Stillbirth: Causes, Symptoms, Prevention & Support
Understanding stillbirth: causes, warning signs, prevention strategies, and emotional support resources for grieving families.
Understanding Stillbirth: Definition and Prevalence
A stillbirth occurs when a fetus dies after week 20 of pregnancy. This devastating pregnancy complication affects many families each year, yet remains a topic that many people feel uncomfortable discussing. The condition is medically defined as fetal demise, and it represents a significant loss that requires compassionate medical care and emotional support. Understanding the prevalence and nature of stillbirth is an important first step for expectant parents seeking to educate themselves about potential pregnancy complications.
Remarkably, as many as 1 in 3 stillbirths go unexplained, even after thorough medical evaluation. This statistic underscores the complexity of stillbirth and the ongoing need for research to better understand its causes. While stillbirths can occur for identifiable reasons, the lack of a clear explanation in many cases adds to the emotional burden families experience when facing this loss.
Common Causes and Risk Factors
Stillbirths can result from multiple causes and risk factors that affect fetal development and pregnancy progression. Understanding these potential causes can help healthcare providers identify at-risk pregnancies and implement preventive measures.
Major Causes of Stillbirth
Several well-documented causes contribute to stillbirth, including:
- Placental problems such as placental abruption, where the placenta separates from the uterine wall prematurely
- Umbilical cord abnormalities, including cord thrombosis, velamentous cord insertion, and vasa previa
- Genetic conditions that affect the fetus or compromise pregnancy viability
- Maternal infections that can harm fetal development
- Maternal health complications and pregnancy-related disorders
- Fetal growth restriction, when the fetus is not growing as expected
Identified Risk Factors
Certain maternal and pregnancy factors increase the risk of stillbirth. Healthcare providers can more closely monitor patients with identified risk factors to implement preventive strategies and reduce adverse outcomes. Key risk factors include:
- High blood pressure during pregnancy
- Diabetes, both pre-existing and gestational
- Maternal obesity
- Prior infant loss or obstetrical trauma
- Advanced maternal age
- Multiple pregnancy complications
Warning Signs and Symptoms
While not all pregnancies that result in stillbirth show obvious warning signs, certain symptoms warrant immediate medical attention. One of the most important indicators involves changes in fetal movement patterns. Expectant parents should learn to track their baby’s movements and report any significant changes or concerns to their healthcare provider immediately.
Fetal Movement Tracking
Healthcare providers encourage pregnant individuals to understand normal fetal activity and recognize when movement patterns change. Decreased fetal movement or a complete cessation of movement can indicate a serious problem requiring urgent evaluation. Parents should speak up if they notice their baby’s activity has slowed or stopped, as timing is critical when addressing potential complications. Acting quickly if fetal movement decreases can be lifesaving in some cases.
Additionally, other physical symptoms that may accompany stillbirth include vaginal bleeding, abdominal pain, or cessation of pregnancy symptoms. However, the absence of obvious symptoms does not mean the pregnancy is progressing normally, which is why regular prenatal monitoring is essential.
Prevention Strategies and Risk Reduction
While not all stillbirths can be prevented, several evidence-based strategies can reduce the risk of pregnancy loss and improve overall pregnancy outcomes.
Maternal Lifestyle Modifications
Expectant parents can take proactive steps to support a healthy pregnancy:
- Stop smoking, as tobacco use increases the risk of stillbirth and other complications
- Sleep on your side after 28 weeks of pregnancy to improve placental blood flow
- Maintain regular physical activity appropriate for pregnancy
- Eat a balanced, nutritious diet
- Attend all scheduled prenatal appointments
- Communicate openly with healthcare providers about any concerns
Medical Monitoring and Testing
The American College of Obstetricians and Gynecologists recommends several testing approaches to monitor fetal health and reduce stillbirth risk:
- Risk Assessment: Comprehensive prenatal evaluation to identify specific maternal and fetal needs
- Nonstress Test: Checks the fetus’s heart rate and how it responds to fetal movement, identifying potential distress
- Biophysical Profile: Ultrasound examination measuring body movement, muscle tone, breathing movements, and amniotic fluid volume
- Growth Monitoring: Regular ultrasounds to ensure the fetus is growing appropriately and detect fetal growth restriction
- Genetic Screening: Tests to identify chromosomal abnormalities or genetic conditions
Timing of Delivery
For pregnancies with identified risk factors, healthcare providers may recommend delivery at or before 39 weeks to reduce the risk of stillbirth. The decision to induce early delivery depends on individual circumstances, maternal health status, and the specific risks present in each pregnancy. Pregnant individuals should discuss timing concerns with their healthcare team to determine the best approach for their situation.
Evaluation and Diagnosis
When a stillbirth is suspected or confirmed, healthcare providers perform a comprehensive evaluation to determine the cause and provide important information for future pregnancies.
Essential Evaluation Components
A thorough stillbirth evaluation should include multiple components:
- Fetal Autopsy: Examination of the fetus to identify structural abnormalities, signs of infection, or other pathological findings
- Placental Examination: Gross and microscopic examination by a trained pathologist, the single most useful diagnostic tool
- Umbilical Cord and Membrane Assessment: Detailed evaluation to identify cord abnormalities or membrane complications
- Genetic Evaluation: Karyotype analysis and microarray testing to identify chromosomal abnormalities
- Maternal Blood Work: Complete blood count, Kleihauer-Betke test, and screening for acquired thrombotic disorders
Fetal and Placental Examination
The general examination of the stillborn fetus should occur promptly, documenting dysmorphic features and obtaining measurements of weight, length, and head circumference. Before 23 weeks of gestation, foot length measurement is particularly useful for determining gestational age. Detailed photographs are vital for subsequent specialist review, capturing frontal and profile views of the face, extremities, palms, and any specific abnormalities. This documentation proves invaluable when genetic consultation is needed or when specialists must review the case externally.
Placental examination remains crucial in stillbirth evaluation, often revealing conditions such as abruption, umbilical cord thrombosis, velamentous cord insertion, and vasa previa. These findings provide important insights into the cause of fetal death and inform recommendations for future pregnancies.
Delivery Options and Management
The method and timing of delivery after a stillbirth depend on multiple factors, including gestational age at the time of fetal death, maternal obstetric history, and maternal preference.
Delivery Methods
Healthcare providers typically offer two main delivery options:
- Dilation and Evacuation (D&E): A surgical procedure available in the second trimester when an experienced healthcare provider is present. Parents should understand that this method may limit the effectiveness of fetal autopsy for detecting macroscopic abnormalities and often prevents parents from seeing or holding the fetus after removal.
- Induction of Labor: The most common approach, where medications stimulate contractions to expel the fetus naturally, allowing parents the full birthing experience and the option to hold and spend time with their baby.
Timing of Delivery
Although many parents desire prompt delivery, the timing is not critical from a medical standpoint. Complications associated with prolonged fetal retention are uncommon, allowing families time to process their grief and make decisions about delivery approach and aftercare. Some parents benefit from time to contact family members, arrange for support persons, or plan meaningful rituals around the delivery experience.
Labor Induction Methods
Before 28 weeks of gestation, vaginal misoprostol appears to be the most efficient method of labor induction, regardless of cervical readiness, though high-dose oxytocin infusion is also acceptable. Both induction of labor and dilation and evacuation remain viable options for women with previous cesarean delivery, with studies showing successful vaginal delivery in approximately 91% of cases. Cesarean delivery for fetal demise should generally be reserved for unusual circumstances, as it carries potential maternal morbidity without providing fetal benefit.
The Delivery Experience
The experience of delivering a stillborn fetus will feel similar to delivering a live baby, with important modifications for emotional support and family needs. Your pregnancy care team will coach you throughout the process and provide medicines to help manage pain and discomfort. The medical staff will work compassionately to support your emotional and physical needs during this difficult time.
Personal Choices and Options
Parents have meaningful options regarding how much interaction they want with their stillborn child. There is no right or wrong way to feel or respond to this loss—some families wish to spend extensive time with their baby, take photographs, and hold their child, while others prefer more limited contact. Healthcare providers support each family’s unique preferences and honor their individual grief response.
Additional support options may include:
- Professional photography services to capture memories with your baby
- Option for isolation from the labor rooms to provide privacy during this intimate experience
- Access to chaplain or religious support services honoring your faith traditions
- Social worker or counselor availability for immediate emotional support
- Bereavement resources and support groups
Bereavement Care and Emotional Support
Stillbirth represents a profound loss that requires compassionate, individualized bereavement care recognizing the bereaved parents’ personal, cultural, and religious needs. Comprehensive support should include multiple components designed to honor the lost pregnancy and support the grieving family.
Components of Comprehensive Bereavement Care
Effective bereavement support includes:
- Good communication about test results and findings
- Shared decision-making about all aspects of care
- Recognition of parenthood and acknowledgment that parents have lost a child
- Recognition of partners’ and families’ grief alongside the birthing parent’s loss
- Acknowledgment that grief is individual and there is no single “right way” to grieve
- Information about burials, cremation, and funeral planning options
- Ongoing emotional and practical support beyond the hospital experience
- Access to healthcare professionals trained specifically in bereavement care
- Support systems for healthcare providers to ensure they can provide compassionate, sustainable care
Accessing Support Resources
Many healthcare systems, including Cleveland Clinic, provide specialized spaces and services for grieving families. Facilities like the Butterfly Suite offer quiet, dignified environments where parents can grieve their pregnancy loss privately, surrounded by supportive staff and resources. Support groups connect bereaved families with others who have experienced similar losses, reducing isolation and providing practical guidance for navigating grief.
Frequently Asked Questions
Q: How common is stillbirth?
A: While exact prevalence varies, stillbirth affects a significant number of pregnancies annually. Importantly, as many as 1 in 3 stillbirths go unexplained even after thorough evaluation, highlighting the need for continued research.
Q: Can all stillbirths be prevented?
A: Not all stillbirths can be prevented, but many risks can be reduced through proper prenatal care, lifestyle modifications, and medical monitoring. Working closely with healthcare providers to identify and manage risk factors significantly improves outcomes.
Q: What should I do if I notice decreased fetal movement?
A: Contact your healthcare provider immediately. Do not wait. Decreased or absent fetal movement can indicate a serious problem requiring urgent evaluation. Acting quickly can be critical.
Q: Will I be able to see and hold my baby after a stillbirth?
A: Yes, in most cases. Parents can choose the level of interaction they want with their stillborn child. Healthcare providers support families in spending time with their baby, taking photographs, and creating meaningful memories as they wish.
Q: What happens after a stillbirth diagnosis?
A: Your healthcare team will discuss delivery options, evaluation procedures, and bereavement support. You’ll receive compassionate care throughout the delivery process and access to resources to support your grief and recovery.
Q: Will evaluation determine why my baby died?
A: A comprehensive evaluation including fetal autopsy, placental examination, and genetic testing often identifies the cause. However, approximately 1 in 3 stillbirths remains unexplained despite thorough investigation. This can be emotionally difficult, but findings still provide valuable information for future pregnancies.
Q: How does stillbirth affect future pregnancies?
A: Information gained from evaluation helps healthcare providers manage future pregnancies appropriately. Many families successfully carry future pregnancies to term with enhanced monitoring and individualized care based on their specific circumstances.
References
- Management of Stillbirth — American College of Obstetricians and Gynecologists (ACOG). 2020-03. https://www.acog.org/clinical/clinical-guidance/obstetric-care-consensus/articles/2020/03/management-of-stillbirth
- What to Know About Stillbirths — ProPublica. https://www.propublica.org/article/what-to-know-about-stillbirths
- Stillbirth: How Common, Causes, Symptoms & Support — Cleveland Clinic. https://my.clevelandclinic.org/health/diseases/9685-stillbirth
- Stillbirth – Gynecology and Obstetrics — Merck Manuals Professional Edition. https://www.merckmanuals.com/professional/gynecology-and-obstetrics/antenatal-complications/stillbirth
- Stillbirth – Gynecology and Obstetrics — MSD Manuals Professional Edition. https://www.msdmanuals.com/professional/gynecology-and-obstetrics/antenatal-complications/stillbirth
Similar Articles
Read full bio of Sneha Tete
