What You Should Know About Stillbirth
Stillbirth is defined as a baby dying before or during delivery at a later stage in pregnancy. This means there are no signs of life at all when a baby is stillborn.
The number of babies that are stillborn has dramatically decreased over the past 30 years, thanks to advances in medical technology and improved prenatal care. But stillbirth still affects about 1 in 175 births, and each year about 21,000 babies are stillborn in the United States.
The difference between a stillbirth and a miscarriage is that the former happens after 20 to 24 weeks of pregnancy.
However, the exact timing that differentiates a miscarriage from a stillbirth is disputed, with some sources describing a stillbirth as a pregnancy loss between 20 and 28 weeks of pregnancy, and a miscarriage if it takes place in the weeks before that time period.
In the United States, stillbirth is defined as the loss of a baby at or after 20 weeks of pregnancy, according to the Centers for Disease Control and Prevention (CDC). There are different stages of stillbirth, known as "early," "late" and "term." Early stillbirths tend to be defined as fetal deaths occurring between 20 and 27 completed weeks of pregnancy; late stillbirths occur between 28 and 36 completed pregnancy weeks; and a term stillbirth occurs at 37 or more completed pregnancy weeks.
What happens during a stillbirth?
Sometimes with a stillbirth, the baby dies during delivery. However, the loss often occurs before labor has started. In this case, the mother can decide how to give birth, with their doctor's or midwife's advice. If there's no medical reason for the baby to be born immediately, there is the option of waiting for labor to start naturally. In this case, the mother is usually allowed to go home for a day or two before making this decision, which helps many people process what has happened.
The other option for people who have experienced stillbirth is to induce labor using medication (either pessary or oral), which usually takes around 48 hours to kick in. In some cases, induction might be necessary immediately, for example, if you have severe preeclampsia or a serious infection, or the amniotic sac (the bag of water around the baby) has broken.
Why does stillbirth happen?
Stillbirth is a devastating experience for families, and it can be even more difficult if they don't know why it happened.
"Unfortunately, often the cause of stillbirth is unknown, and this is called 'unexplained stillbirth,'" Welsh said.
However, there are some known causes, including pregnancy complications such as preeclampsia, which can cause high blood pressure, and high levels of protein in your urine, which could indicate a type of kidney damage called proteinuria.
Problems with the placenta, the organ that links the baby's blood supply to the mother's, or the umbilical cord, which transports nutrients to the baby from the placenta, can also lead to stillbirth. Other potential reasons could be birth defects, infections including sexually transmitted infections (STIs), malaria and Lyme disease, and poor health in the mother, according to Welsh.
"Whatever the cause, it is a devastating experience for families," Welsh said.
Who is at risk of experiencing stillbirth?
The later a stillbirth occurs during pregnancy, the more likely it is that it will be unexplained, according to the CDC. It is more common for certain groups of people, however.
"Women who are over the age of 35, are smokers, abuse recreational drugs, are in their first pregnancy, or are using assisted reproductive technology, including IVF and frozen embryo transfer, are all at higher risk of stillbirth," Welsh said.
The reason age might impact the chances of stillbirth is that people who get pregnant when they are older often have issues with their placenta. It may not work as well as it should, so it can be difficult for the baby to get nutrients and oxygen. The placentas of older people age faster than the placentas of younger people, according to research by the charity Tommy's. This study also found the cells in placentas of older people are under more stress, so they are less able to repair damage and sometimes show signs of inflammation. The risk of pregnancy complications is even higher for women older than 40, the study stated.
Black people and people who have lower socioeconomic status have higher rates of stillbirths during pregnancy in the U.S., according to the CDC. There is a lack of research on why these factors impact stillbirth, but it is thought to come down to differences in a mother's health before getting pregnant, socioeconomic status, access to quality healthcare and stress.
Are there ways to prevent stillbirth?
One in 3 stillbirths cannot be explained, which means it can be difficult to prevent them. However, there are some steps you can take to minimize your chances of experiencing stillbirth.
"It's important to take care of your health generally in pregnancy, and there are certain actions you can take to reduce your risk, including avoiding alcohol and drugs, not [smoking or] stopping smoking, reducing the amount of caffeine you're consuming and not sleeping on your back after 28 weeks," Welsh said.
Research suggests that after 28 weeks, falling asleep on your back can double the risk of stillbirth. The reason for this isn't known, but doctors think it might be linked to how sleeping in this position impacts the flow of blood and oxygen to the baby. Try not to panic if you wake up on your back. Simply turn over and go to sleep on your side again.
It's also important to keep in regular contact with your healthcare professional and take their advice during pregnancy to try to prevent stillbirth.
"Make sure to attend all antenatal appointments and raise any concerns about your health or your baby's with your midwives or doctor. They're there to help and reassure you," Welsh stressed.