A stillbirth refers to the situation where there is death or loss of a baby. It can occur either during the delivery or even before the labor process has started. If you are confused about miscarriage and stillbirth, know that:
– Miscarriage – refers to the loss of a baby before 20 weeks of pregnancy
– Stillbirth – refers to the loss of a baby after 20 weeks of pregnancy.
This is further classified into early stillbirth (gestational ae between 20 to 27 weeks of pregnancy), late stillbirth (28 to 36 weeks of pregnancy), and term stillbirth (37 or more weeks of pregnancy).
The confirmation of stillbirth is done through an ultrasound.
Stillbirth can be seen in approximately 1% of all pregnancies. In the United States alone, there are about 24,000 babies that are stillborn. The advances in technology and the medical field over the last several decades have improved prenatal care, leading to the reduction of late and term stillbirth cases. However, the numbers remain similar for cases of early stillbirth. In the year 2015 globally, approximately 2.6 million cases of stillbirth occur after 28 weeks of gestation and usually occur in developing parts of the world such as Sub-Saharan Africa and South Asia.
While the exact causes of stillbirth are still unknown, the risk factors generally fall into three broad categories:
a) There could be problems with the baby such as genetic problems or birth defects.
b) There could be issues with the umbilical cord or placenta. This is important as this is how the mother and child exchanges nutrients and oxygen.
c) There could be issues with the mother such as high blood pressure, obesity, or diabetes.
Without a known cause, these cases are usually termed as an “unexplained stillbirth”. It can occur to mothers of all ages, races, or income levels. However, there are some risk factors that increase the risk of having a stillborn child such as:
Being a teenager
Being of black raceo
Being 35 years or oldero
Being a smoker even during pregnancyo
Being pregnant with multiple pregnancieso
Having other medical issues such as diabetes or high blood pressureo
Have a history of previous pregnancy loss
Not only are these factors associated with stillbirth, they are also associated with poor pregnancy outcomes. Fetal deaths are required to be reported by the state law while federal law encourages the collection and publication of fetal death data. In 2016, the National Vital Statistics Reports published a report called “Cause of Fetal Death: Data From the Fetal Death Report, 2014”.
In pregnancy, the term “quickening” refers to the movement of the baby in the uterus. It can feel like light tapping or fluttering of a butterfly. Eventually, these movements become stronger and more regular. A woman who is pregnant for the first time usually feels these movements at about 18 to 20 weeks of gestation while a woman who has been previously pregnant may feel it as early as 15 to 17 weeks.
To read more about quickening, click here!
The “kick count” is important as mothers eagerly anticipate the first movements of their baby. After quickening starts, mothers should start to count the kicks of their baby. For first time mothers, it can be hard to distinguish if it really is your baby kicking but with time, you will learn the sleeping and waking cycles of your baby and also, what triggers activity. If you are attentive to your baby’s movements, you will be able to notice significant changes. Keep count of the kicks, rolls, and jabs as these can help you identify issues and prevent stillbirth. Fetal movement counting should be recommended at 28 weeks as it can be beneficial for all pregnancies. There are many ways on how you can count your baby’s movements. The American Congress of Obstetricians and Gynecologists (ACOG) has recommended that you take note of the total time it takes for you to feel 10 movements (kicks, rolls, flutters, and swishes). It is best if you feel 10 of these movements within a 2-hour timeframe. You can use a notebook where you place a checkmark every time you feel a movement. The time should be recorded as well. Deviations from the usual pattern will alert you that something might be amiss.
Here is a great kick count chart that you can print out for your personal use!
How to Tell if Your Baby is Stillborn
Unlike diseases or conditions, you may only suspect stillbirth if you notice that your baby has stopped moving or kicking. Some women may experience cramping, pain, or vaginal bleeding. There are many patients who rush into the emergency room after noticing that their baby is no longer moving as actively according to the kick count chart. It can be a very useful tool although it may seem trivial. Once you seek medical attention, your doctor will use an ultrasound to check the baby’s heart to see if he or she is suffering from any distress.
Options if Your Baby is Stillborn
Once it has been established that your baby is stillborn, your doctor will have to discuss the options for delivery with you. It will depend on when and how you prefer to deliver your stillborn child, taking into account any medical condition you have. You will be given some time to discuss with your partner or family members if needed. In some cases, immediate delivery is necessary for medical reasons, but it is often safe to wait for you to go into labor by yourself. After the baby’s demise in the womb, labor usually starts spontaneously approximately two weeks later. Your options may include:
Your doctor will provide you with medication or break your amniotic sac to induce labor. In most cases, women often want their labor to start as soon as they have learnt about their baby’s death. Women who prefer to wait for natural labor and has not started on its own after two weeks, labor will be induced to prevent blood clots from happening.
This is a surgical procedure where the cervix is dilated, and the baby and other tissues are removed from the uterus. This method limits the information that your doctor can obtain as to why your baby is stillborn. (Autopsy cannot be performed).
This is also another option where an incision is made in your abdomen and uterine wall to deliver the baby.
In most cases, the mother and family members are allowed to spend time with the stillborn child. There are also some hospitals that help by making mementos such as preserving a lock of hair or making a mold of the baby’s footprint. Photographs can also be allowed if the mother wants to.
Some of the tests after the stillborn child is delivered may include amniocentesis, autopsy, genetic tests, review of your medical history, review of your family’s medical history, and more. If the stillbirth is due to a genetic condition, a genetic counselor will help you understand the condition and the likelihood of having another stillborn baby. However, most women will continue to have a healthy pregnancy after having a stillbirth.