A stillbirth is the death of a baby that occurs before or during delivery, typically after 20 weeks of gestation. According to the Centers for Disease Control and Prevention, “In 2020, about 21,000 stillbirths were reported in the United States.” Having a stillborn baby can be challenging for an expecting mother, so understanding the causes, symptoms, and prevention is key in reducing your risk.

Types of Stillbirth

There are a few different classification of stillbirth, including:

• Early is fetal death that occurs between 20 and 27 weeks of pregnancy.
• Late occurs between 28 weeks and 36 weeks of pregnancy.
• Term is classified as 37 or more weeks of pregnancy.

Causes of Stillbirth

There are many things that can contribute to a baby being stillborn. Some of these causes are uncontrollable, while others are attributed to lifestyle.

Maternal Factors

• Over 35 – Women who are over the age of 35 are at higher risk, and this risk increases again for women over the age of 40. In addition to the risk of the baby being stillborn, the chances of other health conditions increases as well. Examples include preeclampsia and gestational diabetes.
• Pre-Existing Medical Conditions – Many pre-exsiting health conditions can increase the risk of stillbirth. Examples include diabetes, obesity, and hypertension. For example, diabetes can affect the flow of blood to the placenta, reduce oxygen and nutrients supplied to the fetus. These babies can also experience a blood sugar drop after birth because of elevated levels in the womb. This can result in seizures in some cases.
• Infections – Certain infections like urinary tract infections (UTIs) and sexually transmitted infections (STIs), can also contribute to this outcome. These infections can cause inflammation, negatively impacting the placenta. As a result, the baby’s oxygen and nutrient supply can be disrupted, leading to death.
• Obesity – Being overweight is one of the leading causes of complications during pregnancy. It can lead to gestational diabetes and high blood pressure, both of which can contribute to having a stillborn baby. Women who are planning to become pregnant should always asses their lifestyle and make the necessary life changes. Work with your doctor to create a plan, they may recommend a dietitian to help.
• Previous Stillbirth – Women who have experienced a stillbirth during a previous pregnancy statistically are at high risk in subsequent pregnancies. If you have experienced this previously, your doctor may recommend additional tests and monitoring.
• Smoking and Substance Use – Smoking and recreational drugs are at the top of the list in terms of risk factors, leading to a host of possible birth defects and negative birth outcomes. If you have a substance abuse issue, please seek help before becoming pregnant.

Fetal Factors

Genetic Factors

• Chromosomal abnormalities in the fetus can lead to developmental issues in the fetus, and this makes it harder for the baby to make it to term. This occurs when the fetus is missing or has extra chromosomes. Prenatal genetic testing can testing for some of these genetic abnormalities. Examples include cystic fibrosis, sickle cell anemia, Tay-Sachs disease, and hemophilia. Prenatal genetic testing is available to identify potential genetic abnormalities.
• Fetal Growth Restriction – Placental issues can sometimes result in poor fetal growth because of the impact on oxygen and nutrient supply. Fetal growth restriction commonly results in stillbirth, and monitoring the baby’s growth and development throughout the pregnancy is vital to detecting these types of issues.

Placental Factors

• Placental Abruption – This is when the placenta separates from the uterine wall before the baby is born. This is a serious condition that requires immediate medical attention, as it can be life threatening for both both and baby. In severe cases, it can lead to heavy bleeding.
• Placental Insufficiency – This refers to any condition that reduces the placenta ability to supply nutrients to the fetus. Any problems in the function of the placenta and lead to fetal death.

Umbilical Cord Issues

• Cord Accidents – Sometimes the umbilical cord can become knotted or compressed. It can also become wrapped around the baby’s neck. This is called a nuchal cord, and can occur in the womb and during birth and can be life threatening for a baby or lead to major developmental issues. Any disruptions in the oxygen and nutrient supply to the baby can lead to a stillbirth.

Lifestyle and Environmental Factors

There are a number of habits and substances that have the potential to increase the risk of stillbirth. Some of these factors include:

• Smoking
• Drinking alcohol
• Recreational drugs
• Certain medications

Consult your doctor before discontinuing any medications and seek assistance if you are struggling with substance abuse.

Symptoms and Diagnosis

Recognizing the signs and symptoms of stillbirth is important, especially since sometimes this can be life threatening for the mother. Common signs include:

• Reduced Fetal Movements – If you notice that your baby is no longer kicking or moving, this can be a potential red flag. Pregnant women should always be aware of their baby’s patterns of movement, and report any change to their healthcare provider immediately.
• Absence of a Heartbeat – When you go to your routine prenatal check-ups, your doctor will typically check the heartbeat of the baby. This can also be done at home using self-monitoring devices. If there is an absence of a fetal heartbeat, or it sounds like it is weakening, this is a dire symptom that a stillbirth is impending or has occured. Your doctor will perform additional tests to confirm the diagnosis if the absence of a heartbeat is detected.
• Vaginal Bleeding – Not always, but in some cases, there may be bleeding or spotting from the vaginal canal. Bleeding is not uncommon during pregnancy and can have various causes, but it could be a sign of stillbirth. Expectant mothers should always report bleeding to their doctor.

The diagnosis of stillbirth requires medical examination by a trained physician, and self-diagnosis is never recommended. Your doctor may perform an ultrasound, doppler studies, and fetal monitoring. If the diagnosis is confirmed, appropriate care and emotional support will be provided.

Risk Factors

Working with your doctor is important in identifying risk factors that are specific to you. Possible risk factors include:

Pregnancy-Related Risk Factors

• Multiple Pregnancies – Carrying twins, triplets or more may introduce a higher risk of stillbirth for one of both of the babies. This requires specialized care to reduce risk.
• Poor Prenatal Care – It’s important to prioritize prenatal care as missed appointments could mean missed problems with the baby.
• Short Pregnancy Intervals – If you get pregnant too soon after having a baby, this could put you at higher risk. Make sure that have a sufficient gap after a pregnancy before getting pregnant again so you can give your body time to heal.

Prevention of Stillbirth

While not all stillbirths can be prevented, there are steps expectant parents can take to reduce the risk:

• Prenatal Care – As mentioned previously, always make sure to keep your prenatal care appointments. This is crucial for monitoring your baby’s health, tracking development, and addressing any issues.
• Lifestyle Choices – Always avoid smoking, alcohol, and recreational drugs while pregnant. Your healthcare provider can provide resources to help you quit.
• Maintaining a healthy weight – Always focus on a balanced diet that provides all of the nutrients you need while pregnant. Regular exercise and proper diet can help prevent things like gestational diabetes, which increases the risk for stillbirth. Dieting to lose weight is not recommended either while pregnant. as this can also increase the risk.
• Monitoring Fetal Movements – Always pay attention to your baby’s movements, and seek medical attention if there is a noticeable change as this requires immediate care.
• Managing Chronic Conditions – Let your doctor know about any chronic health conditions you may have and work with your doctor to create a tailored treatment plan to help you have a successful pregnancy. For example, women with diabetes will need to get their blood sugar levels under control if they aren’t already.

Treatment and Management

In the unfortunate event of a stillbirth, medical and emotional support is essential:

• Induction of Labor – Labor will be induced to deliver the baby once it has be confirmed there has been a loss. The doctor will chemically induce contractions allowing the mother to deliver. This process is carefully monitored.
• Emotional Support – After the procedure to deliver the child, grieving parents should be offered emotional support in the form of therapy and counseling, as this is a very traumatic event for an expecting mother. This can be very helpful for a mother whose baby died.
• Postmortem Examination – The doctor may recommend an autopsy to determine the cause of stillbirth. This will help provide insights for future pregnancies.

Planning for Future Pregnancies

If and when you are ready to conceive again, your doctor can help create a plan for future pregnancies. They can asses any risk factors, and based on the previous pregnancy, recommend ways to help ensure you can carry to term.

Stillbirth is hard for any parent, and can leave lasting trauma that parents will need to deal with. With the help of family, friends, counseling, and future planning, this experience doesn’t mean you can’t try again. If you are concerned for your baby, to your doctor about what you can do to prevent stillbirth.