several organizations, including the Global Alliance to Prevent Prematurity and Stillbirth, the Stillbirth Collaborative Research Network of the National Institute of Child Health and Human Development, and the International Stillbirth Alliance, are trying to raise awareness and support for further research to determine the causes and risk factors for stillbirth in order to improve treatment aimed at preventing them. These organizations also provide support for mothers and families who have experienced stillbirth.