Stillbirth
Stillbirth is the death of a baby in late pregnancy or during birth. Which week the term starts from is defined differently from country to country — usually…
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Stillbirth is the death of a baby in late pregnancy or during birth. Which week the term starts from is defined differently from country to country — usually after the twenty-second or the twenty-fourth week, with the word miscarriage or late foetal loss used before that point. The difference in wording concerns paperwork and statistics, not what has happened to you. This page is written both for anyone who is pregnant and wants to know what to watch for, and for anyone this has already happened to.
When to make contact immediately
The one sign a woman notices before anyone else is her baby's movements. Not the number of them: there is no rule of ten a day, and every baby has its own usual pattern. What counts is a change.
Ring the maternity unit or your doctor straight away, at any hour of the day or night, if:
- the baby is moving less than usual, or differently from usual;
- the movements have stopped;
- vaginal bleeding has started or you have abdominal pain;
- your waters have broken or you are leaking fluid;
- severe itching has appeared, particularly on the palms and the soles;
- your blood pressure has risen sharply, your face and hands have swollen, or you have a headache with disturbed vision;
- you have a temperature, or you have simply become very unwell all of a sudden.
Do not wait until morning, do not wait for your booked appointment, and do not try to rouse the baby with cold water, something sugary or lying on your side. Those methods test nothing and only use up hours. Nor should it weigh with you that you rang earlier the same week: coming back about the same thing is entirely ordinary.
You will not be making a fuss over nothing or taking up anyone's time. Maternity units are open around the clock for exactly these calls, and they would far rather check ten women who turn out to be fine than miss one. Reduced movements come to nothing in most cases — which is precisely why checking is cheap and not checking is expensive.
How it is confirmed
The heartbeat is listened for first with a hand-held device, and then an ultrasound scan is always done: only the scan gives the answer. If necessary a second doctor is asked to confirm it.
Sometimes a woman still feels movement afterwards. That happens when you shift position and does not mean a mistake was made; if the doubt stays with you, ask for the scan to be repeated. It is a reasonable request and it is not refused.
Hearing this is unbearable, and no amount of preparation protects anyone from it. If you are alone in hospital, say so and ask the staff to call whoever you want beside you. You are entitled to make no decisions at all in the first hours. Whatever is said to you next is worth asking to have repeated later, or writing down: at a moment like that almost nothing stays in the memory, and that is to be expected.
What happens next
The baby has to be born, and how that is done is discussed with you rather than decided over your head.
- Most often labour is induced with medicine. For the woman this is safer than an operation and leaves better conditions for future pregnancies.
- A caesarean is rarely used, only where there is a separate reason for one.
- If nothing is threatening your health, there is usually time to wait: sometimes several days, sometimes going home first. The decision does not have to be made within the hour.
- Labour is induced at once if there is severe pre-eclampsia, infection, bleeding, or if the waters have broken — here it is your own safety at stake.
- Waiting a long time has a cost on the other side: the more time passes, the harder it becomes to establish a cause afterwards, and the more the baby's appearance changes. You will be told this plainly so that you choose knowing it.
The same pain relief is available as in any birth, epidural included, and there is no need to feel awkward asking for it. You can choose who is with you and ask for a separate room; most hospitals make provision for this. Ask about anything you do not follow, as many times as you need to.
Time with your baby, and decisions only you make
After the birth, parents are usually offered the chance to see their baby and hold him or her. That is your decision, and there is no right answer. Some want time with their baby, some do not, and some refuse at first and change their minds later — that too is normal, and you can ask afterwards.
Photographs are usually offered as well, along with a hand or foot print, a lock of hair, or keeping the blanket. If you do not know whether you want any of it now, ask for the mementos to be kept at the hospital: you can collect them a year later. Many parents are glad afterwards that it was done, but the opposite decision is not a mistake either.
You can give your baby a name. Some parents do and some do not.
One thing is worth knowing in advance, because it is rarely mentioned: a few days after the birth your milk may come in. It is hard physically and harder still in every other way. There are medicines that stop lactation — they do not suit everyone and a doctor prescribes them; you can also let the milk dry up on its own, with a firm supportive bra and cold compresses. Ask about this before you are discharged, rather than waiting for it to start at home.
Registration and everything to do with saying goodbye and with the funeral are arranged differently in different countries. The hospital is obliged to explain the procedure and help with the paperwork; ask specifically what time limits apply where you are and what can be left until later.
Why it happens
The causes found most often are:
- the placenta failing to work properly — the largest single group, which also takes in placental abruption;
- restricted growth of the baby, usually with that same placenta behind it;
- pre-eclampsia and other conditions involving raised blood pressure;
- problems with the umbilical cord;
- an infection in the mother that reaches the baby;
- intrahepatic cholestasis of pregnancy, the condition that causes severe itching;
- diabetes, including diabetes that was never picked up before the pregnancy;
- chromosomal and congenital conditions in the baby.
What can be found out, and why there is not always an answer
To look into it, investigations are offered: blood tests, cultures and tests for infection, examination of the placenta, cord and membranes, and genetic testing. A post-mortem — an examination of your baby's body — is offered separately. It is not carried out without your written consent, and you may decline it or choose a limited version: external examination only, imaging only, or examination of the placenta only. The doctor has to explain what each option would give you.
Whether to agree is yours to decide. For many families it matters that the results can change how a future pregnancy is managed; for others it matters more not to put their baby through it, and that is respected too.
The cause is not always found. Even after a full set of investigations, a noticeable proportion of families are left without an answer. It is the hardest thing to be told and the thing people live with longest. But the absence of an answer means precisely one thing: medicine cannot yet explain every case. It does not mean that anything was missed by you.
And this is worth saying outright, because nearly everyone thinks it: this was not your fault. Not a heavy bag, not an argument, not the drink you had before you knew you were pregnant, not noticing the quietness late. None of these kills a baby. Going back over the last weeks looking for your own mistake is an ordinary part of grief, not a conclusion the doctors have reached.
Grief keeps no timetable
There is no correct order for the feelings here. There can be numbness instead of tears, there can be anger, there can be a sense that the body is no longer there. It can be worse a month on than it was in the first week, because life around you has gone back to normal and yours has not.
A few things that get said less often:
- The other parent is grieving too, often silently and often on a different clock. Rhythms that fail to match are not a sign that one of you feels it less.
- Older children are told simply and truthfully, in your own words, without the death being swapped for "gone to sleep" or "gone away".
- People will say unfortunate things, "you're still young" among them. Behind it is usually awkwardness rather than indifference, but you are under no obligation to sit through it.
- Dates — the due date, the anniversary, a birth elsewhere in the family — weigh more than ordinary days, and that is not a relapse.
Help can be sought at any point: a week later, six months later, several years later, and again even if you asked once before. There is no deadline after which it is "too late" or time to "manage on your own". Some things are better not left, though: if insomnia will not lift, if you cannot eat or work, if intrusive memories of the birth keep returning, if thoughts come that life is not worth living, tell a doctor at once. These are conditions that are treated.
Ask your own doctor or the maternity unit what support services and parents' groups exist where you live: many hospitals have a member of staff whose work is exactly this, and the same person helps with the paperwork. Talking to other parents who have been through it helps a great many people, though not everyone, and choosing not to try it is fine.
A future pregnancy
This question comes up early, sometimes unexpectedly early, and it is best worked through with a doctor.
As a rule there is no medical interval you "have to wait": it depends on how the birth went, what the investigations showed and how you feel. Physical readiness and emotional readiness rarely arrive together, and that does not make either of them wrong.
What usually happens before and during a next pregnancy:
- an appointment a few weeks after discharge, going through the results and anything you want to ask; write the questions down beforehand, because they scatter once you are in the room;
- if a cause was found, treatment or monitoring for it is arranged before conception;
- care from the very start of the pregnancy, more frequent scans, checks on the baby's growth and on your blood pressure, and further tests if needed;
- an arrangement agreed in advance: where and whom to ring at the slightest doubt about movements, without waiting for an appointment;
- a conversation about timing the birth as the pregnancy nears its end.
For most families the next pregnancy ends well, although the risk does stay above average. It is worth knowing separately that it is almost always an anxious one, particularly as it approaches the stage of the earlier loss. That can and should be discussed with your doctor: anxiety here is not an obstacle to good care but part of it.
Online consultation
Remotely, a doctor can go through the results of the investigations and put them in plain words, if a great deal was left unclear after discharge, help you prepare questions for a face-to-face appointment, and point you to the support services available where you live. The same appointment can cover preparing for a future pregnancy: what is worth checking beforehand and how the monitoring will be organised. If you are pregnant now, an online consultation suits unhurried questions about how the pregnancy is going and what to keep an eye on — but not worry about movements. Changed or absent movements, bleeding, abdominal pain and leaking fluid are not assessed remotely: for those you ring the maternity unit straight away or call an ambulance (in Europe, the single number 112).
This material is for information only and does not replace medical advice.
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Discuss your symptoms and possible next steps for Stillbirth with a doctor online.
