Stillbirth

Page last reviewed: 13/07/2011

A stillborn baby is a baby who is born dead after 24 completed weeks of pregnancy. If a baby dies before 24 completed weeks and weighs less than 500g, it is known as a late miscarriage.  

Stillbirth is much more common than many people think. In Ireland, around 360 stillbirths are registered every year  and one in every 200 births ends in a stillbirth. Stillbirth is 10 times more common than infant cot death.

What causes stillbirth?

In many stillbirths, the direct cause of the baby's death cannot be established, although it is possible to identify conditions associated with the death through a post-mortem examination or autopsy.

Help and support

Stillbirth represents a significant and complex bereavement and may have profound and devastating effects on the parents, their other children and their wider family. The hospital bereavement team will provide support at the time and offer subsequent follow up. Counselling support should also be offered some time after hospital discharge to help parents to work through difficult aspects of the grieving process.

 

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Stillbirths deserve to be investigated in the same way as adult deaths.  The best way to investigate stillbirths can be controversial and is influenced by many factors – including the family’s beliefs, concerns about autopsy, availability of specialists, and by lack of research and agreed protocols of investigation.

Unexplained stillbirths make up anywhere from 20 to 50% of all stillbirths, but sometimes a death called unexplained is actually one that has not been investigated fully.

Some conditions that can cause stillbirth or may be associated with stillbirth include:

  • ·Bleeding (haemorrhage): before or during labour

·Problems with the placenta (afterbirth)

  • the placenta can separate from the womb before the baby is born (placental abruption),
  • the placenta can fail to provide the baby with enough oxygen and nutrients which means that the baby does not grow properly (intra-uterine growth restriction is associated with one-third of all stillbirths)

A problem with the umbilical cord

  • the cord can slip down through the entrance of the womb before the baby is born (known as cord prolapse and it occurs in about 1 in 200 births)
  • the cord can wrap tightly around the baby's neck – however this is also noted in many deliveries of liveborn infants

Pre-eclampsia: a condition that can cause high blood pressure in the mother; mild pre-eclampsia can affect up to 10% of first time pregnancies and more severe pre-eclampsia can affect 1-2% of pregnancies

A  physical abnormality in the baby – this may be isolated but severe or there may be multiple abnormalities.  The cause of these problems may be unknown or may be part of a genetic or chromosomal syndrome. Around 6% of stillborn babies will have a chromosomal abnormality.

Abnormalities of blood clotting in the mother, leading to an increased tendency to form thrombosis (clot).  These conditions are associated with an increased risk of placental problems, pre-eclampsia and pregnancy loss.

A liver disorder in the mother called obstetric cholestasis which occurs in 1 in 200 pregnancies

Diabetes in the mother,

Infection in the mother that also affects the baby .  Infection can either ascend from the vagina into the womb (uterus) or it can be passed from the mother to the baby through the placenta. Examples include:

  • Cytomegalovirus: a common virus from the herpes family of viruses that often causes few symptoms in the mother
  • Leptospirosis: a bacterial infection that is caught from animals such as cows, pigs and rats
  • Listeriosis : an infection that usually develops after eating food that has been contaminated by bacteria called Listeria monocytogenes; it may cause vomiting and diarrhoea
  • Parvovirus B19: which causes slapped cheek syndrome, a common childhood infection
  • Rubella (German measles): this is rare because most pregnant women have had the MMR vaccine to protect against rubella
  • Influenza: it is recommended that all pregnant women have the seasonal flu vaccine irrespective of their stage of pregnancy
  • Toxoplasmosis: an infection caused by a parasite that is found in soil and cat faeces

Increased risk

There are a number of factors that increase your risk of having a stillborn baby. They are:

  • having twins or a multiple pregnancy - see risks in multiple pregnancy for more information
  • being younger than 20 years of age
  • being over 35 years of age
  • having diabetes, high blood pressure or a blood-clotting disorder
  • being a smoker: see why should I stop smoking if I'm pregnant?
  • eing obese: having a body mass index (BMI) of over 30

Why smoking is a risk

When you smoke, your blood is unable to carry as much oxygen as usual. This means that smoking while you are pregnant will adversely affect your baby’s development. The reduction in the amount of oxygen in your blood is likely to result in your baby’s growth being restricted, and smaller babies are at greater risk of illness and of being stillborn.

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Most stillbirths happen before labour starts and can be detected with an ultrasound scan. An ultrasound scan uses high-frequency sound waves to create an image of your baby, which will show whether or not your baby's heart is beating. 

If your baby's heartbeat cannot be found, a doctor will usually be asked to give a second opinion. There may also be other signs to suggest that your baby has died.

Sometimes, after the baby's death has been confirmed, a mother may still feel her baby moving. This is called passive fetal movement and can happen when the mother changes position. Sadly, it does not mean that the baby is still alive.

Finding out that your baby has died is devastating. The healthcare professionals who are with you should offer you support and explain your options to you.

Induced labour

If a baby dies before labour starts, labour is nearly always induced (started by using medication). This is because labour is safer for the mother than having a caesarean section (see below).

It may sometimes be necessary to induce labour immediately. This is usually the case if the:

  • mother has severe onset pre-eclampsia: a condition that causes high blood pressure in the mother and can lead on to life –threatening complications such as liver or kidney failure, clotting abnormalities or seizures
  • mother has a life-threatening infection: which makes her immune system (the body's natural defence against infection and illness) overreact, causing blood clotting and widespread failure of her other organs
  • the bag of waters around the baby (the amniotic sac) has broken

If the mother is otherwise healthy, labour can be delayed for a little while if that is what the mother prefers.

The labour is induced by inserting a pessary (tablet), or gel, into the vagina, or by swallowing a tablet. Sometimes, medication is given through a drip into the mother's arm. About 9 out of 10 women will give birth within 24 hours.

Caesarean

In a very few cases, a caesarean section will be necessary. A caesarean section is a surgical procedure where the baby is delivered through a cut in the mother's lower abdomen.

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After a stillbirth the parents will be sensitively supported and guided in making decisions that are right for them and for their family. This includes choices regarding seeing and holding their baby for the first time, spending quiet time together and involving other family members.

The bereavement team will help with creating mementos such as photos and footprints for the parents to keep. You will also receive information and advice on the paperwork required for registering the stillbirth.  Pastoral care will be offered and support given with organising services and funeral arrangements, respecting parents wishes at all times. You may meet a bereavement nurse or midwife who will help to coordinate your care and provide ongoing support following discharge.

The traumatic nature of stillbirth loss means that some parents will benefit from bereavement counselling. You may meet a social worker/counsellor during your time in hospital or alternatively receive an appointment invitation in the weeks or months following discharge. You can also speak with your midwife or GP to assist with organising counselling.

Finding the cause

The baby's mother will be offered some tests that might find the cause of the stillbirth.

These include:

  • blood tests: which may show that the mother has pre-eclampsia, obstetric cholestasis, thyroid disease or diabetes
  • testing for infections: a sample of urine, blood or cells from the vagina or cervix (the neck of the womb) can be tested

There are also tests that can be carried out on your baby to try to establish the cause of death or any conditions that might have contributed to your baby's death.

Finally, analysis of the placenta, cord and membranes is always recommended. This includes a detailed pathological examination as well as sending samples of these tissues for chromosomal and genetic testing.

Post-mortem

A post-mortem is an examination of your baby's body and is undertaken by a specialist doctor called a perinatal pathologist. The examination can provide more information about why your baby died, which may be particularly important if you plan to become pregnant in the future.

A post-mortem cannot go ahead without your written consent and you will be asked if you want your baby to have one. The procedure can involve a number of tests, such as examining your baby's organs in detail, looking at blood and tissue samples and carrying out diagnostic genetic testing to see whether your baby has a genetic disease.

The healthcare professional who asks for your consent will explain the different options so that you can decide whether you want your baby to have a post-mortem and, if you do, which tests you want the perinatal pathologist to carry out.

Registering a stillbirth

By law, all babies who are stillborn after 24 completed weeks of pregnancy or who weigh more than 500 grams must be registered within a year. Registering a stillbirth gives the parents an opportunity to acknowledge their baby's birth. It is also important for statistical records. For more information on registering a stillbirth see www.citizensinformation.ie

Breast milk

After a stillbirth, the mother’s body may start producing breast milk. This can cause discomfort and distress.

Medicines called dopamine agonists are very effective at stopping your breasts from producing milk. However, dopamine agonists are not suitable if you have pre-eclampsia or some other medical problems. Some mothers prefer to let their milk supply dry up without medication. Your doctor or midwife will be able to advise on natural methods to support this process.

 

Breast milk

After a stillbirth, the mother’s body may start producing breast milk. This can cause discomfort and distress.

Medicines call dopamine agonists are very effective at stopping your breasts from producing milk. They cause few side effects and may also help you feel better emotionally.
However, dopamine agonists are not suitable if you have pre-eclampsia (a problem with your placenta).

Some mothers prefer to let their milk supply dry up without medication. Your doctor or midwife will be able to discuss your options with you.

Page last reviewed: 13/07/2011

Some stillbirths remain unexplained - that is, the babies appear to be perfectly healthy and no cause for the death can be found after all the tests are done.  Scientists still do not know why these babies die and much more research is needed.

There are some things that you can do to improve your health and reduce your risk of having a stillborn baby

These include:

  • stopping smoking (if you smoke): smoking increases the risk of stillbirth
  • avoiding drinking alcohol while pregnant: alcohol can seriously affect your baby's development and increases the risk of miscarriage during the first three months
  • avoiding recreational drugs: illegal drugs, such as cannabis, cocaine, ecstasy and heroin, can harm your baby
  • monitoring your baby's movements (see below)
  • reporting any tummy pain or vaginal bleeding that you have
  • protecting yourself against infections
  • attending all your antenatal appointments

Your weight

Obesity (a body mass index of over 30) is a risk factor for stillbirth. You can check your BMI using the healthy weight calculator. However if you’re pregnant the calculator may not be accurate so you should consult your midwife or doctor instead.

The best way to protect your health and your baby's wellbeing is to achieve a healthy weight before you become pregnant. By reaching a healthy weight, you cut your risk of all the problems that are associated with obesity in pregnancy. If necessary contact your GP for advice about how to lose weight.

If you're obese when you become pregnant, you should discuss with your midwife or GP how much weight you expect to gain during the pregnancy.

Eating healthily and activities such as walking and swimming are good for all pregnant women. If you were not active before becoming pregnant, you should consult your midwife or doctor before starting a new exercise programme while you're pregnant.

Monitoring your baby's movements

You will usually start feeling some movement between weeks 18 and 22 of your pregnancy. Every baby has its own pattern of movements and around this stage of your pregnancy you will start to get to know your baby's movements.

At each antenatal appointment, a midwife will talk to you about the pattern of movements. A change, particularly a reduction in movements, may be a warning sign that your baby needs further monitoring.

After week 28 of your pregnancy, you should contact your GP or the hospital immediately if, compared to normal movements for your baby, you notice that:

  • there has been a continuous decrease in movements over several days
  • there is a big decrease in your baby's movements
  • your baby has stopped moving completely

Avoiding certain foods

There are some foods that you should not eat during pregnancy and some extra precautions that you should take for you and your baby's wellbeing.

For example, you should not eat some types of fish or cheese, and you should make sure that all meat and poultry is cooked thoroughly.

Attending antenatal appointments

During your antenatal appointments, your midwife and doctor, as well as your GP will monitor the development of your baby. They will monitor your baby's growth and position.

Will a stillbirth affect future pregnancies?

If another pregnancy is an option, your postnatal check up or your appointment to discuss your baby’s post-mortem results are both good opportunities to ask for advice about future pregnancies.

After a stillbirth, women are usually monitored more closely during all future pregnancies and births.

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A stillbirth can be emotionally traumatic for both the mother and father. Parents may experience many difficult feelings such as guilt, depression or anxiety following the loss of their baby. Each parent will grieve in his or her individual way, which may cause misunderstandings between them. These reactions are very understandable but with time and support, the pain of the loss gradually lessons.

Public health services

For many parents attending their GP or Public Health Nurse - with whom they may have an ongoing relationship - may provide the support they need. Alternatively these health professionals can help you access other relevant supports.

Counselling

Some parents may choose to use bereavement counselling to assist them in the grieving process or their GP or midwife may recommend it depending on their circumstances. This gives you an opportunity to talk to a trained professional about how you and your family are coping with the loss.  Counsellors are trained to provide a sympathetic space to help you express you grief and distress. They assist you in making sense of your difficult feelings and in finding helpful ways of coping for you and your family members.

The hospital bereavement team

The hospital chaplain, the bereavement midwife or the social work/counselling service remain available to offer support, organise check up appointments or advise you in getting the help you need.

Support groups

Many parents find that talking to others who have experienced the death of their baby through stillbirth to be the most valuable form of support for them.

Feilacain (http://www.feileacain.ie/) and A little Lifetime Association (www.islands.ie) offer information and support to those affected by the death of a baby during pregnancy or soon after.

Special memories packs, memorial gardens, remembrance services and books of dedication are all possible ways of honouring stillborn babies and marking their short lives.

 

Content provided by NHS Choices www.nhs.uk and adapted for Ireland by the Health A-Z.

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