Stillbirth

Types of stillbirth

A loss before 20 weeks is called a miscarriage.

Causes

A thorough evaluation finds a likely cause in many cases, but about a quarter to a third remain unexplained.

• placental problems: poor placental function, placental abruption (the placenta separating early), blood clots or inflammation of the placenta
• fetal growth restriction: a baby that is not growing well, often from placental insufficiency (intrauterine growth restriction)
• birth defects and genetic conditions, including chromosome abnormalities
• infections: bacterial infections of the womb and membranes, and infections such as syphilis, listeria, parvovirus and CMV
• umbilical cord problems: knots, compression or a cord prolapse, though cord findings are often present without causing harm
• maternal health conditions: high blood pressure and preeclampsia, diabetes, lupus, antiphospholipid syndrome, thyroid and kidney disease, and cholestasis of pregnancy
• complications in twins or other multiple pregnancies

Risk factors

• previous stillbirth
• smoking, alcohol and drug use
• obesity
• age 35 or older
• high blood pressure or diabetes before pregnancy
• multiple pregnancy
• pregnancy going beyond 41 weeks
• Black women in the US face about twice the risk, reflecting inequities in health and care
• sleeping on your back in the third trimester has been linked to higher risk in some studies

Signs and symptoms

Many stillbirths happen without warning. Signs that need same-day assessment:

• a change in your baby's movements: fewer, weaker or a different pattern
• no movement felt
• vaginal bleeding
• severe belly pain or cramping
• fluid leaking

There is no "normal" number of kicks, but you will learn your baby's pattern. Movements do not slow down near the end of pregnancy. Do not use home heartbeat monitors to reassure yourself; contact your provider.

Diagnosis

Stillbirth is confirmed by ultrasound showing no heartbeat. Your care team will explain what happens next and support you through decisions.

What happens after a stillbirth

Birth

Most people are offered induction of labor. Some choose to wait a short time at home before induction. Cesarean birth is usually reserved for specific medical reasons. Pain relief options are the same as for any labor.

Memory-making

Many parents find it helps to see and hold their baby, take photographs, collect handprints, footprints and locks of hair, name their baby and involve family. There is no right or wrong choice.

Finding a cause

Tests can help explain why the loss happened and guide future pregnancies:

• examination of the placenta, the most useful single test
• autopsy of the baby, with your consent
• genetic testing, such as chromosomal microarray
• blood tests for infections, diabetes, clotting disorders and antibodies
• a test for fetal blood cells in the mother's bloodstream

Physical recovery

Your body will recover as after any birth, including bleeding for several weeks and breast milk coming in. Options to suppress milk, or to donate it, can be discussed.

Emotional support

Grief after stillbirth is profound and affects partners, siblings and grandparents too. Support can come from:

• hospital bereavement teams and chaplains
• counseling and support groups
• organizations such as Star Legacy Foundation and Share Pregnancy and Infant Loss Support

Watch for signs of depression, anxiety or post-traumatic stress, which are common after stillbirth, and seek help. Call or text 988 (US) if you have thoughts of harming yourself.

Pregnancy after stillbirth

• the chance of another stillbirth is increased but most future pregnancies end in a healthy birth
• see your provider early, ideally before conceiving, to review test results
• manage health conditions, stop smoking and reach a healthy weight
• expect closer monitoring, including extra ultrasounds and fetal testing in late pregnancy
• timing of delivery may be planned earlier
• emotional support during the next pregnancy is important, as anxiety is common

Reducing risk

• attend all prenatal appointments
• do not smoke, drink alcohol or use drugs
• learn your baby's movement pattern and report changes promptly
• go to sleep on your side in the third trimester
• get vaccinated against flu and other infections as recommended
• manage high blood pressure and diabetes closely

Frequently asked questions

What causes stillbirth?

Common causes are placental problems, poor fetal growth, birth defects and genetic conditions, infections, umbilical cord problems and maternal conditions such as preeclampsia and diabetes. For many families no cause is found, and it is almost never due to anything the parent did.

What are the warning signs of stillbirth?

The key warning sign is a change in your baby's movements, such as fewer or weaker movements or none. Vaginal bleeding, severe belly pain and fluid leaking also need urgent assessment. Contact your provider or labor and delivery right away.

Can stillbirth be prevented?

Not always, but the risk can be lowered by attending prenatal care, avoiding smoking and alcohol, managing conditions like diabetes and high blood pressure, sleeping on your side late in pregnancy and reporting changes in movement promptly.

Can I have a healthy baby after a stillbirth?

Yes. Most people who have had a stillbirth go on to have a healthy baby. Future pregnancies are monitored more closely, and any identified cause is treated or managed to reduce risk.