Stillbirth represents the profound loss of a baby before or during birth. This distressing event brings immense grief and can be isolating for families. Understanding its nature is a first step toward comprehending its complexities and supporting those affected.
Understanding Stillbirth
Stillbirth is medically defined as the death of a fetus at or after 20 weeks of gestation. This distinguishes it from a miscarriage, which typically occurs before this gestational age. Stillbirths are further categorized by gestational age into early stillbirth (between 20 and 27 completed weeks of pregnancy), late stillbirth (between 28 and 36 completed weeks), and term stillbirth (at 37 or more completed weeks of pregnancy).
Globally, stillbirth remains a public health concern, with an estimated 2 million stillbirths occurring each year. About 80% of these losses happen in low- and middle-income countries. In the United States, the stillbirth rate is around 5.7 per 1,000 live births and stillbirths, affecting thousands of families annually.
Key Causes of Stillbirth
One significant cause of stillbirth involves complications with the placenta, the organ providing oxygen and nutrients to the fetus. Placental abruption, where the placenta detaches from the uterine wall prematurely, can lead to severe bleeding and deprive the baby of oxygen. Another issue, placental insufficiency, occurs when the placenta does not develop properly or is damaged, failing to deliver enough nutrients and oxygen for the baby’s growth and survival.
Problems with the umbilical cord also contribute to stillbirths. A true knot, where the cord forms a knot that tightens and restricts blood flow, can be a cause. Umbilical cord prolapse, where the cord slips into the birth canal before the baby, can also compress the cord and cut off oxygen supply. These incidents often lead to sudden fetal demise.
Maternal health conditions present another category of causes. Uncontrolled high blood pressure, known as pre-eclampsia, can restrict blood flow to the placenta. Gestational diabetes, if not managed, can lead to fetal overgrowth and complications. Infections in the mother, such as cytomegalovirus or parvovirus, can cross the placenta and directly harm the fetus. Untreated thyroid disorders in the mother can also increase the risk of stillbirth.
Fetal conditions, including genetic abnormalities or structural birth defects, account for a portion of stillbirths. These can range from chromosomal disorders to severe malformations of organs like the heart or brain. Despite thorough investigations, 20-30% of stillbirths remain unexplained, highlighting the complexity of identifying a definitive cause in every case.
Identifying and Reducing Risk
Several identifiable risk factors can increase the likelihood of stillbirth. Maternal factors include advanced maternal age (over 35), obesity, and chronic medical conditions like pre-existing hypertension or diabetes. Lifestyle choices such as smoking and substance use during pregnancy are well-documented risk factors that can severely impact fetal development and survival.
A history of previous pregnancy complications, including a prior stillbirth, significantly increases the risk for subsequent pregnancies, requiring specialized care and careful monitoring.
Strategies for risk reduction focus on consistent prenatal care to monitor maternal and fetal health. Regular monitoring of fetal movement can help identify distress early. Managing pre-existing health conditions before and during pregnancy through medication and lifestyle adjustments is important. Avoiding harmful substances like tobacco, alcohol, and illicit drugs supports fetal well-being. Timely medical intervention for concerns like reduced fetal movement can be vital.
Navigating Loss and Seeking Support
The emotional and psychological impact of stillbirth on parents and families is profound. Parents often experience intense grief, shock, and complex emotions like guilt, anger, and despair. This loss can lead to long-term psychological distress, including depression and anxiety. Acknowledging this grief is a key step in healing.
Support for grieving parents is vital, with various resources available. Support groups, in-person or online, offer a space for parents to share experiences and connect. Grief counseling helps individuals and couples process loss and develop coping strategies. Many organizations offer remembrance options, like memorial services or keepsakes. Follow-up medical care for parents after the loss addresses physical recovery and emotional well-being.
References
Centers for Disease Control and Prevention. (2023, April 14). Stillbirth. Retrieved from https://www.cdc.gov/ncbddd/stillbirth/facts.html
World Health Organization. (n.d.). Stillbirths. Retrieved from https://www.who.int/news-room/fact-sheets/detail/stillbirths
MacDorman, M. F., & Gregory, E. C. (2020). Stillbirths: United States, 2019. NCHS Data Brief, No. 393. Centers for Disease Control and Prevention.
American College of Obstetricians and Gynecologists. (2020). Stillbirth: A Guide for Patients. Retrieved from https://www.acog.org/womens-health/faqs/stillbirth
Mayo Clinic. (2024, April 20). Stillbirth: Causes, risk factors, prevention. Retrieved from https://www.mayoclinic.org/diseases-conditions/stillbirth/symptoms-causes/syc-20354889
March of Dimes. (n.d.). Coping with grief after a stillbirth. Retrieved from https://www.marchofdimes.org/complications/stillbirth/coping-grief-after-stillbirth