Stillbirth, the loss of a baby after 20 weeks of pregnancy, is a devastating experience for expecting parents. The grief and sadness of losing a child is immense. Many parents wonder if there was anything they could have done to prevent their baby’s stillbirth.
What causes stillbirth?
Unfortunately, in many cases the exact cause of stillbirth is unknown. Some potential causes include:
- Problems with the placenta – Issues like placental abruption where the placenta separates from the uterine wall or placental insufficiency where the placenta does not provide enough oxygen and nutrients to the baby.
- Birth defects – Certain birth defects, like heart defects or neural tube defects, can result in stillbirth.
- Umbilical cord issues – Complications like umbilical cord knots, compression, or prolapse can cut off blood flow and oxygen to the baby.
- Infection – Maternal infections like syphilis, listeriosis, or cytomegalovirus can cross the placenta and infect the baby, leading to stillbirth.
- Chronic health conditions – Diabetes, high blood pressure, thyroid disorders, obesity and other conditions in the mother increase stillbirth risks.
- Advanced maternal age – Stillbirth rates are higher in women over age 35.
- Lifestyle factors – Cigarette smoking, alcohol and drug use can increase risks.
- Pregnancy complications – Issues like preeclampsia, placental abruption or poor fetal growth raise risks.
- Genetic factors – Inherited disorders or genetic mutations can sometimes lead to stillbirth.
Often stillbirth is caused by a combination of factors, or the cause is never identified at all. However, knowing some of the potential risks and causes can help women take steps to reduce the chances of a stillbirth occurring.
Can stillbirth be prevented?
While not all stillbirths can be prevented, researchers estimate that about 1 in 3 stillbirths are potentially avoidable. This means that with improved education, monitoring, access to care and early intervention, some stillbirths could potentially be avoided.
Some of the ways women can reduce stillbirth risks include:
- Getting regular prenatal care – Early and regular prenatal visits allow careful monitoring of mom and baby.
- Following doctor’s recommendations – Take prescribed medications, undergo recommended tests and procedures, and make diet and lifestyle adjustments.
- Avoiding cigarettes, alcohol and drugs – These substances significantly increase stillbirth risks.
- Managing chronic conditions – Work with your doctor to keep conditions like diabetes or high blood pressure under tight control.
- Maintaining a healthy weight – Obesity increases stillbirth risks, while healthy eating and exercise promote good pregnancy health.
- Reducing stress – Find healthy stress relief techniques like prenatal yoga, meditation or talking with a counselor.
- Getting tested and treated for infections – Communicable infections like syphilis and cytomegalovirus can be treated with antibiotics or antivirals.
- Monitoring baby’s movement – Notify your provider right away if you notice any decrease or changes in baby’s normal activity.
- Delivering at week 39 – Some research indicates delivering at 39 weeks lowers stillbirth risks compared to expectant management.
- Learning CPR – Knowing infant CPR means you could potentially help revive your baby if you deliver at home or en route to the hospital.
Warning signs and symptoms
Being aware of potential warning signs is another way women can be proactive about reducing stillbirth risks:
- Decreased fetal movement – Every baby is different, but you should inform your provider if you notice major changes in baby’s normal activity patterns after 28 weeks.
- Vaginal bleeding – While some light spotting may be normal, heavier bleeding or bleeding along with cramping, pain or fluid leakage warrants prompt medical attention.
- Severe or persistent headache – Headaches can be a sign of dangerously high blood pressure.
- Changes in vision – Blurry vision, spots or flashing lights can signal preeclampsia.
- Severe abdominal pain – Intense and constant belly pain, especially along with bleeding or fluid leakage, requires immediate evaluation.
- Difficulty breathing – Shortness of breath or rapid breathing is not normal and indicates an urgent need for evaluation.
- Reduced amniotic fluid – Oligohydramnios or too little amniotic fluid can indicate placental problems or birth defects.
- Poor fetal growth – Babies measuring small for gestational age have higher stillbirth risks.
- Prolapsed umbilical cord – A prolapsed cord can quickly cut off oxygen to the baby.
Being tuned into your body and your baby’s signals can prompt you to seek urgent medical care when needed. Always contact your provider right away if you have any concerns during pregnancy.
Prenatal testing and monitoring
Your prenatal care provider has access to various tests and monitoring methods to assess stillbirth risks:
- Blood tests – Blood work can screen for infections, anemia, blood disorders and other problems.
- Urine tests – Urine screening helps detect preeclampsia, infections and gestational diabetes.
- Ultrasounds – Ultrasounds allow visualization of baby’s growth and development, amniotic fluid levels, placental position and umbilical cord.
- Nonstress tests – Nonstress tests check on baby’s heart rate patterns in response to movement.
- Biophysical profiles – BPPs use ultrasounds and nonstress tests to evaluate baby’s well-being.
- Fetal kick counts – You may be instructed to track baby’s kicks and movements.
- Doppler monitoring – A handheld Doppler device tracks baby’s real-time heart rate.
- Contraction stress tests – CSTs look at how baby handles induced contractions.
Your doctor can decide if these tests are recommended based on your individual risk factors and pregnancy progression. Additional testing and monitoring provides more opportunities to detect potential problems and intervene when necessary.
Medical interventions
If testing and monitoring reveals risks or complications, your doctor may recommend medical interventions like:
- Hospital bed rest – Hospitalization allows close fetal monitoring and treatment for preterm labor.
- Steroids for fetal lung development – Steroids speed lung maturity if preterm delivery looks likely.
- Tocolytics to stop labor – Medications can temporarily stop premature contractions.
- Emergency cerclage – A cerclage or stitches to the cervix may be placed to prevent premature cervical dilation.
- Intrauterine transfusion – Blood transfusions can treat some fetal blood disorders.
- Plasma exchange therapy – This filters out antibodies causing hemolytic disease.
- Early delivery – Delivery may be recommended if pregnancy complications put the baby at high risk.
Medical interventions aim to treat reversible causes of stillbirth and deliver the baby safely when necessary. Close monitoring and prompt treatment improve outcomes.
Genetic testing and counseling
For couples who have experienced stillbirth or have risks for genetic disorders, genetic testing and counseling can provide important information. Testing options may include:
- Karyotype analysis – Examines chromosomes for abnormalities like Down syndrome.
- Microarray testing – Detects smaller chromosomal changes that can impact development.
- Whole exome sequencing – Analyzes exons that contain most of the genetic code.
- Single gene testing – Checks for specific inherited disorders present in the family.
Genetic testing of parents, the baby, or preserved fetal tissue can identify genetic mutations causing disorders. This helps determine recurrence risks and guide future family planning.
Meeting with a genetic counselor provides a thorough discussion of:
- Inheritance patterns
- Testing options
- Test results interpretation
- Associated diagnoses
- Available treatments
- Recurrence risks
- Options for preventing transmission
Genetic counseling empowers couples to make fully informed choices about current and future pregnancies.
Autopsy and placental examination
An autopsy and placental exam after a stillbirth can potentially determine the cause of death in up to 60% of cases. These may include:
- Autopsy – This examines all the baby’s organs and tissues under a microscope to uncover problems or defects.
- X-rays – X-rays help detect subtle bone disorders and heart defects.
- Toxicology tests – These screen for substances impacting the baby through the placenta.
- Cultures – Cultures identify infections in the baby or placenta.
- Chromosomal analysis – Examines chromosomes from fetal cells.
- Biochemical tests – Metabolic disorders are detected by enzyme analysis.
- Placental examination – The whole placenta is closely evaluated under a microscope.
Identifying a clear cause can give parents some closure and help guide doctors in monitoring future pregnancies. However, autonomy is fully respected if parents decline testing.
Bereavement counseling and support
The deep grief after a stillbirth should never be understated. Many parents find bereavement counseling and support groups helpful, such as:
- Individual counseling – Meeting with a perinatal grief counselor allows you to explore your emotions in a safe, understanding environment.
- Couples counseling – Sessions together can help you unite in processing your grief as partners.
- Family counseling – This helps other children and family members struggling to handle the loss.
- Support groups – Sharing experiences with other parents who’ve lost babies can provide comfort and connection.
- Online forums – Anonymously conversing with others coping with stillbirth is readily accessible.
- Reading materials – Books on stillbirth grief can aid the healing journey.
Don’t hesitate to reach out for help from experienced professionals and others who’ve walked this road. Healing happens gradually through sharing emotions in a compassionate space.
Creating memories
Though brief, your baby’s life was meaningful. Treasuring memories is part of the grieving process. Some supportive hospital staff will offer ideas like:
- Holding and photos with your baby
- Hand/foot molds or prints
- A baby blanket, hat or outfit
- A memory box with keepsakes
- Taking locks of hair
Parents can also consider options like:
- A private burial or cremation
- Planting a memorial tree
- Holding a naming ceremony
- Getting a special tattoo or jewelry
- Lighting candles on significant days
Memorializing and honoring your baby’s brief but meaningful life can be very healing for families.
Advocating for change
Some grieving parents find comfort in advocating for improvements that could spare other families such deep pain. This may include:
- Raising awareness about stillbirth’s impacts
- Campaigning for better bereavement care in hospitals
- Advocating for more research into stillbirth causes and prevention
- Supporting policies that improve prenatal care access
- Donating to organizations funding stillbirth research and education
Turning grief into action and hope for the future brings purpose and direction to many families after losing a baby.
Trying again
For parents hoping to conceive again, these steps can promote a healthy pregnancy:
- Waiting 12-18 months to allow for emotional healing
- Seeking tighter glucose control if you have diabetes
- Reaching a healthy BMI before conceiving again
- Taking higher dose folic acid and baby aspirin
- Undergoing recurrent pregnancy loss testing
- Trying medications like low-dose heparin
- Having more ultrasounds and NSTs for closer monitoring
- Working with a high-risk maternal-fetal medicine doctor
- Delivering no later than 39 weeks if possible
While anxiety will be high in subsequent pregnancies, take comfort in utilizing all available precautions and interventions.
Conclusion
Stillbirth leaves enormous grief and emptiness behind for families. While some cases sadly cannot be prevented, being proactive with prenatal care, recognizing warning signs, following medical advice, and accessing bereavement support can make a difference. If another pregnancy is desired, excellent care and close monitoring provide the best chances for a successful outcome. Most importantly, remember kindness and grace for yourself on difficult days – your baby rests softly in the hearts of all who love them.