Stillbirth: What you need to know

The dream of every expectant mother or father is to welcome a healthy baby into the world. However, unimaginably, sometimes during pregnancy, especially after 20 weeks, the baby can be lost inside the womb. This very sad situation is what we medically call `(Stillbirth)`. In Sinhala, we also call this ``stillbirth''. This is truly a heartbreaking and indescribably painful experience.

What exactly is `(Stillbirth)`?

Simply put, a ``Stillbirth`` is the death of a baby in the womb after 20 weeks of pregnancy. Many people think that this only happens if the baby's heartbeat stops during birth. But in reality, most babies die in the uterus. It is very rare for this to happen during labor, when the baby is close to being born. In most cases, doctors can detect this condition early and take the necessary measures before the due date.

A `(Stillbirth)` is just as difficult to bear as a `(Miscarriage)`. However, in a `(Miscarriage)`, the baby is lost before 20 weeks of pregnancy. In a `(Stillbirth)`, it happens after 20 weeks. However, when something like this happens, you may need a lot of time to bear the grief and recover from it, and the strong support of your loved ones is essential.

What are the main types of `(Stillbirth)`?

Doctors classify stillbirths based on the number of weeks of pregnancy that have passed when the baby dies in the womb.

• Early stillbirth: The baby dies between 20 and 27 weeks.
• Late stillbirth: The baby dies between 28 and 36 weeks.
• Term stillbirth: The baby dies after 37 weeks.

How common is this condition?

The incidence of stillbirth varies greatly in different parts of the world. In developing countries, there are sometimes as many as 22 stillbirths per 1,000 births. However, in developed countries, this number is much lower. For example, in the United States, there are only about 6 stillbirths per 1,000 births, and in the United Kingdom, there are only about 3.5 stillbirths per 1,000 births.

Stillbirth rates have declined worldwide as prenatal care has improved. However, much more needs to be done to reduce the disparities in health care that make some people more likely to experience stillbirth than others.

Who is at higher risk of having a `(Stillbirth)`?

In fact, a stillbirth can occur during any pregnancy. However, factors such as your health, lifestyle, and the environment you live in can increase or decrease this risk.

• Age: This risk is slightly higher for young mothers under 20 years of age and for mothers over 35 years of age.
• Health conditions:You may be at higher risk if you have certain medical conditions, such as diabetes, high blood pressure, blood clotting disorders, thyroid disorders, lupus, and obesity (a body mass index (BMI) greater than 30).
• Nature of pregnancy: The risk is higher if you are expecting twins or more.
• Complications from previous pregnancies: If you have had a previous stillbirth, or other complications such as preterm birth, you are slightly more likely to have a stillbirth again.
• Drug use: Drug use, smoking, and alcohol use can cause stillbirth. The risk increases when these are used together.
• Stress: Risk may also increase when dealing with major life stressors, such as severe financial difficulties or family disputes.
• Environment and health care: If you live in a country or environment where prenatal care is not readily available, the risk of stillbirth is higher. Socioeconomic factors also play a role. In some parts of the world, certain populations experience stillbirths at twice the rate as others. This is due to barriers and disparities in access to health care.

What are the causes of a `(Stillbirth)`?

Sadly, in one out of every three stillbirths, doctors can't figure out exactly why the baby was lost. The causes can be very complex. They can be caused by problems affecting the mother, problems affecting the baby, or problems with the tissues and organs that maintain the connection between mother and baby.

Infections

Infections caused by viruses, parasites, bacteria, or other germs (pathogens) account for about 50% of stillbirths in developing countries and about 25% in developed countries. Sometimes, these infections don't cause any symptoms, so you may not know there's a problem until it becomes a complication during pregnancy.

The risk of stillbirth due to infection can often be reduced by receiving good quality prenatal care.

Placenta or umbilical cord problems

The placenta is an organ that helps share nutrients from you to your baby through the umbilical cord. If there is a problem with these lifelines, your baby may stop getting the oxygen, blood, and nutrients it needs to survive.

• Placental abruption: This is the separation of the placenta from the uterus . It accounts for between 10% and 20% of all stillbirths.
• Knotting the umbilical cord:If the umbilical cord is twisted and the baby does not get the oxygen it needs, it can result in a ``Stillbirth``. This accounts for about 10% of ``Stillbirth``.

Conditions affecting the baby

Sometimes, a baby may have a developmental problem or a congenital disability / birth defect. A baby may also have a genetic condition. Genes are the instructions that tell a baby's body how to grow and function. If there are errors in these instructions, the baby's organs may not develop or function properly. For example, conditions like Down syndrome.

The baby may not get the nutrients it needs to grow healthily. This is called intrauterine growth restriction . This is also a common cause of stillbirth.

Pregnancy complications

If you have a chronic medical condition such as diabetes, lupus, high blood pressure, obesity, or blood clotting disorders, you are more likely to have problems during pregnancy.

However, just because you have a chronic condition doesn't mean you will definitely develop complications. A doctor can help you manage your chronic conditions and reduce your risk by monitoring your health regularly.

Some pregnancy complications that can cause stillbirth are:

• Preeclampsia: A condition of high blood pressure that begins in the second half of pregnancy.
• Cholestasis of pregnancy: A liver disease that occurs in late pregnancy.
• Premature birth: A baby is born prematurely (before 37 weeks).
• Preterm premature rupture of membranes (PPROM): The premature rupture of the fluid-filled protective sac surrounding the baby.

What are the symptoms of a `(Stillbirth)`?

Often, the only warning sign of a stillbirth is that you feel that the baby is not as active as before, or that he is struggling less. Some people may experience stomach cramps and vaginal bleeding.

Important: These symptoms do not always mean a stillbirth. However, if you notice any of these changes, you should see a doctor immediately.

How is the diagnosis made?

Most stillbirths happen before labor. Your doctor will perform an ultrasound to check for the baby's heartbeat.

What tests are done to find the cause of `(Stillbirth)`?

For some parents, knowing the cause of a stillbirth can help them cope with the pain and make up their mind. Also, understanding how something like this happened can help reduce the risk of complications in future pregnancies.

Your doctor will carefully review your medical records and the circumstances surrounding the incident. They may also examine the baby, umbilical cord, or placenta to determine the cause.

These tests may include:

• Tests for infections: Doctors will take samples of your urine, blood, or cells from your vagina or cervix to check for infections.
• Blood tests: Blood tests can show whether you have a condition related to a pregnancy complication.
• Genetic tests: The doctor will examine a sample from the umbilical cord to see if the baby has genetic problems, such as Down syndrome, which can cause stillbirth.
• Autopsy: An autopsy is a surgical procedure. It allows a doctor to examine the baby carefully to determine the cause of death. This may involve making small incisions to examine the baby's organs. In most cases, you have the right to decide whether or not to have this examination. You can also say how much of an autopsy is done.

When should I decide to perform an autopsy on my baby?

This is a very difficult decision. For some parents, the thought of an autopsy after such a heartbreaking event is unbearable. Not all insurance plans cover a baby's autopsy, so the cost is also a factor.

The biggest advantage of performing an autopsy is that it increases the likelihood of finding the cause of a stillbirth. Recent research has shown that an autopsy can increase the chance of finding the cause from as low as 20% to more than 90%. This information can help your doctor prevent complications in future pregnancies.

However, every case is different, and this is a very personal decision. Talk to your doctor to decide what is best for you.

What happens after the baby dies?

Your doctor will recommend the safest option for delivering your baby. This experience will feel like giving birth to a live baby. Your pregnancy care team will guide you and give you medication to help ease the pain.

• Inducing labor: Doctors recommend inducing labor as soon as possible after a stillbirth. If you have a medical condition, inducing labor may be best for your health. You will usually be given medication to induce labor within two days of delivery.
• Natural birth: If you want to wait a while before giving birth, that's possible too. Labor usually begins naturally within two weeks of losing the baby. However, if you choose to give birth naturally, it can be a little more difficult to perform an autopsy.
• Cesarean section / C-section:If your health condition is at risk, you may need to have an emergency C-section. However, C-sections are very rare in cases of stillbirth.

What happens after childbirth?

You have choices about how much interaction you have with your baby. There is no right or wrong feeling or response at this time.

For example, you can hold the baby in your arms if you like. You can ask for mementos, such as a lock of the baby's hair or a hospital ID tag. Many hospitals issue a birth certificate. You can also ask for the baby's hand and footprints to be included on it.

Take as much time as you need and never hesitate to ask for help from others. Having your loved ones by your side will be a great help in coping with this grief and in getting your mind back together.

Will I have milk after a stillbirth?

Milk usually comes in within a few days after delivery. Unless you have preeclampsia, you can take medications called dopamine agonists to stop your breasts from producing milk. Or, if you prefer, you can wait for the process to stop naturally. Talk to your doctor about what you think is right for you.

Is it possible to get pregnant again after a stillbirth?

Yes, it is possible. Many people have gone on to have normal pregnancies and healthy babies. If the stillbirth was caused by a congenital disability or umbilical cord problem, there is a small chance of another one. If the cause is an illness or genetic disorder, there is only a 3% chance of a stillbirth in your next pregnancy.

How long after a stillbirth should you get pregnant again?

Some studies have shown that women who wait at least a year after a stillbirth to get pregnant again have less depression and anxiety during their next pregnancy. However, being physically and mentally ready to try again varies from person to person.

Talk to your doctor about your next pregnancy.

Can stillbirth be prevented?

Most of the time, there's nothing you can do to prevent a stillbirth. It's often caused by a medical condition or complication that's out of your control. However, you can take these steps to increase your chances of delivering a healthy baby:

• Avoid drugs, tobacco, and alcohol: Drug use not only increases the risk of stillbirth, but also other complications such as fetal alcohol syndrome and sudden infant death syndrome.
• Adjust your diet: Change your diet during pregnancy. Increase your calorie intake to provide the nutrition you and your baby need, and eat nutritious foods. You should also avoid certain foods that carry the risk of foodborne illnesses.
• Maintain a healthy weight: Before getting pregnant, try to reach a healthy weight that suits you.
• Prevent infections: This includes following good hygiene practices (such as washing hands, cooking food thoroughly), and getting recommended vaccinations before, during, and after pregnancy.
• Daily "kick count": By about 26-28 weeks, become familiar with your baby's movements. Learn what is normal for your baby. If your baby is not acting normally, contact your doctor.
• Don't sleep on your back, sleep on your side: If you're 28 weeks pregnant or more, sleeping on your back can increase your risk of stillbirth. While the exact reason for this isn't clear, experts suspect it has something to do with the flow of blood and oxygen to the baby.
• Get regular checkups, ultrasounds, and/or fetal heart monitoring if needed: Regular medical checkups can help your doctor detect any conditions that may affect your pregnancy. This is especially important if you are at high risk for pregnancy complications.
• Report symptoms immediately: If you have symptoms during pregnancy, such as abdominal pain or vaginal bleeding, see a doctor immediately.

How do I take care of myself after a stillbirth?

Take as much time as you need to grieve and process after a stillbirth. Grieve in a way that feels most comfortable to you. This may include holding a funeral with friends and family who are willing to help you at this time. Or it may mean taking time to process your feelings on your own, or asking for help with childcare.

Counseling and pregnancy loss support groups are also invaluable resources at this time. No matter what stage of pregnancy you are in, you are still a mother and a father. The bond you nurtured is real. It is common to experience depression and post-traumatic stress disorder (PTSD), which require professional help to deal with such a major loss.

A stillbirth is a devastating loss. It can take time to recover from it. Remember that it is normal to feel overwhelmed at times like this. There is nothing wrong with seeking help from support groups and mental health professionals to help you through this.

If you are concerned about the risk of future stillbirth after a loss, seek advice from your prenatal care provider or a maternal-fetal medicine (MFM) specialist. They may recommend testing or genetic counseling to assess your risk. The decision to try to get pregnant again is a big one. There are experts who can advise and support you.

Finally, take-home message:

Stillbirth is a truly heartbreaking and difficult experience. It is important to be aware of this, understand the risk factors, and seek help when needed.

• You are not alone: ​​You are not the only one experiencing this kind of grief. There are places where you can find support and understanding.
• Causes are varied and sometimes unclear: Not every stillbirth has a clear cause. Don't blame yourself for it.
• Seek medical advice: Be aware of your baby's movements during pregnancy, and see a doctor immediately if you experience any unusual symptoms.
• Give yourself time to grieve: It will take time to get over this. Allow yourself to feel your emotions, and seek professional help if necessary.
• Be hopeful about the future: Many people go on to have healthy babies after a stillbirth. Talk to your doctor about your future plans.

We hope this information has helped you gain some insight into this difficult topic. If you have had a similar experience, we pray that you will find strength.

` Stillbirth, Stillbirth, Pregnancy, Baby Loss, Death in the Womb, Pregnancy Complications, Maternal Health