Is a stillbirth painful?

A stillbirth can be an extremely painful and traumatic experience for parents. The grief of losing a baby is enormous, no matter when in the pregnancy it occurs. Understanding whether the baby experienced any pain or suffering can weigh heavily on parents’ minds after a stillbirth.

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What is a stillbirth?

A stillbirth refers to the death of a baby in the womb after 20 weeks of pregnancy. Prior to 20 weeks, it is considered a miscarriage. Stillbirths can occur right up until labor begins. According to the Centers for Disease Control and Prevention (CDC), about 1 in 160 births end in stillbirth in the United States.

Some potential causes of stillbirth include:

Placental problems – The placenta detaches from the uterine wall or does not provide proper nourishment.
Umbilical cord issues – The cord becomes twisted, compressed, or ruptures.

Birth defects – Issues with the baby’s development or genetics.
Infection – Infections in the mother, like influenza or syphilis.
Chronic conditions – Health issues in the mother like high blood pressure, diabetes, or blood-clotting disorders.

Lifestyle factors – Use of drugs, alcohol, or tobacco during pregnancy.

Oftentimes the exact cause is unknown even after thorough medical investigation.

Does a baby feel pain during a stillbirth?

Whether a baby can feel pain during a stillbirth depends largely on when the death occurs during the pregnancy. Here is what the research indicates:

Before 24 weeks

Prior to 24 weeks, the baby’s brain and nervous system are still extremely underdeveloped. Most experts believe a baby cannot perceive pain before 24 weeks gestation. The neural pathways that allow pain signals to reach the brain have not formed yet.

24-28 weeks

Between 24-28 weeks gestation, the baby’s brain continues to rapidly develop. Some sensory receptors in the body connect to the thalamus, which regulates consciousness. However, the connections to the cortex, which allows actual pain perception, do not exist yet. Most research indicates the baby likely does not feel pain, but some sensory responses may occur.

After 28 weeks

Experts agree that after 28 weeks, the baby’s brain and nervous system are developed enough to likely perceive pain. The sensory receptors, neural pathways, thalamus, and cortex have connected and function. The baby is aware of and reacts to painful stimuli. Most doctors provide pain medication for any procedures done after this point.

During labor

If the baby dies during the stresses of labor and delivery, it is likely they experienced pain and suffering. The process involves extreme forces on the baby’s body as it moves through the birth canal. In addition, contractions progressively reduce oxygen flow to the placenta. These forces may directly harm or gradually asphyxiate the baby leading to death.

Does the type of stillbirth affect pain?

There are three classifications of stillbirth according to when the baby passes away:

Antepartum – Death occurs before the onset of labor, sometimes weeks or days before delivery.

Intrapartum – Death occurs during labor and delivery.
Intrauterine fetal demise – The baby dies in the womb but does not immediately deliver.

An antepartum stillbirth earlier than 24 weeks likely did not involve pain. However, an antepartum death closer to term may have involved some suffering as the baby slowly lost life.

An intrapartum stillbirth almost certainly involved significant pain from contractions, lack of oxygen, and compression in the birth canal. This type of stillbirth occurs during full-term labor.

With intrauterine fetal demise, pain depends on when the baby passed. If death occurred before 24 weeks then probably not, but if closer to term then more likely.

Physical signs baby experienced pain

Sometimes physical signs on the baby’s body provide clues into whether it experienced pain and struggle:

Head molding – The head develops an abnormal elongated or cone shape from compression in the birth canal.
Bone fractures – Bones may fracture from muscular contractions and forceful labor.
Skin damage – Peeling skin or bruising indicates trauma.

Stress hormones – Elevated cortisol and catecholamine levels signify the baby was under stress.
Meconium staining – Fetal bowel movements in the amniotic fluid signal oxygen deprivation.

While not definitive, these markers suggest the baby may have experienced painful stimuli during labor and delivery.

Effects of pain medication given before stillbirth

Sometimes labor may begin unexpectedly early. If a stillbirth occurs during premature labor, any pain medication given to the mother can affect the baby’s pain perception. Effects include:

Epidural – This numbs the mother from the abdomen down. It prevents painful stimuli reaching the baby during labor and delivery.
Narcotics – Opioids like fentanyl cross the placenta and can produce analgesia in the baby.

General anesthesia – This causes a loss of consciousness for the baby as well as the mother.

These medications act directly on the baby’s brain and nerves. They can reduce pain, awareness, and any memory of painful stimuli.

Autopsy findings

An autopsy can uncover information about whether the baby responded to painful events prior to death. Important findings include:

Adrenal gland hypertrophy – Enlarged adrenal glands suggest high stress hormone levels.
Airway foam or crying tears – Fluid in the airways indicates attempts to breathe and cry.
Blood pressure signs – Hemorrhages in the lungs or brain point to surges in blood pressure.

While not definitive, these clues indicate the baby may have mounted pain responses before death.

How can parents cope with guilt over baby’s pain?

Many parents feel substantial guilt and anguish wondering if their baby suffered. Some helpful coping strategies include:

Talking through feelings with trusted friends, family, clergy, or mental health professionals.

Joining a grief support group to share experiences with others who understand.
Focusing on moments spent bonding with and caring for the baby before birth.
Considering perspectives from doctors and literature that the baby likely did not experience significant pain.

Allowing oneself to work through the complex grief in stages – denial, anger, bargaining, depression, and acceptance.

The grieving process takes time, patience, and support. But by working through the emotions, parents can eventually find peace and healing.

Conclusion

Experiencing a stillbirth can be incredibly difficult and raise many questions for grieving parents. The issue of whether the baby felt any pain often weighs heavily. The medical evidence indicates that before 24 weeks gestation, the baby likely does not perceive pain due to an underdeveloped nervous system. Between 24-28 weeks, the baby may have some sensory responses but probably not pain. After 28 weeks, most experts believe the baby can experience and react to painful stimuli. An intrapartum stillbirth during labor would almost certainly involve significant pain from compression and lack of oxygen. Physical signs on the baby’s body, effects of pain medicine given to the mother, and autopsy findings may give clues into any distress or suffering. While the issue of pain may never be fully resolved, parents can find comfort in the evidence that early stillbirths likely did not involve substantial suffering. Sharing feelings with others and allowing time for grief can eventually bring peace.