Stillbirth is the devastating loss of a baby before or during birth, distinct from miscarriage, referring to fetal death at a specific point in pregnancy. Understanding its definition, potential causes, medical investigations, and available support can help families navigate this challenging journey.
Defining Stillbirth
Stillbirth is defined as the death of a fetus at or after 20 weeks of pregnancy. Some health organizations, like the CDC, specify loss at or after 20 completed weeks of gestation, or a fetal weight of 350 grams or more if gestational age is unknown. The World Health Organization (WHO) defines stillbirth as a baby born without signs of life at 28 completed weeks of gestation or more, or with a birth weight of 1000 grams or more.
Stillbirths are categorized by gestational age. An early stillbirth occurs between 20 and 27 completed weeks of pregnancy. A late stillbirth is defined as fetal death occurring between 28 and 36 completed weeks of pregnancy. When the loss happens at 37 completed weeks of pregnancy or later, it is classified as a term stillbirth.
In the United States, about 21,000 babies are stillborn annually, affecting approximately 1 in 175 births. While stillbirth rates have declined since the 1940s due to advancements in maternity care, the overall rate of decline has slowed in recent years.
Identifying Causes and Risk Factors
Many stillbirths remain unexplained despite thorough investigation, leaving families without a clear answer for their loss. However, several known factors can contribute to stillbirth, often categorized into issues with the placenta, the fetus, the umbilical cord, or maternal health conditions.
Problems with the placenta, such as placental abruption where the placenta separates from the uterine wall prematurely, can deprive the fetus of oxygen and nutrients. Other placental concerns, including poor blood flow or inflammation, also pose risks.
Fetal conditions, like genetic or structural abnormalities, can increase the risk of stillbirth. Infections, whether bacterial, viral, or parasitic, affecting the mother, baby, or placenta, are also recognized causes, particularly before 24 weeks of pregnancy. Umbilical cord issues, such as knots or compression, can restrict blood flow and oxygen to the baby.
Maternal health conditions also play a significant role. These include pre-existing diabetes or gestational diabetes, high blood pressure (hypertension disorders like preeclampsia), and thyroid disorders. Obesity (a body mass index of 30 or above) is an independent risk factor for stillbirth. Other risk factors include advanced maternal age (35 years or older), being pregnant with multiples, smoking, drug use, and a history of previous stillbirth or preterm birth.
Medical Investigations After Stillbirth
Following a stillbirth, medical investigations are typically offered to families to help identify a cause and inform future pregnancies. These investigations may include a thorough physical examination of the baby, taking measurements and photographs. The placenta and umbilical cord are also carefully examined, as they can provide valuable insights into the cause of the stillbirth.
Genetic testing, which may involve taking small tissue samples from the baby, can check for chromosomal abnormalities or single gene disorders that might have contributed to the loss. Blood tests for the mother are also common, checking for issues such as blood sugar levels, blood clotting problems, liver function, or infections.
An autopsy, a more comprehensive internal examination of the baby’s organs, is often offered. While a difficult decision for grieving parents, an autopsy can significantly increase the chances of determining the cause of death. Even if a definitive cause is not found, the investigations can rule out certain conditions and provide information that may guide care in subsequent pregnancies.
Support and Resources for Families
Families benefit from various forms of support after a stillbirth. Grief counseling provides a structured environment for individuals and couples to process their emotions and navigate the complexities of their loss. These sessions can help families understand the grieving process and develop coping strategies.
Support groups offer a unique and powerful avenue for healing by connecting individuals with others who have experienced similar losses. Organizations such as Share Pregnancy & Infant Loss Support, The Compassionate Friends, and the Star Legacy Foundation provide online and in-person support groups, creating a safe space for sharing experiences and feelings. These groups foster a sense of community and reduce feelings of isolation.
Many hospitals and local organizations also offer remembrance services, which can be a meaningful way for families to honor their baby and acknowledge their loss. Emotional and psychological support extends to both parents and other family members, including siblings, who may also be grieving. Resources like the MISS Foundation and the International Stillbirth Alliance offer ongoing support, educational programs, and advocacy for affected families.