Stillbirth
The loss of a baby in the womb after 20 weeks
Quick Facts
- Type: Pregnancy complication / loss
- Definition: Fetal death at or after 20 weeks
- Key warning sign: Reduced or absent baby movements
- Support: Medical and emotional care are essential
Overview
Stillbirth is the death of a baby in the womb at or after 20 weeks of pregnancy. (A loss before this point is usually called a miscarriage.) It is a deeply distressing experience, and parents and families deserve compassionate medical care and emotional support.
Stillbirth can happen for many reasons, and sometimes no clear cause is found even after investigation. Understanding the possible causes and warning signs, particularly changes in the baby's movements, can help with early evaluation. This page provides general, supportive information; individual situations should always be discussed with a healthcare provider.
Warning Signs
The most important warning sign during pregnancy is a change in the baby's movements. Each baby has its own pattern, and a noticeable decrease or absence of movement should never be ignored.
- Reduced, slowed, or absent fetal movements
- No longer feeling kicks at the usual times of day
- Cramping, vaginal bleeding, or fluid leakage
- Severe abdominal or back pain
If you notice your baby moving less or not at all, contact your maternity care provider or go to the hospital right away. Prompt assessment is important and should not be delayed.
Causes
Stillbirth can result from problems with the baby, the placenta, the umbilical cord, or the mother's health. In a significant number of cases, no definite cause is identified.
- Placental problems: Issues such as the placenta not working well or separating early.
- Birth defects and genetic conditions in the baby.
- Infections affecting the mother or baby.
- Maternal health conditions: Such as high blood pressure, preeclampsia, or poorly controlled diabetes.
- Umbilical cord problems.
- Growth restriction, when the baby is not growing as expected.
Investigations after a stillbirth can sometimes identify a cause, which may help guide care in future pregnancies.
Risk Factors
- High blood pressure conditions of pregnancy, including preeclampsia
- Diabetes that is not well controlled
- A baby that is not growing well (growth restriction)
- Carrying twins or more
- Smoking, alcohol, or substance use during pregnancy
- Obesity and older maternal age
- A previous stillbirth
Having a risk factor does not mean a stillbirth will occur, and many stillbirths happen without any known risk factor.
Diagnosis
When stillbirth is suspected, usually because of reduced movements, a healthcare provider will assess the baby.
- Ultrasound: Confirms whether the baby's heart is beating.
- Doppler or fetal heart monitoring: May be used to check for a heartbeat.
- After the loss: With the family's consent, tests such as examination of the placenta, blood tests, genetic testing, or a postmortem examination may help look for a cause.
Care and Management
When a stillbirth is confirmed, the care team will explain the options with sensitivity and respect for the family's wishes.
- Delivery: In most cases, labor is induced to deliver the baby; the timing and method are discussed with the parents.
- Pain relief and medical care are provided throughout.
- Emotional support: Counseling, bereavement services, and time to spend with the baby if the family wishes.
- Follow-up: A later appointment to discuss any findings and plan for future pregnancies.
Grief after stillbirth is profound and personal, and there is no single right way to feel or to mourn. Some families find comfort in creating memories, such as naming the baby, holding the baby, or keeping mementos, while others prefer privacy; either choice is valid. Support from healthcare providers, counselors, partners, family, and bereavement organizations can be an important part of healing, sometimes over a long period.
Reducing Risk
- Attend all recommended prenatal appointments
- Be aware of your baby's movement patterns and report any decrease promptly
- Avoid smoking, alcohol, and recreational drugs during pregnancy
- Manage conditions such as high blood pressure and diabetes with your care team
- Sleep on your side in later pregnancy, as advised by your provider
- Report any concerning symptoms without delay
When to Seek Care
Contact your maternity care provider or go to the hospital immediately if you notice:
- Your baby moving less than usual or not at all
- Vaginal bleeding or leaking fluid
- Severe abdominal or back pain
- Severe headache, vision changes, or sudden swelling, which can signal preeclampsia
Do not wait to see if movements return. Prompt assessment can be important, and your care team would always rather check.
Frequently Asked Questions
What is the difference between stillbirth and miscarriage?
Both are forms of pregnancy loss. A miscarriage usually refers to a loss before 20 weeks of pregnancy, while a stillbirth is the death of a baby in the womb at or after 20 weeks. The distinction is based on the stage of pregnancy.
What is the most important warning sign to watch for?
A change in the baby's movements, particularly a decrease or absence of movement, is the most important warning sign. If you notice your baby moving less than usual, contact your maternity provider or go to the hospital right away. Do not wait to see if movements return.
What causes stillbirth?
Causes can include placental problems, birth defects or genetic conditions, infections, umbilical cord problems, poor fetal growth, and maternal conditions like high blood pressure or diabetes. In a notable number of cases, no clear cause is found even after testing.
Can stillbirth be prevented?
Not all stillbirths can be prevented, but attending prenatal care, monitoring your baby's movements, avoiding smoking and alcohol, managing health conditions, and reporting concerns promptly can help reduce risk. Your care team can advise on steps specific to your pregnancy.
What support is available after a stillbirth?
Families are offered medical care, counseling, and bereavement support, and may be able to spend time with their baby. A follow-up appointment can discuss any test findings and future pregnancies. Bereavement organizations and mental health professionals can provide ongoing support through grief.
References
- Centers for Disease Control and Prevention (CDC). Stillbirth.
- American College of Obstetricians and Gynecologists (ACOG). Stillbirth.
- MedlinePlus, U.S. National Library of Medicine. Stillbirth.