Signs, Causes and Prevention of Stillbirth
Stillbirth is an extremely distressing experience for parents and families. The loss of a baby you have planned a future around causes pain, grief and shock.
Often the cause of stillbirth is unknown, but there are things that can lower the risk of losing a baby.
The content in this article may be distressing for some people. Please reach out if you need support in coping with stillbirth.
What is a stillbirth?
When a baby dies any time after 20 weeks pregnancy up to the date of birth, this is referred to as a stillbirth.
The baby may have died during pregnancy or during labour.
Sometimes, the birth is considered to be a stillbirth if the baby weighs 400 grams or more and the length of the pregnancy isn’t known.
Stillbirth is different to a miscarriage, which happens when a pregnany loss occurs before 20 weeks of pregnancy.
How common is stillbirth in Australia?
Australia is one of the safest places in the world to give birth. Yet sadly every day 6 babies are stillborn in this country.
The risk of having a stillbirth is higher for certain groups of women, such as Aboriginal and Torres Islander women.
What is the main cause of stillbirth?
There are some known causes of stillbirth but unfortunately why a stillbirth occurs isn’t always known.
The most common reasons for stillbirth are:
- Congenital anomalies, which are conditions that affect the structure or function of the baby’s body
- Maternal conditions such as diabetes, preeclampsia or heart disease
- Problems with the placenta or umbilical cord
- Premature labour that can’t be stopped and the baby is too immature to survive.
Some risk factors can increase the chances of a woman having a stillbirth. These are:
- Smoking tobacco, drinking alcohol or using recreational drugs
- Being overweight or obese before becoming pregnant
- Sleeping on your back in late pregnancy
- Not having regular prenatal check ups
- Trauma to abdomen
- Family violence during pregnancy.
What are the signs of stillbirth?
The most common sign of a pregnancy loss is when you stop feeling your baby’s movements and kicks.
Fetal movements are an important indication of your baby’s wellbeing. Most women feel their baby’s movements from around 20 weeks pregnant (sometimes earlier, sometimes a few weeks later).
The number of movements you feel increases until you’re around 32 weeks, then stays the same. The type of movement might change as your pregnancy progresses and baby gets bigger, but the amount of movement should stay the same.
If you haven’t felt movement by 24 weeks pregnant, talk to your midwife or doctor and they can check your baby’s heartbeat and possibly refer you for an ultrasound.
If you’re between 24 and 28 weeks pregnant and can’t feel any movement, speak to your maternity care provider immediately – don’t wait until the next day or your next appointment. You will have a full check up and monitoring of the baby.
If you’re over 28 weeks pregnant, again if you can’t feel any movement or your baby’s movements have slowed down, speak to your maternity care provider immediately. Fewer movements can mean baby’s not well but in most cases, check ups reveal everything is fine.
If you have any of the following symptoms, please contact your maternity care provider or go to your nearest hospital emergency department:
- Strong pain or cramping in your lower belly or back
- Any bleeding or discharge that is more than normal for your gestation
- You’ve had a hard blow to the belly
- You feel dizzy, have severe headaches and changes to your vision
- Any sudden swelling in hands, feet or face, or painful swollen legs
- Severe nausea and vomiting
- Fever or high temperature.
Listen to your intuition – if something doesn’t feel right, get it checked out. Maternity care providers would much rather you came in and had checks and find nothing is wrong than to wait.
How is a stillbirth diagnosed?
If you or your care provider suspects there is something wrong, you will need to have some tests and checks.
The most common is to check for the baby’s heartbeat, which your midwife or doctor may do with a stethoscope or Doppler, or via ultrasound.
If no movement or heartbeat is seen on ultrasound, this is a definite diagnosis of the baby having died.
What happens when a baby is stillborn?
It’s very traumatic to hear your baby has died. You will be supported by many people as you make difficult decisions in the coming hours.
Your midwife or doctor will talk with you about the best way to give birth to your baby. In most situations, it’s recommended to have a vaginal birth rather than a c-section.
The reason a vaginal birth is recommended is because you will recover quicker and better than from a c-section and are less at risk of complications.
Some women choose to wait for labour to begin on its own, which usually happens within two weeks of the baby dying. Many women don’t wish to wait that long and choose to have labor started with medications.
You will be given support and time to decide who will be with you in the room, any special things you want to have, if you want photos taken afterwards and so on.
During labour, you can have pain relief if you want it. The midwives looking after you will support you and your partner in every way and you shouldn’t be worried about asking for anything that you need during this time.
What happens after a stillbirth?
Once your baby is born, you’ll be supported to spend as much time with him or her as you wish. We know spending this precious time with your baby can help support you through your grief in the time ahead.
If you’re scared or worried about being upset seeing your baby, talk to your healthcare team. They’ll be able to answer any questions you have about what your baby will look like and manage the process with you.
Many parents are surprised how this concern disappears once their baby is born.
Your midwife will help you to get comfortable after the birth, and you and your partner can hold, bathe and dress your baby. Many parents create keepsakes or mementos of this time, such as a lock of their baby’s hair, hand or foot prints, photos and videos. Some parents have a naming ceremony and invite family and friends to visit.
It’s up to you how you want to remember your baby and the hospital staff will support your wishes. They will also organise the necessary paperwork to register your baby’s birth.
When you’re ready, your baby will be taken care of by the funeral home you have chosen. You will be able to visit your baby during this time until the funeral takes place. The funeral home will treat your baby with respect and support you through this time.
Finding out why your baby died
Most parents want to know if there was a specific cause of death. In some cases, this might already be known, but it may be suggested to have some tests to see if the reason for the stillbirth can be discovered.
These tests can involve:
- Blood taken from the mother
- Autopsy of the baby
- Examination of the placenta.
You don’t have to agree to any of these tests, or only some, but it may be helpful to know any information these tests can discover.
It’s important to know these tests may not give you a definite answer as to why your baby was stillborn. This can be very distressing and your healthcare team will support you as much as possible.
The grief experienced after stillbirth can be very isolating and consuming. You can access grief counselling services or contact Sands Australia for 24 hours support on 1300 072 637. Still Aware is a stillbirth awareness organisation which offers support to parents and health professionals.
Having another baby after stillbirth
It takes time for your body to return to a pre-pregnant state after stillbirth. Shortly after birth, your breasts will be sore and your milk will come in. This can be a very distressing reminder of your loss and many women feel incredibly emotional at this time. Some mothers chose to dry their milk up quickly, others wish to donate their milk to babies in need. The choice you make is the right one for you and your situation.
In time, you may begin to think about having another baby. It’s normal to feel conflicted about this and even guilty. It doesn’t mean you have moved on from your baby or have forgotten them.
Make sure you have support and guidance from your midwife or doctor about being prepared for another pregnancy.
Nurtured Birth offers support during pregnancy and birth for parents experiencing stillbirth or want to explore options for care during a pregnancy after stillbirth. Please contact us for more information.