The creation of human life is one of the complex and shockingly beautiful things our bodies are designed to do. The micro-anatomy that goes into this complex task is so astonishingly complicated that it's a miracle any of us walk around at all. And yet, most of us do. Most...but not all.
When a baby dies, we are fragmented. Shattered, we must pick up the pieces and put them back together as we pay tribute to our children, our tables forever missing one, our families incomplete, our treasures in heaven, our babies alive only in our hearts.
It is through our stories that they live forever. These children were here and they mattered. They were loved. They are loved.
Stillborn, but born still.
Maybe it is that simple.
Stillbirth is defined as fetal death after 20 weeks of pregnancy. Stillbirths happen in approximately one in every 160 pregnancies, at seemingly random times. Stillbirth is used as a distinction between the miscarriage or live birth.
Losing a baby to stillbirth is a tragic and tender time when all hopes and dreams are born, only for those hopes and dreams to be shattered upon delivery. The body recovers from the birth, but the heart is forever injured.
How is Stillbirth Diagnosed?
Most stillbirths occur prenatally - stillbirths are relatively infrequent during labor and delivery. Often a woman notices her baby is not moving as usual and may suspect that something is wrong.
Once a woman suspects that there is something wrong and calls her doctor, a fetal death is confirmed (or denied!) via ultrasonography. Sometimes, these images may explain what caused the stillbirth.
What Happens After Diagnosis?
After it's determined that the fetus has, in fact, died, the health care team will work with the woman to discuss options for delivery. Some women may, for medical reasons, need to deliver immediately.
If not medically necessary, couples are often given the option of when they want to deliver their baby - waiting for labor does not usually pose any problems for the mother.
A couple can wait to go into labor naturally with their baby; labor usually begins within 2 weeks of a stillbirth. If labor does not begin within two weeks, most doctors push to induce their patients because there is a risk of blood clots for the mother after that time.
Most couples, however, opt to have labor induced after they've learned that their baby has died. A vaginal suppository is inserted into the cervix, if it has not begun to dilate naturally. Then, an IV drip of synthetic oxytocin, which stimulates uterine contractions, is begun.
Barring any problems with labor and delivery, most women can deliver vaginally.
Why Does Stillbirth Happen?
There are many known causes for stillbirth; however, not all stillbirths have a known cause. Here are some common causes for a stillbirth:
Birth Defects - According to the March of Dimes, 15-20% of stillborn babies have at least one birth defect; 20% of these have chromosomal problems, such as Down Syndrome. Others have birth defects caused by genetics, environmental, or unknown causes.
Placental Problems - According to the March of Dimes, placental problems cause 25% of stillbirths. Placental abruption (the placenta peels away partially or entirely from the uterine wall prior to delivery) results in heavy bleeding that can threaten the life of the mother and fetus. It may cause fetal death due to lack of oxygen. Women who use cocaine or smoke cigarettes while pregnant are at increased risk of placental abruption.
Poor Fetal Growth - Fetuses that grow too slowly are at an increased risk for stillbirth. According to the March of Dimes, 40% of stillborn babies have poor growth. Women who smoke cigarettes or have high blood pressure are at increased risk for small babies. If poor growth is noted prior to fetal demise, a woman will be closely monitored by her OB-GYN.
Infection - Maternal, fetal, or placental infections appear to cause 10-25% of stillbirths, according to the March of Dimes. Some infections, such as genital and urinary tract infections and certain viruses, may go undiagnosed and asymptomatic through a pregnancy until they cause complications like stillbirth or preterm birth.
Chronic Maternal Health Conditions - According to the March of Dimes, 10% of stillbirths are related to chronic health conditions of the mother. These include high blood pressure, diabetes, kidney disease, and thrombophilias. These conditions may lead to placental abruption or poor fetal growth. Preeclampsia also increases the risk for a stillbirth, especially in subsequent pregnancies.
Umbilical Cord Accidents - 2-4% of pregnancies involve umbilical cord accidents, such as knots in the cord or abnormal placement of the cord into the placenta. Umbilical cord accidents can deprive the fetus of oxygen.
Other stillbirths may be caused by maternal trauma (like a car accident), pregnancy longer than 42 weeks, Rh Disease (incompatibility of maternal and fetal blood), and lack of oxygen during a difficult delivery.
Risk Factors for Stillbirth:
- Maternal age over 35
- Maternal Obesity
- Multiple gestation (twins or triplets)
- African-American Ancestry
How Do I Reduce My Risk for Stillbirth?
A woman should schedule a visit with her doctor before she gets pregnant to allow the doctor to identify and treat any maternal conditions before pregnancy to reduce risks during pregnancy. This is also a time when a woman should share all medications, including herbal supplements, with her doctor to identify and discontinue any potentially harmful medications.
Women who are obese should consider losing weight prior to conception. A doctor or other health care provider can help a woman develop a weight loss plan before pregnancy. No woman should try to lose weight during a pregnancy.
Women shouldn't smoke, use street drugs, or drink alcohol during pregnancy because these can increase the risk of stillbirths.
I Had a Previous Pregnancy End in Stillbirth - Can it Happen Again?
Understandably, those who have suffered a stillbirth are worried about subsequent pregnancies also ending in stillbirth. The risk for those who have had a previous stillbirth is lower than those who have not. For example, placental problems and cord accidents are unlikely to occur in another pregnancy.
If the stillbirth was due to maternal health complications or genetic disorders, the risk of a subsequent stillbirth may be higher. These couples should visit a genetic counselor and discuss the risks of pregnancy complications, including stillbirth.
Doctors carefully monitor any woman who has had a previous stillbirth for any signs of fetal problems - this may assure the woman that all steps necessary for prevention of another stillbirth are taken.
Can We Prevent Stillbirths?
Stillbirth rates, since the 1950's, have declined dramatically. This is due to better management of certain conditions - high blood pressure and diabetes. Rh disease can be prevented by administering a dose of immunoglobulin at 28 weeks to an Rh- mother carrying an Rh+ fetus.
Women who have high risk pregnancies are monitored more carefully by their doctors during late pregnancy. Women who are carrying high-risk pregnancies are often told to do a "kick count" starting around week 28 of pregnancy. If a woman counts less than ten kicks an hour for two hours or if she feels the baby is moving less than usual, she should call the doctor for additional testing.
Any bleeding during pregnancy should be reported to the doctor immediately. Vaginal bleeding during the second trimester may indicate placental abruption, and an emergency c-section may save the baby.
Since stillbirths are often a complete mystery, there are very few ways to eradicate them entirely; however, with proper prenatal care and monitoring, some stillbirths may be prevented.
How Do I Handle the Grief of a Stillbirth?
Any couple who has lost a baby due to stillbirth needs time and space to grieve. A pregnant woman and her partner have already bonded with their child, well before it is born, so having a stillbirth means that most will feel an intense, pervasive loss when their baby dies. Grief is a very unique process, and each parent may feel the loss differently. Some common emotions are anger, sadness, denial, shock, numbness, depression, despair, and guilt.
Often a woman and her partner cope with a stillbirth differently, which may create tension within the relationship. These couples may benefit from seeing a grief counselor together so that they can be there for one another at a time when they are both in desperate need.
Many stillbirth parents find strength from joining a stillbirth support group. These groups are full of people who understand the unique grief journey that accompanies a stillbirth. This may help each person feel less alone.
How Do I Help a Loved One Who Has Suffered a Stillbirth?
- Follow their lead - everyone grieves a loss - any loss - differently. If you find out how your loved one is coping and what they need from you, it can help you figure out how to respond. Acknowledge your friend's feelings. Maybe they're not the reactions you'd have, but they are hers and she is allowed. A little, "I understand why you feel this way" can go a long way. Don't be afraid to ask questions or talk candidly about the loss with your friend.
- Don't ever say these things: "You can try again." "There must've been something wrong with the baby." "At least it happened now." Even if these are all true statements, they're about the most unsupportive thing you can say to someone who is grieving.
- You probably DO NOT know how your friend feels, so don't say so. When you say, "I know how it feels...I lost my cat once," you're minimizing the loss your friend just experienced. There's nothing more hurtful than being told that someone else "gets" their pain when they truly cannot.
- If you weren't informed of the stillbirth by the parents, be careful what you say. It's wonderful to want to be supportive and send love and condolences, but if the couple hasn't officially told many about their loss, they may feel their confidence has been betrayed. Let them come to you.
- Send a card - just a simple card saying that you are sorry and available if your friend wants to talk. Those sort of words can be extremely comforting when someone is brokenhearted over the loss of their unborn child.
- Follow up - grief is an ever-evolving thing, coming in all sorts of stages and waves. What may be comforting one week may be not the next. So keep calling. Keep emailing. Keep sending notes and letters. Your friend will appreciate it.
Additional Stillbirth Resources:
Now I Lay Me Down To Sleep: a non-profit network of professional photographers around the country that will come to the hospital and offer free professional portraits to families who have lost a baby.
International Stillbirth Alliance: a non-profit coalition of organizations dedicated to understanding the causes and prevention of stillbirth. The group seeks to raise awareness of stillbirth, promote the prevention of stillbirth through international collaboration, and help provide appropriate care for parents whose baby is stillborn.
Empty Cradle, Broken Heart: Surviving the Death of Your Baby -by Deborah L. Davis, PhD: This book has wonderful information on issues such as the loss of multiples, stillbirth, miscarriage, ectopic pregnancy, and infant loss. There is a special chapter for fathers, and it's an exceptional book for doctors, nurses, grandparents, and others to read to help them offer comfort to the grieving parents.
Still Standing Magazine - an online magazine focusing on encouraging women, men and even children to embrace life, connecting hearts around the world who have similar life experiences and becoming a resource for friends, family and even medical professionals, to know how to support someone enduring child loss and/or infertility.
www.stillbirthday.com - Wonderful resource page full of love, support, and information about all things related to miscarriage and baby loss. In addition to information about the loss, there is information about how to care for yourself during this incredibly difficult time. It also contains information about how to start the process again after a loss.