Stillbirth

Stillbirth is when a baby dies in the womb after the 20th week of pregnancy. Stillbirth occurs in one of every 200 pregnancies. The loss of a baby in the second half of pregnancy can come as a complete shock, as about half of all stillbirths happen in pregnancies that seemed healthy. Often, the only sign of stillbirth is that the baby suddenly stops moving and kicking.

Confirmation of stillbirth

Stillbirth is confirmed using an ultrasound. This procedure can also be helpful in determining what went wrong in the pregnancy. Blood tests are sometimes used to help explain the reason for the baby’s death. After delivery, careful examination of the baby and the placenta can give more information about the cause of death. However, in one-third of stillbirths, the exact reason cannot be determined.

Causes of stillbirth

Some of the causes of stillbirth include:

• Placental complications: Placental abruption, which is a condition where the placenta separates partially or completely from the uterus before childbirth, can cause heavy bleeding and threaten the lives of both mother and baby. Placental abruption deprives the baby of oxygen and can lead to stillbirth. Other problems with the placenta, such as placental insufficiency where the placenta does not provide enough oxygen to the baby, can also contribute to stillbirth.
• Birth defects: Although chromosomal abnormalities and other birth defects are more likely to cause miscarriage during the first half of pregnancy, they can still cause death of the baby after the 20th week.
• Fetal growth restriction: Unborn babies who are small for their gestational age are at higher risk of death both before and during birth. Some women, such as those who have high blood pressure, are at higher risk of carrying a baby with growth restriction.
• Infection: Some infections go undiagnosed in pregnancy and can cause serious complications such as premature birth or death of the unborn baby. After delivery, the placenta can be tested to see if a viral, bacterial, or protozoal infection was the cause of death.

Prevention of stillbirth

Due to medical advances in the treatment of certain conditions during pregnancy, the incidence of stillbirth has decreased over the past couple of decades. For example, rhesus (Rh) hemolytic disease, which is an incompatibility between the blood groups of the mother and her baby, used to be a major cause of stillbirth, but now can be prevented. The treatment of other high-risk conditions such as high blood pressure and diabetes has improved in recent years. If you are considered high-risk, you and your baby will be monitored closely during pregnancy, and life-saving treatment can be given if necessary. In some cases, a baby may need to be delivered prematurely in order to save his life.

Other ways to guard against stillbirth are as follows:

• Report any vaginal bleeding to your health care provider right away. Vaginal bleeding can be a sign of placental abruption, in which case, an emergency caesarean section will be needed to save the baby’s life.
• If you have had a stillbirth in a previous pregnancy, you will be monitored closely so that all necessary steps can be taken to prevent another stillbirth.
• Refrain from smoking, drinking alcohol, or using street drugs, because they all increase your chances of having a stillbirth.
• Keep track of the number of fetal kicks that you feel during the second half of pregnancy. If the kick count decreases or stops, you may be given an ultrasound, the baby’s heart rate may be monitored, and steps can be taken if there is a problem.

For more information, see "Kick Counts."

Treatment after a stillbirth

Often a woman will go into labour after her baby has died in the womb. If there is no medical reason to deliver the baby immediately, the woman has the choice of waiting until labour begins naturally. However, many women feel traumatized at the thought of carrying a dead baby, and thus may choose to have labour induced. Caesarean section is not usually done unless there is a problem during labour and delivery or a medical condition that precludes vaginal birth.

Grieving for your loss

If you and your partner receive news that your baby has died in the womb, the grief can be overwhelming. Because stillbirth often comes without warning, you can go from happy anticipation of the baby’s birth to immense grief in just a short time. You may experience many emotions, ranging from numbness or denial to anger or depression. You and your partner may grieve in different ways, which may cause tension in your relationship.

Some ways to cope with your grief are to seek counselling from a professional who specializes in pregnancy loss and to join a support group for parents who have been through pregnancy loss. A support group will allow you to share your feelings with people who have been through similar circumstances and will help you to feel less alone.