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Pregnancy loss is devastating. A stillbirth can be particularly traumatic. They occur from well into the second trimester through the end of the third trimester, and there may be an unknown cause for a stillbirth. At this point, families have often made accommodations for their new baby—their homes and lives are full of reminders of the bundle of joy they were expecting. They may have chosen a name for their baby, made plans for maternity leave and childcare, installed a car seat, and prepared a nursery. Unexpectedly coming home with empty arms is bewildering and tragic. Families who have suffered a stillbirth need answers and support.
Besides supporting and empathizing with families who have experienced a stillbirth, we can learn from their experiences. Identifying potential causes and getting answers to help prevent them from happening again and to others is essential. Here we will examine what stillbirth is, risk factors and causes of stillbirth, potential ways to prevent stillbirth, and how a stillbirth is treated.
What is Stillbirth?
Sometimes called a fetal death, stillbirth is the death of a baby after 20 weeks of pregnancy while the fetus is still in the womb or during delivery. A miscarriage is a fetal death before 20 weeks of gestation, which can be just as devastating and tragic.1 Stillbirths can be further divided into early, late, and term.2 Early stillbirths occur between 20 and 27 weeks of gestation, while late stillbirths refer to those occurring between 28 and 36 weeks.2
Term stillbirths occur at 37 or more weeks of pregnancy.2 Every year, around 24,000 stillbirths occur in the United States, and approximately 1 in 160 pregnancies end in stillbirth.2
Risk Factors for Stillbirth
While all the causes and risk factors for stillbirth are unknown, many have been identified. Below are some of the risks commonly associated with stillbirth.
Race
Black mothers are twice as likely to experience stillbirth as white or Hispanic mothers.3 This is likely due to underlying conditions and pregnancy health problems affecting Black women more often. Regardless of income or education, Black women are less likely to receive treatment for medical conditions that may cause or contribute to stillbirth.15
Advanced Maternal Age
A systematic review examining multiple studies on stillbirth concluded that women with advanced maternal age have a significantly increased risk of stillbirth. It is unclear how exactly older maternal age may cause this increased risk, but further studies on this mechanism have been recommended.4
Low Socioeconomic Status
Poor socioeconomic conditions double the risk of stillbirth for women. This may be partially due to these women’s access to healthcare—stillbirth rates are lower for women who have medical care before and during pregnancy and during labor and delivery.5
Cigarette Smoking During Pregnancy
In a systematic review that examined cigarette use in pregnancy, smoking significantly increased the risk for stillbirth by close to 50 percent. Stillbirth odds were higher based on the number of cigarettes smoked per day. Reducing or quitting smoking during pregnancy may help to reduce the risk of stillbirth.6
Multiples Pregnancy
Depending on the configuration of the gestational sacs and placentas, pregnancies with multiples, such as twins or triplets, are at a significantly increased risk of stillbirth. This is likely partly due to multiples sharing nutrients, often unequally.7
What are Some Causes of Stillbirth?
It can be challenging to determine the cause of every stillbirth after the fetus has been delivered. In some cases, the cause of the stillbirth remains unexplained, while in others, it can be related to issues with the baby or the pregnancy itself. Here are some of the most common causes of stillbirth.
Unexplained
Almost 1 in 3 stillbirths is unexplained. The further a pregnancy has progressed before ending in stillbirth, the more likely the cause will be unexplained.3
Birth Defects
Stillbirth is caused by one or more congenital disabilities 25 percent of the time. While some congenital disabilities are discovered via ultrasound, many may not be found until the fetus is delivered and thoroughly examined.8
Genetic and Chromosomal Issues
A quarter of stillbirths have been attributed to genetic causes such as trisomy or inherited disorders. If any fetal structural issues have been identified on ultrasound, a genetic cause of the stillbirth is more likely.9
Issues With the Placenta or Umbilical Cord
Your baby’s placenta and umbilical cord provide all their nourishment while in the womb. Any issues with this system can cause the fetus not to develop properly.8
Maternal Health Problems
Pregnancy-related conditions such as gestational hypertension, preeclampsia, and gestational diabetes can cause stillbirths. Other preexisting maternal health problems such as diabetes, obesity, heart disease, thyroid issues, and infections can also contribute to stillbirths.8
Stillbirth Prevention
Attend All Prenatal Appointments
Your provider likely checks your blood pressure and urine at each prenatal appointment. These tests can indicate if you have any pregnancy conditions that may affect your health and your baby’s health. In addition, ultrasounds and other tests can identify any genetic or chromosomal disorders with your baby that may ultimately cause or contribute to your risk for stillbirth.8 If your doctor discovers these conditions before becoming uncontrolled, they may be able to suggest interventions that will reduce the risk of stillbirth.
Healthy Lifestyle
Avoiding alcohol, tobacco, and recreational drugs during pregnancy can help to reduce the risk of stillbirth. A healthy diet and exercise routine before and during pregnancy can help foster a healthy weight for your body, which may also reduce the risk of stillbirth. Aim to avoid infections and follow your provider’s recommendations on foods you should steer clear of during pregnancy.8
Kick Counts
Starting in the third trimester, set a timer for 10 minutes at the same time each day when the baby is usually active. Count the kicks or fetal movements you feel during those minutes and compare that to previous days. Keep a record of your daily kick counts and contact your provider if your kick count significantly decreases from your baby’s usual pattern. There is an association between changes in your baby’s fetal activity and an increased risk of stillbirth.10 If you can identify decreased fetal movement before the fetus has passed, you may be able to deliver your baby early and prevent stillbirth.
Advocate for Yourself
Trust your gut and communicate with your provider if you feel something is off with your pregnancy or baby. Your doctor or midwife can check your baby’s fetal heartbeat to ensure it is still thriving in your womb. This is your baby and your body, so if you are concerned, be sure to express that to your obstetric provider.
If Stillbirth Occurs
After the devastating diagnosis that your baby has passed away in your womb, the fetus still must make its way out of your body. Delivering a stillborn baby is like other labor and delivery options. You can wait for labor to start naturally, you can induce labor, or you can have a Cesarean section.
Natural Labor
If your baby has passed away in your womb, your body will likely eventually recognize this and go into labor naturally. However, this may or may not take some time. Some healthcare providers will allow you to wait for natural labor to occur for up to two to three weeks. Waiting much longer than that puts you at risk for infection and other health concerns. Keep in mind that while waiting for natural labor, your baby’s body may start to deteriorate. The body might not look how you would expect when it is finally delivered, and the deterioration may make it more challenging to identify the cause of the stillbirth. Therefore, many providers will recommend immediate induction in the case of a stillbirth.11
Induction
Labor induction may happen immediately if the mother’s health is at risk. Otherwise, medical personnel allows mothers to take some time to decide how they want to proceed. Inductions can begin with medications taken orally, inserted vaginally, or administered through an IV. How ready your body is for childbirth will determine this.8
Cesarean Section
A C-section is considered major surgery with many more risks than vaginal birth. Most providers discourage performing them on-demand for a stillbirth. However, they may recommend a C-section if your baby is breech, if you have had a previous C-section, or if you have another immediate health condition that prevents you from delivering vaginally.12
Getting Answers
After you deliver your baby, you may be wondering what is next. You should have the option to see, hold, and take photos of your baby for as long as you would like. After that, you will need to decide if you want tests done to determine the cause of the stillbirth. Here are some of those testing options.
Placental Evaluation
After delivery, your doctor can examine the placenta and umbilical cord in plain sight and under a microscope. This evaluation can reveal possible causes of stillbirth, such as placental abruption, genetic anomalies, and infection.11 In one study, an examination of the placenta helped to find the cause of stillbirth in around two-thirds of cases.13
Autopsy
A fetal autopsy identified a cause of stillbirth in about 40 percent of cases.11 Fetal autopsy consists of measurements, examination for intrinsic abnormalities, and signs of infection. All this data can help point to a cause.11
Genetic Testing
There are many methods to obtain samples of your baby’s DNA, chromosomes, and genes to identify a potential genetic cause of stillbirth. Abnormal genetics may be found in six to 13 percent of stillbirths.11 Genetic testing results can give some families peace in knowing why this may have happened.
You may feel devastated and confused if you or someone you know is going through a stillbirth. You may want answers or to rewind the clock. Talk to your provider about what testing is available to provide the answers you need. Your doctor may also have recommendations on grief resources in your area. Do what you need to process everything you have been through, whether having a funeral for your baby, attending group or individual therapy, or talking to close loved ones. If you are hoping for a successful pregnancy in the future, talk to your provider about when it is safe and healthy to try again. Rest assured that the chance of a subsequent pregnancy that results in a liveborn infant is over 97 percent.14 That may not soften this loss, so allow yourself the time and space to grieve this baby for whom you had prepared.
Resources
1.https://www.mayoclinic.org/diseases-conditions/symptoms-causes/syc-20354298
2. https://www.cdc.gov/ncbddd/facts.html
3. https://www.cdc.gov/ncbddd/features/kf-.html
4. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2175002/
5. https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(15)00818-1/fulltext
6. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4372174/
7. https://obgyn.onlinelibrary.wiley.com/doi/10.1111/1471-0528.16291
8. https://my.clevelandclinic.org/health/diseases/9685
9. https://pubmed.ncbi.nlm.nih.gov/20661047/
10. https://bmcpregnancychildbirth.biomedcentral.com/articles/10.1186/s12884-017-1555-6
11. https://www.acog.org/clinical/clinical-guidance/obstetric-care-consensus/articles/2020/03/
12. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5649029/
13. https://pubmed.ncbi.nlm.nih.gov/19358031/
14. https://journals.lww.com/greenjournal/Fulltext/2022/01000/6.aspx
15. https://countthekicks.org/
