The phrase “born sleeping” is a compassionate euphemism used to refer to a stillbirth. Stillbirth is the medical term for the death of a fetus at or after a specific point in pregnancy, resulting in a baby born without signs of life. Understanding this loss involves knowing the medical definitions, potential underlying factors, the clinical steps that follow, and the resources available for emotional support. This article provides factual and respectful information on this experience.
Defining Stillbirth and Associated Terminology
Stillbirth is medically defined as the loss of a fetus at or after 20 completed weeks of gestation, or one weighing 350 grams or more, depending on regional reporting criteria. This definition distinguishes it from a miscarriage, which occurs before the 20th week of gestation, and neonatal death, which is the death of a baby born alive.
Stillbirth affects families of all backgrounds and is more common than many realize. In the United States, stillbirth occurs in approximately 1 out of every 175 births, translating to about 21,000 babies stillborn annually. Globally, an estimated 1.9 million stillbirths occur each year, with most taking place in low- and middle-income countries.
Identifying Potential Factors in Stillbirth
The causes of stillbirth are complex, frequently involving an interplay of multiple factors related to the placenta, the fetus, and the health of the pregnant person.
Placental and Cord Issues
Placental issues are the most common identifiable cause, often impairing the organ’s ability to deliver oxygen and nutrients. These issues include placental abruption, where the placenta prematurely separates from the uterine wall, and placental insufficiency, which can lead to fetal growth restriction. Umbilical cord complications, such as a true knot, excessive coiling, or cord prolapse, can restrict blood flow to the fetus.
Fetal and Maternal Factors
Fetal factors include genetic or chromosomal abnormalities (like Trisomy 13 or 18) and major structural birth defects. Infections, such as Group B Streptococcus, E. coli, or certain viruses like cytomegalovirus, can pass from the pregnant person to the fetus, causing serious complications. The pregnant person’s pre-existing or developing medical conditions significantly increase the risk. Chronic conditions like diabetes and hypertension, or pregnancy-specific conditions like preeclampsia and intrahepatic cholestasis of pregnancy, can compromise fetal well-being.
Unexplained Cases
Despite comprehensive investigation, a substantial number of stillbirths remain classified as unexplained. However, detailed post-loss investigation is important, as researchers are often able to determine a probable cause in over 75% of cases, with placental pathology being particularly informative.
Immediate Clinical Management and Investigation
Following the diagnosis, immediate medical management focuses on the safe delivery of the baby and initiating a comprehensive investigation to determine the cause. The preferred method of delivery is usually induction of labor for a vaginal birth, though a Cesarean section may be necessary if the pregnant person’s health is at risk. The medical team offers parents time to absorb the news and make decisions about the delivery process.
A thorough evaluation is performed, as finding a cause can provide answers and guide care for subsequent pregnancies. The investigation includes:
- A detailed external examination of the baby.
- A complete placental pathology report, which is crucial for revealing problems with blood flow or signs of infection.
- A fetal autopsy, which is offered to parents but is voluntary.
- Maternal blood tests are performed to check for infections, genetic conditions, and clotting disorders.
- Genetic analysis of fetal tissue and a Kleihauer-Betke test to check for feto-maternal hemorrhage.
A comprehensive clinical summary, including the full medical history and the parents’ account of events, is also required to ensure all relevant information is captured.
Navigating Grief and Available Support Resources
The emotional aftermath of a stillbirth involves navigating intense and complex grief. Hospitals often have specialized bereavement teams, including social workers and trained nurses, who provide immediate support and guidance. These professionals can facilitate the creation of cherished memories, such as memory boxes containing footprints, hand molds, and photographs.
Finding connection with others who have experienced a similar loss is a powerful component of healing. Support is available through:
- National and local organizations (e.g., The Compassionate Friends, Share Pregnancy and Infant Loss Support, and the Star Legacy Foundation) offering peer-to-peer support groups and online forums.
- Counseling and therapy with a professional trained in perinatal loss to process trauma and grief.
For couples planning a subsequent pregnancy, pre-conception counseling is important. Healthcare providers use the investigation findings to assess recurrence risk and develop a specialized management plan. Organizations like Pregnancy After Loss Support (PALS) focus on supporting parents who are pregnant again following a loss.