I’ve spent the last few weeks on the blog focusing on miscarriage. My hope was to shed some light on the statistical and emotional landscape of what is an incredibly painful and yet remarkably common occurrence. This week I am switching focus to speak specifically about stillbirth.
Stillbirth refers to a pregnancy loss that occurs after the 20th week of pregnancy and includes losses that happen when pregnancy is full term (loss after 37 weeks) or when a baby dies during labor. Stillbirths occur in about 1% of all pregnancies, most commonly between the 20th-27th week. Stillbirths are low probability, high impact events that deeply and profoundly affect families. However, because they are not common, there is not enough research into what causes them and how to prevent them. Many people are ill informed about their risk factors and either under or overestimate their risk.
So here is what we know:
- The most common causes of stillbirth include
- a problem with the baby (such as a severe birth defect or genetic anomaly)
- a problem with the placenta or umbilical cord or a cord accident
- a health condition of the mother (such as obesity, an infection, or uncontrolled diabetes
- There are sometimes multiple causes that contribute to a stillbirth
- Sometimes the cause of a stillbirth is unable to be explained.
- The risk of stillbirth is increased in women who:
- are over 35
- are teenagers
- are smokers
- have had previous stillbirths
- have had previous pregnancy complications including intrauterine growth restriction, preeclampsia, or hypertension
- have chronic medical problems such as lupus or diabetes
- are African American
- are pregnant with multiples
I have also found that because it is so painful to talk about stillbirths, many people do not fully understand how they are diagnosed and what happens in the aftermath of the diagnosis. Below are some basics on typical procedures, as well as information and your rights following a stillbirth.
- Stillbirths are usually diagnosed when a pregnant woman notices her baby is not moving. The diagnosis is confirmed with a Doppler to check for a heartbeat, and then an ultrasound is used to confirm the findings.
- After a stillbirth is diagnosed, many women need to deliver the baby right away. This is typically done by inducing labor. Some women who experience the loss while still in their second trimester may have the option of a D&E (dilation and evacuation) procedure.
- After delivery, your medical team will examine the baby, placenta, and umbilical cord. They will likely ask to take tissue samples for testing. It is your right to agree or refuse.
- You have a right to agree to or refuse an autopsy of the baby. This is a very complicated decision for grieving parents and you are allowed to take your time making it.
- Your medical team will likely run tests on you to see if they can identify any additional risk factors or genetic anomalies that may have contributed to the loss.
- You have the right to hold, dress, and/or bathe your baby. You have the right to have photographs taken or to take a lock of hair or a hand print. It is also your right and OK if you choose not to look at or touch your baby.
- States vary in terminology and laws but you will have to register the stillbirth of your baby. Many states now have “certificates of birth resulting in stillbirth” or “certificates of stillbirth.”
- You have a right to plan a burial or farewell ritual in accordance with your beliefs, religious traditions, and state laws.
In subsequent posts, I will address emotions and coping following stillbirth. In the meantime, for some helpful information I recommend checking out the following websites.