Stillbirth is the heartbreaking loss of a baby after 24 weeks of pregnancy. It’s a devastating experience, often leaving parents with many unanswered questions. While doctors sometimes identify a clear cause, in many cases, the reason remains unknown.

What increases the risk of stillbirth?

Certain factors can raise the risk of stillbirth, some beyond your control, and others that can be influenced through lifestyle choices or medical intervention. Here's a breakdown:

Unchangeable risk factors:

• Being very young (under 20) or older (over 35)
• A history of stillbirth or pregnancy complications, like preeclampsia
• Carrying multiples (twins, etc.)
• Carrying a baby beyond 41 weeks
• Having a smaller baby, known as Fetal Growth Restriction
• Low education levels
• Reduced fetal movement
• Underlying health conditions, such as thyroid issues, blood clotting disorders, or infections (e.g., malaria, COVID-19)
• Autoimmune diseases (e.g., lupus), kidney disease, or liver conditions (cholestasis)

Changeable risk factors:

• High blood pressure or obesity
• Smoking more than 10 cigarettes a day
• Drinking alcohol or using drugs
• Living in areas with limited healthcare access or higher levels of deprivation

What causes stillbirth?

There’s no one-size-fits-all answer. Some common causes include:

1. Placenta problems:

• This could be placental abruption (where the placenta separates from the uterus) or poor placental function.

2. Health issues with the baby:

• These could include developmental problems or infections that interfere with growth and well-being.

3. Maternal health conditions:

• Issues like poorly controlled diabetes, high blood pressure or bleeding before baby is born can increase the risk of stillbirth.

4. In many cases, however, the exact cause remains unclear.

Signs and symptoms of stillbirth

The most noticeable sign of a stillbirth is a lack of fetal movement. If you notice a significant reduction or complete cessation of movement, it’s crucial to contact your doctor immediately.

How is stillbirth diagnosed?

If you’re concerned, your doctor will likely check for a fetal heartbeat and may perform an ultrasound to confirm whether a stillbirth has occurred. Ultrasound is the most accurate way to detect the absence of a heartbeat or any other potential issues.

What happens after a stillbirth is confirmed?

Once stillbirth is confirmed, the doctor will discuss delivery options with you. Labor is typically induced using medication to start contractions, though some women may choose to wait for labor to begin naturally. In certain cases, a Cesarean section may be needed, depending on the situation.

Emotional and practical support following a stillbirth

Losing a baby is a deeply emotional experience, and emotional support is critical. You will be offered counseling and access to mental health resources to help you navigate this incredibly painful time.

The news should be delivered in a private, calm environment to allow for processing. Clear and direct language should be used, with a professional interpreter if necessary. Written information and contact details for ongoing support should also be provided.

What happens after the diagnosis?

Once the diagnosis is made, you and your family should be given time to process. While privacy is important, you should not feel isolated—support should be available, and healthcare providers will answer questions and guide you through decisions, including birth plans, pain relief options, and ways to make memories with your baby.

If needed, extra time before proceeding with labor can be granted—typically up to 48 hours—unless medical concerns require quicker intervention. For those who experience health risks like heavy bleeding or high blood pressure, doctors may recommend expedited delivery to avoid further complications.

Physical and emotional recovery after a stillbirth

After delivery, you may experience bleeding, cramping, and fatigue, similar to what you would experience after any birth. However, if you notice heavy bleeding, fever, or any other signs of infection, it's vital to seek immediate medical attention.

In addition to physical recovery, emotional health must be carefully monitored. Many women may face postpartum depression (PPD), which can manifest as sadness, trouble bonding with other children, excessive crying, or difficulty sleeping. If you're struggling, seeking support from a counselor or mental health professional is essential.

Investigating the cause of stillbirth

While some causes of stillbirth can be identified through tests, in many cases, the reasons remain unclear. Your healthcare team will likely conduct an investigation, including examining the placenta or performing a post-mortem on the baby, to determine what happened. Understanding the cause, if possible, can help you and your doctors in future pregnancies.

Memory making after a stillbirth

While the loss is devastating, families are encouraged to make memories with their baby. This could include taking photographs, making handprints, or spending time with the baby to honor their memory.

Caring for your health after a stillbirth

After a stillbirth, it’s crucial to take steps to care for your health, especially if you plan to try for another pregnancy. Your healthcare team will closely monitor factors like blood pressure, thyroid function, and other conditions that could impact future pregnancies. This ensures that any potential risks are identified early.

When you decide to become pregnant again, you’ll receive more frequent monitoring and additional screenings to keep a close eye on both your health and the baby’s development. This may include regular ultrasounds and possibly medication to help reduce the risks of complications.

It’s also important to consider the duration between pregnancies. Research suggests waiting at least 6 months after a stillbirth before trying to conceive again. This allows your body time to heal physically and emotionally, while also reducing the risk of complications such as preterm birth or low birth weight.

For those considering pregnancy again, preconception care is essential. Your healthcare provider may recommend specific steps, including managing any existing medical conditions, adopting a healthy lifestyle, and possibly using contraception until you feel ready to try for another baby. This proactive approach helps optimize your health and prepares your body for a future pregnancy.

How can I get emotional support after a stillbirth?

Emotional support is crucial after a stillbirth, as the grief can be overwhelming and isolating. Here are some ways to access the help you need:

1. Counseling and therapy:

• Professional therapy, including grief counseling, can be incredibly helpful in navigating the intense emotions that come with loss. A counselor who specializes in pregnancy loss can provide a safe space to process your feelings. Therapy should be offered to everyone in the immediate family, if possible, including the grieving mother, father, and any children—future siblings—who may also be affected by the loss.

2. Support groups:

• Many hospitals, community centers, and online platforms offer support groups where you can connect with others who have experienced a similar loss. Sharing your feelings with others who understand can be very comforting.

3. Partner and family support:

• Leaning on your partner, family members, and close friends is crucial. They can provide emotional support and help with practical tasks during this difficult time.

4. Online communities:

• Many online groups are dedicated to supporting parents through pregnancy and infant loss. These can provide a sense of belonging, support, and validation during a time when you might feel disconnected from others.

5. Memory boxes and rituals:

• Some parents find comfort in creating a memory box with keepsakes or holding a small ceremony to honor their baby. These rituals can help you process your grief in a personal and meaningful way.

How to support someone after a stillbirth

If you’re supporting a loved one through a stillbirth, here’s how you can help:

1. Acknowledge the loss:

• Don’t shy away from mentioning the baby. Simple, heartfelt words can be incredibly supportive.

2. Offer practical help:

• Grief can make everyday tasks overwhelming. Help with cooking, cleaning, or errands.

3. Respect the grieving process:

• Every individual grieves differently. Some may want to talk; others may need space. Be supportive either way.

4. Listen and be patient:

• Sometimes, the best way to help is to listen without offering solutions unless asked.

5. Encourage professional support:

• Gently suggest therapy or a support group if needed. Let them know they’re not alone.

6. Honor their baby’s memory:

• Respect how they wish to remember their baby, whether through rituals, keepsakes, or simply acknowledging the loss.

How can I prevent future stillbirths?

If you’ve experienced a stillbirth, it’s natural to wonder how to reduce the risk in future pregnancies. Here are some steps that can help:

1. Preconception care and regular prenatal care:

• Frequent check-ups help catch potential problems early.

2. Monitor fetal growth:

• Close monitoring in future pregnancies can help detect growth restriction or other issues.

3. Consider low-dose Aspirin:

• If placental problems were a factor previously such as high blood pressure issues, your doctor might recommend low-dose aspirin to improve blood flow.

4. Gestational Diabetes screening:

• If you had a stillbirth, getting screened for gestational diabetes is crucial.

5. Managing health conditions:

• If you have high blood pressure, diabetes, or other conditions, ensuring they are under control during pregnancy can help.

6. Healthy lifestyle choices:

• Avoid smoking, alcohol, and drugs. Focus on maintaining a healthy weight, eating balanced meals, and managing stress.

7. Inducing labor at 39 Weeks:

• If you’ve had a stillbirth previously, doctors may recommend inducing labor at 39 weeks to reduce the risk of recurrence.

8. Emotional support:

• Receiving counseling can help manage stress and mental health, supporting a healthy pregnancy.

In summary:

Though a stillbirth is an unimaginable loss, know that you are not alone. Whether through physical care, emotional support, or family and community networks, there are resources to help you cope with your grief and help prepare for a healthier future. Above all, remember that grieving is a personal journey, and healing takes time, but with the right support, it is possible to move forward.