The Facts About Stillbirth

Losing a baby due to stillbirth is traumatic and sad for all family members. The World Health Organization defines stillbirth as "a baby who dies after 28 weeks of pregnancy, but before or during birth." However, this definition can differ from country to country.

In the United States, if a baby dies before 20 weeks gestation, it is classified as a miscarriage, and after 20 weeks, it is classified as a stillbirth. In the United Kingdom, a baby is stillborn if delivered after 24 completed weeks of pregnancy.

In the U.S., approximately 21,000 babies are stillborn every year, and globally, over 40 percent of stillbirths occur during labor. If you are ever worried about your baby's movements during pregnancy, contact your maternity provider immediately for a checkup.

The reason for a stillbirth is often unknown. It can affect healthy babies, and doctors can't always explain the cause, making it extremely difficult if you are grieving and looking for an answer to why your baby died. Research is ongoing to learn more about stillbirth and miscarriage.

Some causes are known and include:

• Placenta complications or placental abruption
• Hemorrhaging (bleeding) before or in labor
• Problems with the umbilical cord, such as cord prolapse
• Liver disorders such as intrahepatic cholestasis of pregnancy (ICP), also known as obstetric cholestasis 
• Preeclampsia, a pregnancy-related condition that causes high blood pressure
• A physical genetic defect in the baby (this is the cause of around 10 percent of stillbirths)
• An infection in the mother that affects the baby
• Preexisting or gestational diabetes

Sometimes an autopsy (an examination of the baby's body after death) can help find the cause of stillbirth, but not always.

There aren't always symptoms of stillbirth. It's important to understand that there may not be any signs of a problem. But there are some physical signs you can look out for, including:

• No movement from your baby (it has stopped moving or kicking)
• Bleeding from the vagina
• Abdominal pain and cramps

If you experience any of these symptoms, contact your healthcare provider immediately.

Monitoring the baby's movements is an important part of your pregnancy. Some people feel their baby move as early as 16 weeks, but movements usually begin anytime between 16 and 24 weeks gestation.

If you reach 24 weeks of pregnancy and haven't felt your baby move, it's advised to see your healthcare provider to check the baby's heartbeat and movements.

If your baby moves less or stops moving, it can be a sign that there is a problem. But no movement doesn't always mean stillbirth. The only way to know whether a stillbirth has occurred is for a healthcare professional to check the baby's heartbeat with an ultrasound.

To diagnose a stillbirth, the baby must:

• Have stopped breathing
• Have no heartbeat
• Not make any voluntary movements
• Have no pulsations in the umbilical cord

Sometimes a mother may still feel her baby moving after the baby has been declared dead. It can happen when the mother changes position. But your healthcare team can offer you another ultrasound scan to recheck the baby. Hearing the news that your baby has died is devastating, and your healthcare team can provide you with lots of support, time and information about the next steps.

Some factors can increase the risk of stillbirth, including:

• Having a multiple pregnancy
• If you are of Black race
• Being older than age 35
• If you are of low socioeconomic status
• Smoking while pregnant
• Taking drugs when pregnant
• Drinking alcohol during pregnancy
• Obesity, or having a body mass index (BMI) above 30
• Certain preexisting medical conditions, such as diabetes or epilepsy
• Having a baby who doesn't grow as they should in the womb
• A previous pregnancy loss
• Post-term pregnancy (going more than two weeks beyond the due date)

Being subject to these factors does not automatically mean you will have a stillbirth. It just means statistics show stillbirth rates are higher in groups of women with these risk factors. Stillbirth can happen to anyone of any race, age, ethnicity or income level. It's important to share your complete medical and lifestyle history with your doctor so they can look out for any risks and monitor your pregnancy.

In many cases, you cannot prevent stillbirth from happening. But there are steps you can take to help reduce the risk of having a stillbirth. These include:

• Not smoking if you are a smoker
• Avoiding alcohol and drugs during pregnancy
• Protecting yourself against infections
• Trying to get to a healthy weight before getting pregnant
• Attending all your prenatal appointments 
• Avoiding certain foods 
• Reporting abdominal pain, vaginal bleeding, itching or reduced fetal movements to your healthcare team right away
• Sleeping on your side, not on your back, in the third trimester
• Managing any preexisting medical conditions 

Stillbirth affects about 1 in 175 births in the U.S. The CDC states that although improvements in maternity care since 1940 have reduced the occurrence of stillbirth, the decline has slowed in recent years.

If your baby dies before you go into labor, there is no reason to give birth immediately. You have time to discuss your options with your healthcare provider. Some women choose to wait and go into labor naturally, while others may choose to be induced. Your doctor can talk you through all your options. You may even want to take some time to go home and think about it.

You have the choice to see, hold and spend time with your baby. You can take photos if you wish or collect a lock of hair. You may want to keep a handprint or footprint or your baby's blanket. It is entirely your decision if you want to see your baby. You might want to name your baby, or you might not. All of these decisions are personal to you.

The doctor may discuss a postmortem with you. It can provide more information about why your baby died. Again, this is your choice, and you don't have to have one.

There is no hurry to make any decisions. Your healthcare team can guide you through the following steps, the available options and the support you can access. It's a lot to take in and a lot to think about all while you are grieving. Be kind to yourself and don't be afraid to reach out to others for support.

First Candle: A nonprofit organization committed to reducing sleep-related infant deaths through education while providing support for grieving families who have suffered a loss. It has a grief phone line and offers bereavement support, online support programs and peer support.

The Compassionate Friends: A support group that provides comfort and hope to every family experiencing the death of a child.

International Stillbirth Alliance: A membership organization that promotes and supports stillbirth research. It provides information about support services, memory-making, advocacy and other resources for bereaved parents.

Share Pregnancy & Infant Loss Support: A group that serves families who experience the tragic death of a baby through pregnancy loss, stillbirth or in the first few months of life.