Stillbirth

What is a stillbirth?

A stillbirth is when a fetus dies after the 20th week of pregnancy. Many people imagine a stillbirth as a single moment when a baby’s born with no heartbeat. But most stillbirths happen in the uterus. Although it happens, the fetus rarely dies during labor. In most cases, providers diagnose the loss beforehand and take steps to intervene well before the due date.

A stillbirth is a jarring pregnancy loss, similar to a miscarriage. Stillbirths involve fetal death after week 20, while miscarriage involves the fetus passing away before week 20. Like a miscarriage, a stillbirth is a traumatizing event that may require lots of time and a strong support network to grieve.

What are the types of stillbirth?

Healthcare providers classify stillbirths based on the number of weeks of pregnancy before the fetus passes.

• Early stillbirth: The fetus dies between 20 and 27 weeks.
• Late stillbirth: The fetus dies between 28 and 36 weeks.
• Term stillbirth: The fetus dies the 37th week or after.

How common are stillbirths?

Stillbirth rates vary significantly depending on the part of the world. Developing countries have as many as 22 stillbirths out of every 1,000 births. The rate is much lower in developed countries. For example, the U.S. has approximately 6 stillbirths for every 1,000 births. In the U.K., there are about 3.5 stillbirths for every 1,000 births.

Improved prenatal care has led to reduced rates of stillbirths worldwide. But there’s a long way to go to reduce healthcare disparities (differences) that make some people more likely to experience stillbirths than others.

Who is at risk of having a stillbirth?

A stillbirth can happen during any pregnancy. But health, lifestyle and environment all shape the risks associated with pregnancy loss.

• Age. Stillbirth rates are higher for teenagers and people 35 or older.
• Health conditions. Having certain health conditions can increase your risk. These include diabetes, high blood pressure, blood clotting disorders, thyroid disorders, lupus and obesity (body mass index above 30).
• Type of pregnancy. People pregnant withmultiples (twins or more) are at increased risk.
• Previous pregnancy complications. There’s a slightly higher risk of stillbirth if you’ve experienced a previous stillbirth or other pregnancy complications like preterm birth.
• Substance use. Using recreational drugs, smoking and drinking alcohol can lead to stillbirth. Pairing or combining these substances raises the risk.
• Stress. Dealing with significant life stressors, including financial strain and relationship problems, can increase your risk.
• Environment and resource access. You’re at greater risk of stillbirth if you live in a country or environment with limited access to prenatal care. Factors like race play a role, too. In the U.S., people who are Black experience stillbirths twice as often as people who are white. Racism creates barriers to health and well-being in all its forms. The consequences can trickle down and affect every aspect of health, including pregnancy.

What causes a stillbirth?

In 1 in 3 stillbirths, healthcare providers don’t know why the fetus passed. Causes can be complex. Issues primarily affecting the mother (gestational parent), the fetus, or the tissues and organs connecting them can all lead to stillbirth.

Infections

Infections from a virus, parasite, bacteria or another pathogen (germ) cause up to 50% of stillbirths in developing countries. They cause up to 25% of stillbirths in developed countries. Sometimes, the infection doesn’t cause symptoms, so you don’t know there’s an issue until a pregnancy complication happens.

Access to high-quality prenatal care can often reduce the risk of stillbirths related to infections.

Problems with the placenta or umbilical cord

Theplacenta is an organ that allows you to share nutrients with the fetus via the umbilical cord. A problem with these lifelines can prevent the fetus from receiving the oxygen, blood and nutrients needed to thrive.

Placental abruption is when the placenta separates from your uterus. It’s responsible for 10% to 20% of all stillbirths. A twisted umbilical cord can lead to a stillbirth if it prevents the fetus from getting enough oxygen. It causes up to 10% of stillbirths.

Conditions affecting the fetus

Sometimes, there’s an issue with how the fetus develops, or a congenital disability (birth defect). The fetus may have a genetic condition.Genes contain the instructions that tell the fetus’s body how to grow and work. Errors in these instructions can prevent the fetus’s organs from growing and working properly.

The fetus may not get the nutrition it needs to grow at a healthy rate. This is calledintrauterine growth restriction. It’s a common cause of stillbirths.

Pregnancy complications

You’re more likely to experience problems during pregnancy if you have a chronic health condition, like diabetes, lupus, high blood pressure, obesity or a blood clotting disorder.

Still, having a chronic condition doesn’t mean you’ll experience complications. A provider can help you manage chronic conditions and keep tabs on your health to reduce your risk.

Pregnancy complications that may lead to stillbirth include:

• Preeclampsia: High blood pressure that starts during the second half of pregnancy.
• Cholestasis of pregnancy: A form of liver disease that develops late in pregnancy.
• Premature birth: When a baby’s born prematurely (before 37 weeks of pregnancy).
• Preterm premature rupture of membranes (PPROM): When the fluid-filled protective sac surrounding the fetus breaks too early.

What are the symptoms of stillbirth?

Often, the only warning sign of stillbirth is noticing the fetus isn’t as active as it used to be. Some people experience cramps and vaginal bleeding.

These symptoms don’t always mean a stillbirth, but you should see a provider immediately if you notice these changes.

How is the diagnosis made?

Most stillbirths happen before labor. Your provider will use an ultrasound to find the fetus’s heartbeat.

What tests will be done to determine what caused my stillbirth?

For some people, learning what caused a stillbirth is important for closure. Understanding the circumstances surrounding a loss can help as you allow yourself to grieve. For others, knowing the cause can reduce the risk of future pregnancy complications.

Your healthcare provider will review your medical records and the circumstances surrounding the loss. They may perform tests on the fetus, the umbilical cord or the placenta to determine the cause.

Tests include:

• Tests for infection. Healthcare providers will take a sample of your urine, blood, or cells from your vagina or cervix to test for infection.
• Blood tests. Blood tests show if you have a condition associated with a pregnancy complication.
• Genetic tests. Your healthcare provider will test a sample of the umbilical cord to determine if the fetus had genetic problems that can cause stillbirth, such as Down syndrome.
• Autopsy. An autopsy is a surgical procedure that allows a provider to examine the fetus closely to determine the cause of death. This may include making careful incisions to examine their organs. In most cases, you have the right to choose or refuse this procedure. You can specify how invasive the autopsy will be.

When should I choose to have a fetal autopsy?

It’s a difficult decision. Some parents find the thought of an autopsy too much to bear following such a heartbreaking loss. Not all insurance plans cover fetal autopsies, so cost also plays a role.

The greatest benefit of having an autopsy is that it increases the chance of learning what caused the stillbirth. Recent research has shown that an autopsy can increase the detection rate from just under 20% of stillbirths to more than 90%. This information may help your provider prevent complications in future pregnancies.

Still, every case is different, and this is a deeply personal decision. Talk with your provider to decide what’s best.

What happens after the fetus passes away?

Your healthcare provider will recommend the safest option available to deliver the fetus. The experience will feel similar to delivering a live baby. Your pregnancy care team will coach you and give you medicines to help with the pain.

• Induced labor: Healthcare providers often recommend starting labor as soon as possible after a stillbirth. Inducing labor may be best for your health if you have a medical condition. You’ll receive medicine that usually starts labor within two days of the loss.
• Natural birth. You may prefer to wait before delivering the fetus. Labor usually begins naturally within two weeks after the fetus has passed. Having an autopsy done may be more difficult if you choose to give birth naturally.
• Cesarean section (C-section). You may need an emergency C-section if your health is at risk. But C-sections are rare with stillbirths.

What happens after delivery?

You’ll have options about how much interaction you want with the fetus. There’s no right or wrong way to feel or respond.

For example, you can hold the fetus if you’d like. You may ask for mementos and keepsakes, like a lock of hair or their hospital ID bracelet. Most hospitals will issue a birth certificate. You can request that it includes handprints and footprints.

Take as much time as you need, and don’t hesitate to reach out to others for support. Having loved ones nearby can help with processing the loss.

Will I lactate after a stillbirth?

Milk usually starts coming in within a few days after delivery. Unless you have preeclampsia, you can take medicines called dopamine agonists to stop your breasts (chest) from producing milk. Or, you may prefer to let the process stop naturally. Let your provider know what feels right for you.

Can stillbirth be prevented?

There’s usually nothing you can do to prevent a stillbirth. Often, it happens because of a medical condition or complication outside of your control. But every pregnant person can take steps to increase the odds of delivering a healthy baby:

• Avoid recreational drugs, tobacco and alcohol. Substance abuse puts you at risk of stillbirth and other complications, including fetal alcohol syndrome and sudden infant death syndrome (SIDS).
• Adjust your diet. Change your diet during pregnancy. You’ll need to up your calorie intake and eat foods that provide the proper nutrition for you and the fetus. You should also avoid certain foods, including those that may put you at risk of foodborne illness.
• Work toward a healthy weight. Before getting pregnant, work toward a weight that’s right for you.
• Work to prevent infections. This includes practicing good hygiene, like handwashing and cooking foods thoroughly. Get recommended vaccines before, during and after pregnancy.
• Do a daily “kick count.” Around 26 to 28 weeks, familiarize yourself with fetal movements. Learn what’s normal for the fetus. If they stop acting normally, contact your healthcare provider.
• Sleep on your side, not your back. Sleeping on your back can increase the risk of stillbirth if you’ve been pregnant for 28 weeks or more. It’s not completely clear why, but experts suspect it has something to do with blood and oxygen flow to the fetus.
• Get routine tests, ultrasounds and/or fetal heart monitoring as needed. Regular checkups can help your healthcare provider identify any conditions that may affect your pregnancy. This is especially important if you’re at high risk for pregnancy complications.
• Report symptoms immediately. See a healthcare provider immediately if you’re experiencing symptoms like stomach pain or vaginal bleeding during pregnancy.

Can I get pregnant after a stillbirth?

Yes. Most people go on to have normal pregnancies and healthy babies. If a congenital disability or umbilical cord problem caused the stillbirth, there’s a slight chance of another. If the cause was an illness or a genetic disorder, the chance that your next pregnancy will result in stillbirth is only about 3%.

How long after a stillbirth should I get pregnant again?

Some studies show that people who wait at least one year to conceive after a stillbirth have less depression and anxiety during a later pregnancy. Still, everyone’s on a different timeline when it comes to being physically and emotionally ready to try again.

Discuss the timing of your next pregnancy with your provider.

How can I take care of myself after a stillbirth?

Take as much time as you need to grieve after a stillbirth. Mourn in ways that feel most healing for you. This may mean having a funeral to grieve alongside friends and family members who want to support you during this time. It may mean asking for help with childcare so you can take time to process your feelings alone.

Counseling and pregnancy loss support groups are also excellent resources. Regardless of the stage of pregnancy, you’re still a parent. The bond you nurtured is real. It’s normal to experience depression and post-traumatic stress disorder (PTSD) that requires professional help to cope with a loss this big.

A note from Cleveland Clinic

A stillbirth is a devastating loss that may take time to grieve. Remember that it’s normal to have difficulty coping. It’s OK to reach out to support groups and mental health professionals to help you through this.

If you’re concerned about the risks of a future stillbirth following a loss, seek counseling from your pregnancy provider or a maternal-fetal medicine (MFM) specialist. They may recommend tests or genetic counseling to assess your risks. The decision to try to get pregnant again is a huge one. There are specialists available to advise and support you.