About Stillbirth

What causes stillbirths?

The most common known causes of stillbirth include:

• placental issues (examples – placental insufficiency, placental abruption),
• maternal health conditions (examples – gestational diabetes, pre-eclampsia, lupus),
• umbilical cord issues (examples – cord knot or compression, ruptured cord),
• infection (examples – CMV, Group B Strep), and
• genetic or anatomic abnormalities (examples – anencephaly, trisomy 18). 
• Unfortunately, nearly half of all stillbirths do not have a known cause. 

What increases the risk of stillbirth?

These conditions or circumstances have been shown to increase the risk of stillbirth. 

• Gestational Diabetes
• Pre-eclampsia and other hypertensive disorders
• Lupus and other auto-immune diseases
• Maternal alcohol, tobacco, or other drug use
• Maternal BMI (overweight or underweight)
• Maternal age (under 18 years or over 35 years)
• Parity (a person’s first baby or a person’s 5^th baby or more)
• History of a previous poor pregnancy outcome (includes stillbirth, neonatal death, preterm labor, etc)
• Multiple gestation pregnancy (twins, triplets, or more)
• Conception via IVF or other fertility treatments
• Fetal growth restriction (baby not growing well)
• Placental conditions (placenta previa, placental insufficiency)
• Polyhydramnios or Oligohydramnios (too much or too little amniotic fluid)
• Umbilical cord abnormalities (velamentous or marginal cord insertion, two-vessel cord, knot in cord, hyper or hypo coiling of cord, umbilical cord cysts)
• Change in fetal movements or behaviors during the pregnancy
• Poor access to care
• Lower socioeconomic status
• Racism
• History of stress or trauma
• Little/no prenatal care
• Lower maternal education level

What helps prevent stillbirths?

• Good prenatal care. Attend all appointments and work with your health provider to address any concerns.  Ask questions about any aspects that are new to you or that you don’t understand. 
• Adopt a healthy lifestyle. Maintain a healthy weight.  Talk to your provider about what that weight should be for you.  Be physically active.  Eat a balanced diet.  Avoid alcohol.  Quit smoking or using any other substances.  Ask for help quitting if needed. 
• Get to know your baby! Baby’s movements will be felt regularly by 20-24 weeks.  Take some time to think about your baby’s behaviors.  Do you notice any patterns?  When is he normally most active?  How would you describe her movements?   Identify the usually frequency, strength, characteristics, and patterns.
• Any change in your baby’s normal movements could be a sign that he/she is not well.  If you notice these changes, call your health provider or go to the hospital to be evaluated immediately.   DO NOT wait until the next day, try waking the baby with a sugary beverage, or worry you are bothering the health professionals.  Babies DO NOT normally slow down at the end of pregnancy.  
• Go to sleep on your side during the 3^rd Studies have shown that women who fall asleep on their backs have a higher risk of stillbirth.  You may try using a pillow or other device to help keep you on your side.  If you wake up on your back, just roll onto your side to go back to sleep. Learn more about safe sleep in pregnancy.
• Trust your instincts. Mothers are the best monitor we have of baby during pregnancy.  Even if you don’t have a specific symptom, you should talk to your health professional if you are worried about your health or your baby’s health. 
• Learn more about having a safer pregnancy.

Are there warning signs of a stillbirth?

Sometimes there are warning signs such as a change in baby’s movements, sharp abdominal or back pain, poor growth in baby, change in maternal health, change in baby’s heart rate pattern, sudden vaginal bleeding, or genetic or anatomic abnormalities in the baby.  Unfortunately, there are many times when there are no warning signs. 

When to call your doctor

You know your baby best and you should never hesitate to contact him/her if you have any questions or are feeling uneasy.  You are not bothering them!  As one health professional said – “You are not being a bother. You are being a mother.”   Click here to order a free copy of our Parenting in Pregnancy Brochure or download and print an electronic copy.

You should contact your doctor if you experience any of the following:

• Fever
• Bleeding or fluid loss
• New, changed or worsening pain
• Headache
• Fainting/dizziness
• Painful urination
• Vomiting more than once a day, especially if accompanied by pain or fever
• Sudden or significant swelling of hands, feet or face
• Constant itching
• Blurry vision
• Regular contractions
• Any time you are uneasy or have a feeling that something might be wrong.  Trust your instincts.

How is a stillbirth diagnosed?

A stillbirth is usually diagnosed by ultrasound.  This may be done as part of routine prenatal care or to evaluate a concern. Some stillbirths occur while the mother is in labor or delivering.  In this case, the stillbirth may be diagnosed by the fetal heart rate monitor or the baby being born without a heart beat. 

What are the delivery options for a stillbirth?

Vaginal deliveries are the preferred option for most stillbirths.  C-sections may be indicated in cases of breech presentation, previous c-section delivery, maternal health concerns, multiple gestation, or other situations identified by the family and health professional.  Induction of labor is often preferred, but is not always necessary.

Options after a miscarriage typically include waiting for natural labor/miscarriage, medication to stimulate labor/miscarriage, Dilation & Curettage (D&C) procedure, or Dilation & Evacuaton (D&E) procedure depending on the family’s preferences and gestational age of the baby.

What happens after a stillbirth?

After a stillbirth, the mother’s body will have a post-partum response similar to any live birth.  Families should be prepared for bleeding, pain management, responding to breast milk production, and healing from any medical procedures. 

Are there post-stillbirth tests?

Several tests may be recommended after a stillbirth if the death was not expected (for example because of a diagnosed anatomic condition).  These tests can help identify what caused the death and provide information about the health implications for the mother or future pregnancies.  Examples of these tests include blood tests on mom, blood tests on baby or cord blood, placenta and umbilical cord examination, genetic testing, ultrasound/MRI, or autopsy. 

Learn more about post-stillbirth testing options.

How do you recover after a stillbirth?

The physical recovery after a stillbirth will look very similar to the recovery after healthy deliveries.  Mothers are encouraged to drink fluids and get rest. Pain management options are available.  It can be easy to ignore physical complications such as excessive bleeding, infection, fever, or severe or new pain.  Call your health professional immediately with any concerns. 

Mothers should be reminded that their milk production will begin a few days after delivery.  This can be painful both emotionally and physically.  Some families like to pump this milk and donate it to a local milk bank.  If you would like to suppress your milk production, wear tight sports bras, minimize stimulation, and use ice packs on the breasts.  Other natural remedies may also be helpful.

Learn more about how you can care for yourself.

Other members of the family should also be encouraged to heal physically.  Ensure all those impacted are eating well, drinking fluids, resting, and responding to new or severe pain/symptoms. 

How do you grieve after a stillbirth?

There is not a ‘right’ way to grieve after this type of loss.  Grief looks different for each person.  It can be common to have feelings of sadness, anger, despair, hopelessness, loneliness, or denial.  Physical symptoms like headaches, nausea/vomiting, lack of appetite, and inability to sleep are also common. 

It is important for each person to have the ability to grieve in a way that works for him/her.  Grief can also change throughout the day or with more time. 

Some families have found the following activities helpful:

• talk to another person who has had a similar experience
• attend a support group
• visit a therapist, counselor, or religious leader
• journal or writing
• arts
• exercise
• meditate/yoga
• read books/blogs/stories about stillbirth
• spend time with family
• self-care (massage, bath, walk, rest)

Some grief tips:

• be kind to yourself.  Grieving takes a lot of energy. 
• do not set rules or expectations for how you should feel at any point in time
• allow those around you to grieve in a way that is healthy for them
• ask for help.  Reaching for help is a sign of tremendous strength and there are many people who will help. 
• give yourself permission to change your plans or approach depending on what you need in the moment

Can the next pregnancy after a stillbirth be healthy?

Yes.  Future pregnancies will be at higher risk for poor outcomes, but many people have gone on to have healthy pregnancies and babies.  The first step is to talk to your health professional about the health concerns or risks that may have contributed to or resulted from your stillbirth.  This information may provide information important to any decisions about future pregnancies. 

The American Congress of Obstetrics and Gynecology (ACOG) recommends additional testing and monitoring for pregnancies after a stillbirth.  Talk to your provider about what your care protocol would look like in subsequent pregnancies. 

Learn more about having a pregnancy after a stillbirth.