What to know about stillbirth

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Although stillbirth and miscarriage both describe a pregnancy loss, doctors define the loss according to when it occurs. A loss before the 20th week of pregnancy is a miscarriage, while a loss beyond this point is a stillbirth.

According to the Centers for Disease Control and Prevention (CDC), 24,000 stillbirths occur in the United States each year, which translates to 1 in 160 births.

There are three categories of stillbirths:

• Early: An early fetal death happens between the 20th–27th week of pregnancy.
• Late: A late fetal death happens between the 28th–36th week of pregnancy.
• Term: A term fetal death happens in the 37th week of pregnancy or beyond.

Doctors do not always know why stillbirth occurs, but the most common causes include:

• Pregnancy and labor complications: These complications account for nearly one-third of stillbirths. Complications may involve preterm labor, pregnancy with twins or triplets, and separation of the placenta from the womb. The placenta provides oxygen and nutrients to the baby.
• Placental problems: Problems with the placenta, such as a lack of blood flow to the organ, occur in nearly one-quarter of stillbirths.
• Developmental abnormalities: More than 1 out of every 10 stillbirths may be due to genetic or structural disorders in the fetus.

• Infection: More than 1 of every 10 stillbirths is due to an infection in the fetus, the placenta, or the pregnant person.
• Umbilical cord problems: These issues may account for around 1 in 10 stillbirths. For instance, the cord may become knotted, which cuts off oxygen to the fetus.
• High blood pressure: Forms of hypertension can contribute to stillbirths, chronic high blood pressure, and preeclampsia, which is the condition involving high blood pressure relating to pregnancy.
• Medical conditions in the pregnant person: In fewer than 1 in 10 cases of stillbirth, research has suggested that an underlying condition, such as diabetes, has been the cause.

Risk factors for stillbirths in the U.S. include the baby being smaller than average, along with the following characteristics of the person who is pregnant:

• a medical history of obesity, diabetes, or high blood pressure
• pregnancy with twins or triplets
• the first pregnancy
• a history of past stillbirths
• pregnancy with assistive reproductive technology, such as laboratory fertilization of an egg with a sperm
• pregnancy in a person older than age 35 years
• a history of smoking tobacco or cannabis or the use of illegal drugs

According to the Star Legacy Foundation, a nonprofit organization dedicated to reducing neonatal death and improving care for families who experience it, stillbirths occur more commonly among Black and Native American families.

Many of the results of health inequity are also risk factors of stillbirth and other poor pregnancy outcomes. These factors include:

• limited access to healthcare
• having little or no prenatal care
• a history of stress or trauma
• racism

One of the main signs is not being able to hear a heartbeat with a stethoscope or ultrasound scan. But each person’s experience of stillbirth can be different.

Other potential symptoms of stillbirth include:

• spotting
• bleeding
• decreased fetal movement

Many other conditions can lead to these symptoms. As a result, it is important to discuss them with a doctor in order to understand what the cause could be.

Learn more about spotting and its causes here.

Doctors typically use an ultrasound before delivery to find out if the baby’s heart is beating. An ultrasound is an imaging test that uses sound waves to create a picture.

After delivery, babies are stillborn if they:

• have no heartbeat
• are not breathing
• make no voluntary movements
• have no pulsations in the umbilical cord

The methods that doctors use to deliver stillbirths include:

• waiting until the pregnant person goes into labor
• dilating the cervix and using instruments to take out the baby
• induction of labor using medications that open the cervix and make the uterus contract

In some cases, doctors may use cesarean deliveries for a stillbirth. A small 2017 study reviewed the charts of 611 people who had a single stillbirth at or after 20 weeks of pregnancy. It found that around 15% had a cesarean delivery.

The authors noted that experts have linked cesarean deliveries of stillbirths with a potential for illness in the pregnant person. For this reason, they urged limiting the procedure to unusual circumstances.

Stillbirth is often a very difficult event for people. One of the hardest aspects is the emotional stress that it can cause. In the process of recovery, a person may go through the following stages:

• Stage 1: Symptoms include numbness, shock, confusion, and denial.
• Stage 2: Symptoms include searching, anger, guilt, and yearning.
• Stage 3: Symptoms include depression, withdrawal, disorientation, or low energy.
• Stage 4: This final stage involves reorganization or resolution.

Although it can be a difficult process, there are certain steps that people can take that may help them. These include:

• holding and touching the baby
• keeping a memento of the baby, such as a photograph or footprint
• learning more about why it happened

A member of the hospital staff should be able to bring parents their baby in a blanket so that they can spend some time with them. This can help with acceptance and provide a tangible memory of their child.

Learn more about grief and how to cope here.

A stillbirth can be very traumatic, and it can have a significant impact on people’s health and well-being. It can be helpful for a person to seek support in the weeks and months that follow.

To manage the grief and depression that can follow a stillbirth, the American College of Obstetricians and Gynecologists recommends joining a peer support group or getting help from a mental health professional or bereavement counselor.

Below are some bereavement support sources:

• The Compassionate Friends
• Share Pregnancy and Infant Loss Support
• International Stillbirth Alliance
• First Candle
• Star Legacy Foundation

Most individuals who become pregnant after a stillbirth have a healthy baby, according to the National Institutes of Health (NIH).

But the NIH notes that people who have a stillbirth have a higher risk for having another stillbirth. Those with a previous history of stillbirth are 2–10 times more likely to have a stillbirth than those who have not had one.

If a family decides to try again to have a baby after a stillbirth, the NIH recommends that they first discuss it with their healthcare professional. A doctor might be able to recommend certain precautions to reduce the risk.

While the causes of many stillbirths are unknown, the below measures can increase the likelihood of having a healthy baby:

• quitting smoking
• reaching or maintaining a moderate weight
• abstaining from the use of illegal substances
• getting high blood pressure and diabetes under control

According to the Star Legacy Foundation, 25% of all stillbirths in the U.S. are preventable today. This figure rises to 47% of stillbirths after 37 weeks of pregnancy.

Many factors related to health inequity and racism — such as a history of stress or trauma and poor access to care — increase the risk of stillbirth occurring. As a result, taking steps to reduce structural racism could help prevent stillbirth for hundreds of families.

Learn more about health equity here.

Stillbirth is when a baby passes away before or during delivery. Doctors typically detect stillbirth if the baby’s heart stops beating, either using a stethoscope or ultrasound scan.

People who have a stillbirth have a higher likelihood of having another one. Despite the increased risk, they can be encouraged to know that most individuals who become pregnant following a stillbirth have a healthy baby.

For those who experience stillbirth, many resources are available to provide support and help people to navigate the grief that comes with this traumatic event.