Still birth: Causes and where to go next

What is stillbirth?

Stillbirth is the death of a baby after 24 weeks of pregnancy before or during birth. Losing a baby earlier than this in pregnancy is classed as a miscarriage.

What causes stillbirth?

In many cases when a baby is stillborn, the cause cannot be identified. This can be particularly challenging for grieving parents who want to know a reason for their baby’s death. A post-mortem may be able to provide some information about the reason for the death, but not always. A recent report (2018) found that around 35.5% of stillbirths were unexplained.

There are some reasons that can be identified as the cause for stillbirth, the most common ones are listed below.

Complications with the placenta

This is a common reason, with 32.5% of stillbirths being linked to a problem with the placenta. The placenta is responsible for providing baby with oxygen and nutrients for growth and development. If the placenta isn’t working effectively, this can lead to baby’s growth and development being restricted.

Placenta Abruption

Another complication that can occur that can lead to a stillborn is if the placenta detaches (either fully or partially) from the lining of the mothers uterus. This can then restrict oxygen to the baby. A placenta abruption is an emergency situation, the signs to look out for are…

• Vaginal bleeding

• Abdominal pain, that doesn’t come and go in waves like contractions

• A hard bump even in between contractions.

• A bump that is sore to touch

• Blood coloured waters if your waters break.

• Reduced movements

• Fainting or feeling dizzy

• Continuous back pain

Any of the above you should seek medical attention immediately.

Infection

4.2% of stillbirths happened because of an infection in the uterus.

Some other conditions linked to stillbirth are pre-eclampsia, high blood pressure, intrahepatic Choleostasis (or obstetric choleostatsis) or diabetes (both pre-exisiting and gestational diabetes.)

In around 10% of stillbirths the baby has a genetic, physical defect.

Factors that increase the risk of stillbirth are;

• multiple pregnancy – carrying twins, triplets or more

• age – being younger than 21 years or older than 35 years

• smoking

• obesity – having a body mass index (BMI) of more than 30

Stillbirth and Reduced Movements 

If there is reduced movement of your baby, immediately contact your maternity triage or place of birth, do not wait till next day. You should be told in your pregnancy of the number to call for this, it should be written on the front of your notes. Reduced baby movements were noticed in around 55% of stillbirths. Reduced movements are not the cause of stillbirth but it could be a sign that something is wrong.

How common is a stillbirth?

Sadly, it happens in around 1 in 225 of pregnancies in the UK (2020).

How is stillbirth diagnosed?

A stillbirth is diagnosed by ultrasound scan. This is often done if the midwife can’t hear baby’s heart rate on a heart rate monitor or sonic aid.

Things that are shown to reduce the risk of stillbirth

• Stop smoking

• Sleeping on your left side in the 3rd trimester

• Attending your midwife appointments

• Avoid alcohol and don't take drugs

• Keep to a healthy weight

• Avoid taking risks 

• If you experience abdominal pain during pregnancy seek immediate medical help

• Be aware of your baby's movements

Preparing for birth with a stillborn baby

Being told about the death of your unborn baby is extremely heartbreaking, overwhelming and often feels too hard to believe. After finding out that your baby has no heartbeat, you will be offered the opportunity to go home, spend some time to prepare for your birth and gather some support from family and friends should you wish. 

When you are at home, gather your hospital bag. Although this is very upsetting, bring something for baby too, such as a baby grow or cuddly toy. Hospitals will have knitted clothes for your baby in various sizes as well.

Usually, if a baby dies in the womb prior to labour, you will be advised to be induced. This is usually done by inserting a pessary, or gel into the vagina, sometimes a tablet can be given. You can often go home during the first step of the induction. If the pessaries/tablet don’t start labour, a hormone drip will be used to encourage your contractions.

Your obstetrician will speak to you about all your options, including awaiting labour to start by itself, an induction and a cesarean birth, considering your wellbeing as well as your recovery.

After the birth 

What happens after baby is born depends on what you want as parents. Some parents want to hold their baby and to have mementos such as photos, a lock of hair or hand and foot prints; others prefer not to see their baby.

You will be given a lot of support both during labour and afterwards. There may be a midwife at the hospital who specialises in bereavement counselling, or the hospital may have a bereavement support worker who can help you get through the practicalities of what happens next.

Post-mortem

You will be asked if you want your baby to have a post-mortem – a detailed medical examination of the baby. This may be able to tell you a reason why your baby was stillborn.

Even if a definite reason isn’t found it may rule out certain causes, such as infection and give information on how your future pregnancies should be supported.

The results of a post-mortem can take several weeks and your bereavement midwife, or doctor should discuss the results with you, giving you the opportunities to ask questions.

Registering a stillbirth

Stillbirths in England and Wales must be registered with the Registrar of Births, Marriages and deaths within 42 days. This can often be done at the hospital or you may need to go to the local register office. In Scotland a stillbirth must be registered within 21 days. In Northern Ireland you have up to one year to register a stillbirth.

Arranging the funeral

The hospital can arrange a funeral, burial or cremation free of charge, or you may choose to organise this yourself.

Coping emotionally

The grief of losing a baby can be traumatic and intense. It can bring up many different emotions and feelings that may be overwhelming and frightening. It is important to know that however you are feeling is normal as everybody experiences grief differently. It is important to remember too that as well as having such a big loss, you will be experiencing hormone changes that come for the next few days/weeks after giving birth.

Talking to your partner or your bereavement midwife may help you to understand the way you are feeling or help you feel less alone. As time passes, you may feel like accessing counselling beneficial, either by yourself or with your partner. Many parents find comfort in talking to other parents who have been through the same. It allows you to be able to talk openly and honestly knowing that other couples most likely have felt the same.

If you would like some support, then have a look at the Tommys Website**, where they have lots of stories from families who have experienced similar to you, support groups and information that may help you navigate your way through grief.

 ** https://www.tommys.org/baby-loss-support

Coping physically

During the weeks after a stillbirth your body itself will be constant reminder of your loss and this can be very distressing.

You'll have vaginal bleeding and your breasts will produce milk, your doctor will be able to help you with these physical changes.

Getting pregnant after a stillbirth

Trying for another baby is something that some women want to do almost immediately, while others put off making the decision for some time. The important thing is that physically you have recovered from your birth and mentally you feel ready, before you become pregnant again. Once you have decided that you want to become pregnant again you should discuss the reason (if known) for the stillbirth with your healthcare providers. After a stillbirth you will be monitored more closely through future pregnancies and births.

For help and support, visit SANDS (the Stillbirth & Neonatal Death Charity)

For more information on registering a stillbirth, getting financial support and taking time off work, visit Gov.UK