- What is stillbirth?
- What are the causes of stillbirth?
- What are the signs of stillbirth?
- What are the risk factors for stillbirth?
- What tests are done to ascertain stillbirth?
- Options for delivering a stillborn baby
- How to cope up with the loss?
- How can stillbirth be prevented?
- Frequently asked questions
Pregnancy brings in hope. You plan everything to welcome your baby – decide what to buy, design their room, and browse through thousands of names to find the right one for them. But sometimes that hope could turn into despair. After waiting for nine months, all you might have is a stillbirth, and this crashes your dreams.
What Is Stillbirth?
- Early stillbirth: When a fetal death occurs between 20 and 27 weeks of pregnancy.
- Late stillbirth: Fetal death between 28 and 36 weeks.
- Term stillbirth: Fetal death after 37 weeks.
Every pregnancy complication has a cause. Read on to know what causes stillbirth.
What Are The Causes Of Stillbirth?
The common causes of stillbirth include (3):
i. Cytomegalovirus (CMV): It is an infection caused by a common virus known as human cytomegalovirus. During pregnancy, this infection can cause serious congenital defects as well as stillbirths by infecting the fetus in utero or causing fetal injury by infecting the placenta (4).
ii. Fifth disease: Only 10% of babies in the womb get infected by the fifth disease caused by a virus called human parvovirus B19. It leads to inflammation of heart and bone marrow damage that stop the red blood cell production, causing fetal anemia. If anemia is severe, it can lead to fetal death (5).
iii. Genital tract infections: Getting infected with a sexually transmitted infection like HIV/AIDS (6) and syphilis can lead to stillbirth.
iv. Listeriosis: Food poisoning caused by a bacterium called Listeria monocytogenes can lead to stillbirth. Pregnant women are at a higher risk of getting infected than others (7).
[ Read: What Is Endometriosis ]
v. Toxoplasmosis: An infection caused by consuming undercooked meat, raw egg, and unpasteurized dairy products, or by cleaning the cat litter (8).
2. Pregnancy-related reasons for stillbirth:
- Prolonged pregnancy, i.e., beyond 42 weeks
- Obesity, high blood pressure, diabetes, and preeclampsia
- Other health conditions like thrombophilia (abnormal blood clots), lupus (an autoimmune disorder), and thyroid disorders
- Preterm labor
- Placental abruption
- Sudden blood loss (hemorrhage) in the mother or fetus (9)
- Cardiac arrest in mother or fetus
- Problems with the placenta such as infections, inflammations, blood clots, a problem with placental blood vessels, or placental abruption
- Umbilical cord problem – A knot in the cord or compression of the cord can cut off the nutrient and oxygen supply to the fetus, leading to fetal death
- Any trauma or injuries (like from a car accident)
- Pregnancy with twins or triplets (10)
3. Conditions related to the fetus:
- Birth defects and genetic conditions like Down syndrome
- Fetal growth restriction
- Insufficient supply of oxygen to the fetus during labor and birth
- Rh disease – When the mother is diagnosed Rh negative and the baby is Rh positive. The Rh antibodies developed by the mother attack the red blood cells of the fetus causing severe anemia and eventually hydrops fetalis, which increases the risk of stillbirth (11).
4. Other causes:
- Financial, emotional or personal stress before delivery
- Smoking tobacco or marijuana, taking prescription painkillers or using illegal drugs (10)
If a mother has one or more of the above causes, then she needs to look out for the signs her body might be showing.
What Are The Signs Of Stillbirth?
[ Read: Folic Acid During Pregnancy ]
Here are some of the signs to watch out for stillbirth during pregnancy:
- Heavy vaginal bleeding
- Tenderness in the uterine area
- Severe back pain
- A sudden reduction in fetal movements after 28 weeks or no movements at all
Note that the above signs do not always indicate stillbirth. But if the mother belongs to the high-risk group, then the chances of stillbirth cannot be ruled out.
What Are The Risk Factors For Stillbirth?
Stillbirth can occur with or without any reason, meaning it is not something we can totally control. That said, some factors increase the probability of a stillbirth. They can be divided into three categories (2):
Maternal medical conditions:
- Obesity – if BMI is 30 or more than that due to excess body fat
- Uncontrolled diabetes
- High blood pressure
Pregnancy history and conditions:
- Pregnant with multiples
- A history of premature birth, preeclampsia or fetal growth restriction
- A previous pregnancy loss.
- Lifestyle habits such as smoking, drinking alcohol, using illicit drugs
- Being unmarried (12)
- Environmental pollutants
If the causes are there, and you belong to the high-risk group, and are showing signs of stillbirth, see a doctor for an immediate diagnosis.
What Tests Are Done To Ascertain Stillbirth?
To start with, the doctor will review your family history to check for any medical conditions. Then, one or more of the following tests are done to find the cause of stillbirth:
Amniocentesis: This test helps find any infection or genetic condition that might have caused stillbirth. This is done before childbirth (3).
[ Read: Amniocentesis Test ]
Autopsy: It is the physical examination of the stillborn fetus to check for any birth defects or other conditions that might have caused stillbirth.
Genetic tests: They check the baby’s genetic conditions.
Blood test: To find if the mother had preeclampsia or problem with the placenta (13).
Tests for determining any infection: A sample of urine, blood or cells from the vagina or cervix are tested.
Thyroid test: To know if the mother had any condition that affected her thyroid.
If the tests confirm a stillbirth, it needs to be removed from your body without much delay.
What Are The Options For Delivering A Stillborn?
If the baby dies inside the womb, the mother can wait for labor to start by itself or choose medication to induce it. Following are some methods used to deliver a stillborn:
Inducing labor: Labor induction is initiated by giving medications to stimulate the uterine contractions or by rupturing the amniotic sac. After that, most women start experiencing labor pains within 24 hours (14).
Dilation and evacuation (called D&E): It is a surgical procedure in which the doctor dilates the cervix to remove the uterine contents (15). However, this method reduces the chances of getting an autopsy done.
Cesarean: It is rarely done and recommended only if the labor process is riskier.
If the mother wants to wait for the labor to start naturally and if it is considered safe for her, then:
- A blood test is done twice a week to check for any infections that affect the mother’s health.
- Your doctor may recommend labor induction if it doesn’t start even after two to three weeks.
Note that long delays in natural labor can deteriorate the baby inside the womb and make it difficult to know about the cause of stillbirth.
After the baby is delivered, the doctors can carry out further tests to determine the cause of stillbirth.
After this episode of loss, you need to take care of yourself as you are weak both physically and mentally.
How To Cope Up With The Loss?
Loss of a baby is one of the most painful experiences that a couple can go through. While you grieve for the baby, you also need to take care of yourself. Here is how.
- Eat well and get plenty of rest. Stay physically fit so that you can continue to heal emotionally.
- Talk about your baby, your feelings, your fears, and your grief. Or, keep a diary and start writing about it. Do not suppress your feelings.
- Read books, articles, and videos to get information, guidance, and support.
- Be with your family and friends. Contact a support group for parents who have had stillbirths. Share your story and learn how they have dealt with it.
Stillbirth is probably the most depressing experience during pregnancy. It leaves scars for life. Therefore, you need to take care to prevent it, if possible.
[ Read: How To Induce Labour ]
How Can You Prevent Stillbirth?
You cannot stop a stillbirth. But you can take every step that makes stillbirth less likely. Here are a few ways to prevent stillbirth and ensure a safe pregnancy:
- Adopt a healthy lifestyle with a well-balanced diet.
- Increase the intake of folic acid when planning for pregnancy, as it reduces the chances of birth defects.
- Do not miss any antenatal appointments.
- Maintain a healthy weight gain throughout the pregnancy by engaging in low to moderate exercises, if recommended by the doctor.
- Get an early pregnancy ultrasound.
- Get screened for pregnancy risks and to determine fetal growth abnormalities.
- Check and manage hypertension and diabetes before and during pregnancy.
- Monitor fetal movements from the second trimester.
- In case of breech presentations, have a planned C-section as recommended by the doctor.
- In case of overdue pregnancies, labor induction is ideal.
- Be careful to avoid accidents such as falling. Avoid wearing heels and wear a seatbelt while traveling in a car.
- Opt for home-cooked food as it reduces any risk of food poisoning.
Sometimes, regardless of the preventive measures and medical intervention, a pregnancy could end in stillbirth. The experience of losing a baby is inconsolable, and coping with it is not easy. But then, that is the only way to move on.
Next, we address a few commonly asked questions about stillbirth.
Frequently Asked Questions
1. Can you have a healthy pregnancy after you’ve had a stillbirth?
Yes. The chances of stillbirth in a subsequent pregnancy are low, i.e., around 3%. Prepare yourself mentally and physically and get check-ups done to know what caused stillbirth in your previous pregnancy. A genetic counselor or your doctor can determine the chances of having another stillbirth (16) and tell you how soon you can plan the next pregnancy.
2. What is the difference between a miscarriage and a stillbirth?
Both the terms describe pregnancy loss, but the difference is in the timing of the loss. A pregnancy loss is termed a miscarriage when it occurs before 20 weeks of pregnancy, and a stillbirth refers to the pregnancy loss after 20 weeks (17).
While there are ways to find what causes stillbirth, there is no strong evidence pointing to the exact cause, which makes it difficult to predict its occurrence. Research in this area is ongoing, and all you can do is take preventive measures to avoid the pain of losing a baby.
Do you have any tips for mothers coping with stillbirth? Share them in our comments section.