Understanding and recovering from a stillbirth

What is stillbirth?

When a baby dies in utero at 20 weeks of pregnancy or later, it's called a stillbirth. (When pregnancy loss happens before 20 weeks, it's called a miscarriage.) Approximately 1 in 160 pregnancies end in stillbirth in the U.S. every year. Most stillbirths happen before labor begins, but a small number occur during labor and delivery.

If you've received the news that your baby is stillborn, you'll need time to grieve, cope with pregnancy loss, and honor your baby if you choose to.

Signs of stillbirth

The most common sign of stillbirth is when a pregnant woman notices that she can no longer feel her baby moving in the womb. Women can also learn of a stillbirth during a regular prenatal appointment, when their healthcare provider listens for the baby's heartbeat using a handheld ultrasound device called a Doppler. If there's no heartbeat, an ultrasound is done to confirm that the heart has stopped beating and the baby has died.

Sometimes the ultrasound provides information that helps explain why the baby died. A healthcare provider can order blood tests to help determine – or rule out – other potential causes. They may also suggest an amniocentesis to check for chromosomal problems that might have caused or contributed to the stillbirth.

What happens when a baby is stillborn

After a stillbirth diagnosis, your healthcare provider will talk with you about options for delivery. Some women need to deliver right away for medical reasons, but others may choose to wait, to prepare for delivery or give labor a chance to begin on its own. During this time, you'll be monitored closely to make sure you're not developing an infection or blood-clotting problems.

Talk with your doctor or midwife about what will happen next. Let them know if you want to hold your baby or perform cultural or religious rituals soon after the birth, including a burial for your baby.

You should be given as much time as you need to be with your baby after delivering. You may also choose not to see the baby after delivery. Every parents' decision is their own.

Most women choose to have labor induced soon after they learn of their baby's death, either through labor and delivery or through a procedure performed under local or general anesthesia.

Labor and delivery

If a woman's cervix hasn't begun to dilate in preparation for labor, her ob-gyn or midwife may dilate the cervix with medicine or a balloon catheter to start that process. Then she may have an IV infusion of the hormone oxytocin (Pitocin) to stimulate uterine contractions. The vast majority of women who experience stillbirth are able to deliver vaginally.

Labor and delivery may be a better choice for women who want to experience birth as part of their grieving process and who want the option of seeing and holding their child. In addition, an autopsy of the baby after an induction may provide more clues about the cause of the stillbirth. An autopsy is only possible with this route.

Dilation and evacuation (D&E)

If a woman is still in her second trimester and she has access to an experienced practitioner, she may be able to have the fetus removed in a procedure known as dilation and evacuation (D&E). During the D&E, she's put under general anesthesia or given IV sedation and local anesthesia while the doctor dilates her cervix and removes the pregnancy.

The D&E procedure may be a better choice for women who prefer a more rapid process. And in experienced hands, women are less likely to have complications from a D&E than from an induction, though the risk of complications is low for both procedures.

In either instance, the medical team can perform a series of tests to try to determine the cause of the stillbirth. First, they examine the placenta, membranes, and umbilical cord right after delivery. They may then ask permission to have these tissues thoroughly analyzed in a lab and to perform genetic testing. If the stillborn baby was delivered, a fetal autopsy may also be performed.

All of this may be especially difficult for parents who are grieving for their child. And even a thorough evaluation may not answer the question of why the baby died.

On the other hand, parents may learn valuable information from these tests. For example, if the stillbirth was the result of a genetic problem, they can be on the lookout for it in future potential pregnancies. Or parents may learn that the cause is something that's unlikely to recur, such as an infection or a random birth defect. This may be reassuring.

For parents who decide not to have a complete autopsy done, there are less invasive tests that may provide some useful information, including X-rays, MRIs, ultrasounds, and tissue sampling.

Tests are also done on the mother, along with a thorough evaluation of her medical, obstetric, and family history for clues that may help determine the cause of the stillbirth.

What causes stillbirth?

In up to a third of stillborn deaths, medical professionals aren't able to determine what caused the stillbirth, even after performing a thorough investigation. And sometimes more than one cause may contribute to a baby's death.

Common causes of stillbirth include:

• Poor fetal growth. Babies with intrauterine growth restriction (they're growing too slowly) have a significantly increased risk of stillbirth, especially if the growth is severely affected.
• Placental abruption. Placental abruption happens when the placenta starts to separate from the uterus before a baby is delivered.
• Birth defects. Chromosomal and genetic abnormalities, as well as structural defects, may result in stillbirth. Some stillborn babies have multiple birth defects.
• Infections. Infections involving the mother, baby, or placenta – including fifth disease, cytomegalovirus, listeriosis, and syphilis – are another significant cause of stillbirth.
• Umbilical cord accidents. Accidents involving the umbilical cord may contribute to a small number of stillbirths. When there's a knot in the cord or when the cord isn't attached to the placenta properly, the baby may be deprived of oxygen. Cord abnormalities are common among healthy babies, however, and are rarely the primary cause of stillbirth.
• Other events, such as a lack of oxygen during a difficult delivery or trauma (from a car accident, for instance), can also cause stillbirth.

Risk factors for stillbirth

Anyone can have a stillbirth, but some women are more at risk than others. The odds of having a stillborn baby are higher if the mother:

• Had a previous stillbirth or intrauterine growth restriction in a prior pregnancy. A history of preterm birth, gestational hypertension, or preeclampsia increases the risk, too.
• Has a chronic medical condition such as lupus, hypertension, diabetes, kidney disease, thrombophilia (a blood clotting disorder), or thyroid disease.
• Develops complications in this pregnancy, such as intrauterine growth restriction, gestational hypertension, preeclampsia, or cholestasis of pregnancy.
• Smokes, drinks, or uses certain recreational drugs or opioids during pregnancy.
• Is carrying twins or multiples.
• Is obese.

Black women are twice as likely to experience stillbirth compared to white and Hispanic women. Researchers are still studying why this disparity exists, but some organizations have acknowledged systemic racism and healthcare inequality as potential underlying causes contributing to this risk factor. The CDC has called for improvements in women's health, including more equitable access to quality prenatal care.

There's some evidence that suggests women who become pregnant as a result of in vitro fertilization (IVF) or a procedure called intracytoplasmic sperm injection (ICSI) have a higher risk of stillbirth, even if they aren't carrying multiples.

Age – at either end of the spectrum – affects risk as well. Both teens and older pregnant women are more likely to have a stillbirth than women in their 20s and early 30s. The increase in risk is most marked in teens under 15 years old and women ages 40 and older.

For teens, experts suspect both physical immaturity and lifestyle choices may contribute to the higher risk. Older women are more likely to conceive a baby with lethal chromosomal or congenital abnormalities, to have chronic conditions like diabetes and high blood pressure, and to be carrying twins, all of which are risk factors for stillbirth.

How can I reduce my risk of stillbirth?

It's important to remember that researchers don't know why some stillbirths occur – and as a result, they may not always be preventable. But in some instances, there are ways women can potentially reduce their risk factors.

Before you get pregnant:

If you're not pregnant, schedule a preconception visit with your provider. This will give you a chance to identify and treat any problems that have come up since you were last seen. If you have a chronic medical condition, such as diabetes or high blood pressure, you can work with your provider to make sure it's under control before you try to conceive.

Let your provider know about any prescription medication you're taking, so adjustments can be made if necessary. And check with your provider before taking herbal and over-the-counter medications to find out if they're safe (and in what amount) during pregnancy.

Take 400 micrograms of folic acid a day (alone or in a multivitamin), beginning at least a month before you start trying to get pregnant. Doing so can significantly reduce your baby's risk of neural tube birth defects, such as spina bifida.

If you're obese, consider losing weight before you attempt to conceive. (Never try to lose weight during pregnancy, though.) Your caregiver can help you work on getting to a healthy weight. Guidelines from the Institute of Medicine recommend that obese pregnant women limit their pregnancy weight gain to between 11 and 20 pounds.

While you're pregnant:

Don't smoke, drink alcohol, or use recreational drugs or opioids during pregnancy. If you're having trouble quitting smoking, alcohol, or drugs, ask your provider for a referral to a program that can help.

Be aware of your baby's movements, and call your provider or go to the hospital right away if you notice that your baby is less active than normal. This may be a sign (sometimes the only warning sign) that your baby is stressed.

If your provider is unavailable, don't wait for them to get back in touch. Head to the hospital.

One way to track your baby's movements is by doing kick counts starting around 28 weeks. To do kick counts, sit or lie quietly and record how long it takes your baby to make ten distinct movements – it should be within two hours.

Also call your healthcare provider or go to the hospital right away if you notice any of the following:

• You have any vaginal bleeding in the second or third trimester, which can be a sign of placental abruption.
• You have abdominal tenderness.
• You have back pain that's new or suddenly worse.
• You're experiencing frequent contractions or have a contraction that stays for a while, like a cramp that doesn't go away.

Be aware of other pregnancy symptoms you shouldn't ignore, and don't hesitate to call your caregiver if you suspect something's wrong.

If you've previously had a stillbirth (or have a high-risk pregnancy for other reasons), you'll be carefully monitored throughout pregnancy and may begin fetal testing during the third trimester, usually starting at 32 weeks. You'll have tests to monitor your baby's heart rate, including nonstress tests and biophysical profiles. If the results indicate that your baby would be better off delivered than remaining in utero, you'll be induced or have a C-section.

Conceiving again after a stillbirth

Most women who experience stillbirth can go on to have healthy pregnancies and babies.

If your medical team was able to determine what caused your stillbirth, they may be able to provide some information about your chances of suffering another loss. The chances are greater, for instance, if you have a medical condition that's still present, such as lupus, chronic hypertension, or diabetes, or if you had a pregnancy complication that makes another stillbirth more likely, such as a placental abruption.

Even if the cause of stillbirth isn't likely to recur, you may be very anxious in future pregnancies. It's hard not to worry that it will happen again. It's understandable, but there are many ways to cope with anxiety during pregnancy.

Review your situation with your healthcare provider before trying to get pregnant again – they may recommend you wait a certain amount of time before trying. If you're seeing a different ob-gyn or midwife, make sure your new provider has access to your medical records, including lab results.

You may also want to consult with a maternal-fetal medicine doctor (a high-risk specialist) and other specialists, as needed. For example, if your stillborn baby suffered from a genetic disorder, a genetic counselor can help you understand your risk of stillbirth or other complications in another pregnancy.

Resources and support for coping with a stillborn baby

If you've experienced stillbirth, the grief may seem unbearable, and you may feel like nobody knows what you're going through. But you're not alone – there are approximately 21,000 stillbirths in the U.S. every year, according to the CDC. There are ways to cope with your loss, including an array of resources and support groups for grieving parents.

Here are a few:

• The International Stillbirth AllianceOpens a new window is a coalition of organizations dedicated to understanding and preventing stillbirth and caring for bereaved families.
• The Star Legacy FoundationOpens a new window supports and conducts research related to perinatal loss and stillbirth, and connects grieving families with support materials and services.
• First CandleOpens a new window provides information and supports research aimed at preventing SIDS and stillbirth. It also offers grief support to those affected by the death of a baby.
• The BabyCenter Community's Miscarriage, Stillbirth, & Infant Loss Support groupOpens a new window is a virtual gathering place where grieving parents can connect.