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What is a stillbirth?
A stillbirth is the death of a baby in the womb after the 20th week of pregnancy. Stillbirths occur in about 1 in 200 pregnancies. A stillbirth is a tragic and heartbreaking experience. In many cases the loss is completely unexpected, because it ends a pregnancy that was seemingly problem-free. About 14 percent of these deaths occur during labour and delivery, and the rest occur before labour begins.
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What are the causes?
Stillbirths may be due to maternal factors, fetal factors, or uterine factors. Injuries, illnesses (such as toxemia), infections, or catastrophic events (such as haemorrhage, or cardiac arrest) would affect both mother and child. Birth defects and growth abnormalities of the fetus can occur. Uterine factors (such as placental detachment, placental obstruction, or restricted uterine growth) can prove dangerous to the fetus. If one is pregnant, the usage of alcohol, drugs, and tobacco, can cause stillbirth, and infant death.
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What are the signs?
Usually the first sign of a problem that a pregnant woman notices is that her baby has stopped moving around and kicking. Stillbirth is usually diagnosed before birth by an ultrasound, and labour is generally induced. After delivery the baby and placenta are examined to help determine the cause of death; even with exhaustive testing, however, in up to one-third of cases the cause of stillbirth cannot be determined.
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How is it diagnosed?
An ultrasound examination can confirm that the baby has died. The doctor will do some blood tests on the pregnant woman which also may help determine why the death occurred.
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What is the treatment?
If there is no medical reason for immediate delivery, the couple can decide when they want to deliver the baby. In most cases, a woman will go into labour within two weeks after the death. There generally is little risk to a woman's health if she chooses to wait for labour to begin. However, because of the emotional trauma of carrying a dead baby, most women choose to have labor induced. If the woman’s cervix has not begun to dilate in preparation for labour, she will be given vaginal suppositories to help prepare her cervix, followed by the hormone oxytocin (which is given through a vein) which stimulates uterine contractions. Generally, a cesarean is recommended only if a woman develops problems with labor and delivery. If labour has not begun after two weeks, doctors recommend inducing labor because there is a small risk that the woman can develop dangerous blood-clotting problems after this time.
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How is it prevented?
Over the past twenty years, stillbirths have declined significantly. This is largely due to better treatment of certain conditions, such as maternal high blood pressure and diabetes, which can increase the risk of stillbirth. An incompatibility between the blood of mother and baby, was an important cause of stillbirth, can now usually be prevented (by giving an Rh-negative woman an injection of immune globulin at 28 weeks of pregnancy, and again after the birth of an Rh-positive baby).
Women with high-risk pregnancies are carefully monitored during late pregnancy. Tests that monitor the fetal heart rate often can tell if the baby is in trouble. This can allow treatment, sometimes including early delivery, which can be lifesaving. Today, women with well-controlled diabetes and high blood pressure face little increased risk of stillbirth.
Doctors often suggest that both high-risk and low-risk pregnant women do a daily "kick count" starting around 26 weeks of pregnancy. If a woman counts fewer than 10 kicks in a day, or if she feels that the baby is moving less than usual, her doctor may recommend tests of fetal well-being (such as fetal heart rate monitoring and ultrasound. If the tests show that the baby could be in trouble, steps often can be taken to help prevent deaths.
Women should not smoke, drink alcohol or use drugs, all of which can increase the risk of stillbirth and other pregnancy complications. Women should report any vaginal bleeding to their health care provider immediately. Vaginal bleeding during the second half of pregnancy can be a sign of placental abruption. When the fetus is in trouble due to an abruption, a prompt cesarean delivery can be lifesaving.
A woman who has had a stillbirth in a previous pregnancy should be monitored carefully, so that all necessary steps can be taken to prevent another death. -
What can one do:
One needs to consult a doctor right away if the baby’s movements have decreased or stopped, or if there is any bleeding from the vagina. If one has high blood pressure or diabetes, it is necessary to make sure that this is being monitored regularly and to kept under control during the pregnancy. One should follow the doctor's advice and take any medication as directed. If one does have a stillbirth, one should allow oneself time to recover physically from the pregnancy and delivery and to grieve for the baby.
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How to deal with the loss of a baby?
Most babies are born healthy. But, sometimes, something goes wrong and the baby dies. The death of an infant is, perhaps, the most difficult and wrenching tragedy any family can imagine. Besides the physical loss, there is an emotional loss and a loss of all that a new life promises. This is true whether the baby died as a newborn or before birth due to miscarriage, stillbirth or other reasons. Society has been slow to recognise that the impact on the parents can be the same regardless of when the loss occurred. Parents' grief over miscarriage is as valid and real as their grief over the loss of a full-term baby.
Parents never really 'get over' the loss of their baby. But they learn to live without his physical presence and, eventually, integrate the loss into their life's experience. What is important for parents who suffer the loss of a baby is to realise that they can and will move through their grief to healing. While grieving is a very individual experience, it also is a process that has a number of phases. Sometimes the phases overlap, some may be skipped, some repeated. Everybody does it differently. There is no right or wrong way to grieve.
