Stillbirth: Essential Facts You Need to Know | Nirogi Lanka

For every expectant parent, the dream is to welcome a healthy baby into this world. However, in heartbreaking and unimaginable circumstances, a pregnancy may end in the loss of the baby before birth, particularly after the 20th week of gestation. In medical terms, this devastating event is known as a 'Stillbirth.' It is a profoundly painful and deeply personal experience that words can hardly describe, and at Nirogi Lanka, we acknowledge the immense weight of such grief.

What exactly is a stillbirth?

Simply put, a stillbirth is the loss of a baby in the womb after 20 weeks of pregnancy. Many people mistakenly believe this only happens if the baby's heart stops during the actual birth, but in reality, most stillbirths occur while the baby is still inside the uterus. It is relatively rare for this to happen during the labor process itself. In most cases, doctors will identify potential risks early and take necessary steps well before your due date.

A stillbirth is an incredibly difficult experience, much like a miscarriage. The main difference is the timing: a miscarriage occurs before 20 weeks, while a stillbirth happens after 20 weeks. Regardless of when a loss occurs, please know that you may need significant time to grieve and heal, and the strong support of your loved ones is vital during this journey.

What are the main types of stillbirth?

Doctors categorize stillbirths based on the number of weeks of pregnancy that have elapsed when the loss occurs:

• Early stillbirth: The loss occurs between 20 and 27 weeks of pregnancy.
• Late stillbirth: The loss occurs between 28 and 36 weeks of pregnancy.
• Term stillbirth: The loss occurs at or after 37 weeks of pregnancy.

How common is this condition?

The rate of stillbirth varies significantly across the globe. In developing nations, rates can be as high as 22 per 1,000 births. However, these figures are much lower in developed countries; for example, the U.S. sees approximately 6 per 1,000 births, and the U.K. reports about 3.5 per 1,000.

With advancements in prenatal care, stillbirth rates have decreased worldwide. Nevertheless, there is still work to be done to address disparities in healthcare that leave certain groups at a higher risk than others.

Who is at higher risk for a stillbirth?

While a stillbirth can occur in any pregnancy, your health status, lifestyle, and environment can influence your individual risk profile.

• Age: The risk is slightly higher for mothers under 20 and over 35.
• Health Conditions: Certain pre-existing conditions can increase risk, such as diabetes, high blood pressure, blood clotting disorders, thyroid disorders, lupus, and obesity (a Body Mass Index of 30 or higher).
• Pregnancy Factors: Carrying twins or multiples increases the risk.
• Previous Complications: If you have experienced a previous stillbirth or other complications like preterm birth, your risk for subsequent pregnancies may be slightly elevated.
• Substance Use: The use of illicit drugs, smoking, and alcohol consumption can contribute to stillbirth. Combining these substances further increases the danger.
• Stress:High levels of life stress, such as significant financial instability or family conflicts, can also play a role.
• Environment and Healthcare: Living in an area with limited access to quality prenatal care increases risk. Socioeconomic factors are critical; in some regions, specific communities face disproportionately higher rates of stillbirth due to systemic barriers to accessing healthcare.

What causes a stillbirth?

It is profoundly difficult to accept that in one out of every three stillbirths, doctors are unable to pinpoint an exact cause. The factors are often complex, involving the mother's health, the baby's health, or issues with the placenta and supporting tissues.

Infections

Infections caused by viruses, parasites, bacteria, or other pathogens contribute to roughly 50% of stillbirths in developing nations and about 25% in developed countries. Because some of these infections show no symptoms, you may be completely unaware that a problem exists until a pregnancy complication arises.

Consistent, high-quality prenatal care from your Nirogi Lanka provider can often help manage these risks.

Placental or Umbilical Cord Issues

The placenta is the vital organ that delivers oxygen and nutrients to your baby via the umbilical cord. If there is a malfunction in this life-support system, the baby may not receive the oxygen or nutrients required to thrive.

• Placental abruption: This occurs when the placenta separates from the wall of the uterus. It is a cause in approximately 10% to 20% of stillbirths.
• Umbilical cord accidents: If the cord becomes compressed or tangled, it can cut off the baby's oxygen supply, accounting for about 10% of stillbirth cases.

Fetal Conditions

Sometimes, there may be issues with the baby's development, a congenital disability (birth defect), or a genetic condition. Genes act as the instruction manual for the body's development and function; errors in these instructions—such as in Down syndrome—can interrupt the growth or function of vital organs.

Additionally, the baby may not receive sufficient nutrition for healthy development, a condition known as intrauterine growth restriction (IUGR), which is a common contributor to stillbirth.

Pregnancy Complications

If you have chronic health issues such as diabetes, lupus, high blood pressure, obesity, or blood clotting disorders, the likelihood of pregnancy complications is higher, necessitating close monitoring by your medical team.

However, having a chronic condition does not mean you will inevitably face complications. A doctor can help you manage your chronic conditions and monitor your health closely to minimize any risks.

Some pregnancy complications that can lead to a stillbirth include:

• Preeclampsia: A condition characterized by high blood pressure that typically begins in the second half of pregnancy.
• Cholestasis of pregnancy: A liver condition that occurs during the later stages of pregnancy.
• Premature birth: When your baby is born too early (before 37 weeks).
• Preterm premature rupture of membranes (PPROM): When the amniotic sac containing the fluid around the baby ruptures prematurely.

What are the symptoms of a stillbirth?

In most cases, the only warning sign of a stillbirth is noticing that your baby is not as active as usual or that their movements have decreased. Some people may also experience abdominal pain or vaginal bleeding.

Important: These symptoms do not always mean a stillbirth has occurred. However, if you notice any such changes, you must consult a doctor immediately.

How is it diagnosed?

Most stillbirths occur before labor begins. Your doctor will perform an ultrasound scan to check for your baby's heartbeat.

What tests are done to determine the cause of a stillbirth?

For many parents, knowing the cause of a stillbirth can help with the grieving process and provide closure. Understanding what happened can also help in reducing the risk of complications in future pregnancies.

Your doctor will thoroughly review your medical records and the circumstances surrounding the event. To identify the cause, they may examine the baby, the umbilical cord, or the placenta.

These tests may include:

• Infection tests: Doctors may take samples of your urine, blood, or vaginal/cervical cells to check for infections.
• Blood tests: These can indicate if you have an underlying medical condition related to pregnancy complications.
• Genetic tests: Your doctor may examine a sample from the umbilical cord to identify potential genetic issues, such as Down syndrome, which could have contributed to the stillbirth.
• Autopsy: An autopsy is a surgical procedure that allows a specialist to examine the baby to determine the cause of death. This may involve minor incisions to inspect internal organs. In most cases, you have the right to decide whether or not to proceed with an autopsy. You can also specify the extent of the examination.

When should I decide to have an autopsy for my baby?

This is an incredibly difficult decision. After such a heartbreaking event, even considering an autopsy can be emotionally painful for many parents. Additionally, as not all insurance plans cover the cost, expenses may also be a factor to consider.

The primary benefit of an autopsy is the increased probability of identifying the cause of the stillbirth. Recent research suggests that an autopsy can increase the diagnostic rate significantly, sometimes from as low as 20% to over 90%. This information can help your doctor prevent complications in future pregnancies.

However, every situation is different, and this is a deeply personal decision. Discuss your concerns with your healthcare team at Nirogi Lanka to decide what is best for you.

What happens after the baby has died?

Your doctor will recommend the safest option for delivery. Please be aware that this experience will physically feel like delivering a live baby. Your maternity care team will guide you through the process and provide medication to manage pain.

• Induced labor: Doctors often recommend starting labor as soon as possible after a stillbirth. If you have an underlying medical condition, induction is often the safest choice for your own health. Usually, medication to start labor is given within two days of the baby's passing.
• Natural birth: If you prefer to wait, it is an option; labor often begins naturally within two weeks. However, choosing to wait may make a post-mortem examination more difficult.
• Cesarean section (C-section): If your health is at risk, an emergency C-section may be necessary. However, C-sections are rarely required in cases of stillbirth.

What happens after delivery?

You have choices regarding how much contact you have with your baby. There is no right or wrong way to feel or react during this time.

For example, if you wish, you can hold and cuddle your baby. You may request keepsakes, such as a lock of hair or the hospital ID band. Most hospitals provide a birth certificate; you can also request to include your baby’s hand and footprints.

Take all the time you need, and never hesitate to ask for support. Having your loved ones by your side can be a great help in managing your grief and healing.

Will I produce breast milk after a stillbirth?

Breast milk production typically begins within a few days of delivery. Unless you have conditions like preeclampsia, your doctor may be able to prescribe dopamine agonists to help stop milk production. Alternatively, if you prefer, you can wait for the process to stop naturally. Discuss what feels right for you with your doctor.

Is it possible to get pregnant again after a stillbirth?

Yes, absolutely, it is possible. Many individuals go on to have healthy pregnancies and welcome healthy babies afterward. If the cause of the (Stillbirth) was a congenital disability or an issue with the umbilical cord, the likelihood of recurrence is often low. If the cause was an underlying health condition or a genetic disorder, the risk of experiencing another (Stillbirth) in a future pregnancy is typically around 3%.

How long should you wait to conceive again after a (Stillbirth)?

Some studies suggest that those who wait at least a year before trying to conceive again after a (Stillbirth) may experience lower levels of depression and anxiety in subsequent pregnancies. However, the timing for when you are physically and emotionally ready to try again is a deeply personal decision.

Please have an open conversation with your healthcare provider about your plans for your next pregnancy.

Can a (Stillbirth) be prevented?

Often, there is nothing you could have done to prevent a (Stillbirth). In many cases, it is caused by medical conditions or complications beyond your control. However, you can take these steps to support a healthy pregnancy:

• Avoid drugs, tobacco, and alcohol: Substance use increases the risk not only for (Stillbirth) but also for complications like fetal alcohol syndrome and Sudden Infant Death Syndrome (SIDS).
• Focus on your nutrition: Adapt your diet to support a pregnancy by ensuring you receive adequate, nutrient-dense calories. Consult your doctor regarding foods to avoid to prevent foodborne illnesses.
• Maintain a healthy weight: Before becoming pregnant, work toward achieving a healthy weight that is right for you.
• Prevent infections: Follow good hygiene practices, such as regular handwashing and proper food preparation. Ensure you are up to date on recommended vaccinations before, during, and after pregnancy.
• Monitor “kick counts” daily: By 26–28 weeks, get to know your baby’s movement patterns. If you notice a decrease or change in your baby's activity, contact your doctor immediately.
• Avoid sleeping on your back; choose your side instead: Once you are 28 weeks pregnant or further, sleeping on your back may increase the risk of (Stillbirth). Experts believe this may be related to blood and oxygen flow to the baby.
• Attend all routine check-ups, (ultrasounds), and fetal heart monitoring sessions: Consistent prenatal care allows your doctor to detect and manage any conditions early. This is especially important if you are at a higher risk for pregnancy complications.
• Report symptoms immediately: If you experience symptoms such as abdominal pain, vaginal bleeding, or unusual discharge, seek medical attention right away.

How can I care for myself after a (Stillbirth)?

After a (Stillbirth), allow yourself as much time as you need to grieve and heal. Express your grief in the way that brings you the most comfort. This might include holding a memorial service with supportive friends and family, or taking quiet time for yourself to process your emotions and asking for help with daily responsibilities.

Counseling and pregnancy loss support groups are invaluable resources during this time. Remember, no matter the stage of pregnancy, you are still a parent. The bond you formed is real. It is normal to experience depression or Post-traumatic stress disorder (PTSD) after such a significant loss; seeking professional support is a sign of strength.

A (Stillbirth) is a heartbreaking loss, and healing is a journey. Remember that it is okay to struggle; you do not have to carry this burden alone. Reaching out to support groups and mental health professionals is a healthy and important step.

If you are worried about future risks, consult your healthcare provider or a Maternal-fetal medicine (MFM) specialist. They can offer guidance, specialized testing, or genetic counseling. The decision to try again is significant, and you have experts available to support you through every step.

Take-Home Message

(Stillbirth) is a profound and difficult experience. Understanding the facts, recognizing risk factors, and knowing when to seek help are essential.

• You are not alone: There are many who understand your pain and resources available to support you.
• Causes vary and are sometimes unclear: Often, there is no definitive answer as to why a (Stillbirth) occurred. Please do not blame yourself.
• Prioritize medical care: Pay attention to your baby’s movements and report any concerns to your doctor immediately.
• Allow yourself to grieve: Healing takes time. Be patient with your emotions and seek professional guidance if you need it.
• Hold onto hope: Many who experience a (Stillbirth) go on to have healthy pregnancies. Speak with your doctor about your future plans.

We hope this information helps you navigate this difficult topic with more clarity. If you have personally experienced this loss, our thoughts are with you, and we wish you strength during this time at Nirogi Lanka.

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Keywords: Stillbirth, Pregnancy, Fetal Loss, Pregnancy Complications, Maternal Health, Nirogi Lanka