How does stillbirth occur

Stillbirth: Definition, Causes & Prevention

Overview

What is a stillbirth?

A stillbirth is when a fetus dies after the mother’s 20th week of pregnancy. The fetus may have died in the uterus weeks or hours before labor. Rarely, the fetus may die during labor. Although prenatal care has drastically improved over the years, the reality is stillbirths still happen and often go unexplained.

A stillbirth is classified as either an early stillbirth, a late stillbirth, or a term stillbirth. Those types are determined by the number of weeks of pregnancy:

Early stillbirth: The fetus dies between 20 and 27 weeks.
Late stillbirth: The fetus dies between 28 and 36 weeks.
Term stillbirth: The fetus dies the 37th week or after.

How common are stillbirths?

A stillbirth occurs in about one of 160 births (about 24,000 babies per year in the United States).

Who is at risk of having a stillbirth?

A stillbirth can happen to pregnant people of any age, background, or ethnicity. They can be unpredictable — 1 in 3 cases go unexplained. There are some ways you can reduce your risk, though. You’re more likely to have a stillbirth if you:

Smoke, drink alcohol, or use recreational drugs.
Are over the age of 35.
Have poor prenatal care.
Are malnourished.
Are Black.
Are having multiple births (twins or more).
Have a preexisting health condition.
Have obesity (body mass index above 30).

What’s the difference between a stillbirth and a miscarriage?

Like a stillbirth, a miscarriage is also a pregnancy loss. However, while a stillbirth is the loss of a fetus after 20 weeks of pregnancy, a miscarriage happens before the 20th week.

Symptoms and Causes

What causes a stillbirth?

The cause of the stillbirth is vital not only for the healthcare providers to know, but for the parents to help with the grieving process. The cause is not always known (1 in 3 stillbirths cannot be explained), but the most likely causes include:

Problems with the placenta and/or the umbilical cord. Your placenta is an organ that lines your uterus when you’re pregnant. Through it and the umbilical cord, the fetus gets blood, oxygen and nutrients. Any problems with your placenta or umbilical cord and the fetus will not develop properly.
Preeclampsia. Preeclampsia is high blood pressure and swelling that often happens late in pregnancy. If you have preeclampsia, you have twice the risk of placental abruption or stillbirth.
Lupus. A person who has lupus is at risk of having a stillbirth.
Clotting disorders. A person with a blood clotting disorder like hemophilia is at a high risk.
The pregnant person's medical conditions. Other illnesses can sometimes cause stillbirths. The list includes diabetes, heart disease, thyroid disease, or a viral or bacterial infection.
Lifestyle. If your lifestyle includes drinking, using recreational drugs and/or smoking, you’re more likely to have a stillbirth.
Birth defects. One or more birth defects cause about 25% of stillbirths. Birth defects are rarely discovered without a thorough examination of the fetus, including an autopsy.
Infection. An infection between week 24 and week 27 can cause fetal death. Usually, it’s a bacterial infection that travels from your vagina to your uterus. Common bacteria include Group B Streptococcus, E. coli, klebsiella, enterococcus, Haemophilus influenza, chlamydia and mycoplasma or ureaplasma. Additional problems include rubella, the flu, herpes, Lyme disease and malaria, among others. Some infections go unnoticed until there are serious complications.
Trauma. Trauma such as a car crash can result in a stillbirth.
Intrahepatic cholestasis of pregnancy (ICP). Also known as obstetric cholestasis, this is a liver disorder that includes severe itching.

What physical symptoms does the mother have after stillbirth?

If you have a fever, bleeding, chills, or pain, be sure to contact your healthcare provider right away because these may be signs of an infection.

Will I lactate after a stillbirth?

After the delivery of the placenta, the milk-producing hormones may be activated (lactation). You might start to produce breast milk. Unless you have preeclampsia, you can take medicines called dopamine agonists that may stop your breasts from producing milk. You can also choose to let the lactation stop naturally.

Does stillbirth cause infertility?

No. A stillbirth does not cause infertility and it doesn’t indicate that there is a problem with it.

Diagnosis and Tests

How is the diagnosis made?

Usually, you’ll notice that the fetus isn’t as active as it used to be. An ultrasound will confirm if the fetus has passed.

How can I find out what caused my stillbirth?

To discover the cause, your healthcare provider will perform one or more of the following tests:

Blood Tests. Blood tests will show if you have preeclampsia, obstetric cholestasis or diabetes.
Examination of the umbilical cord, membranes and placenta. These tissues attach to your fetus. An abnormality could prevent the fetus from receiving oxygen, blood and nutrients.
Tests for infection. Healthcare providers will take a sample of your urine, blood, or cells from your vagina or cervix to test for infection.
Thyroid function test. This test will determine if there’s something wrong with your thyroid gland.
Genetic tests. Your healthcare provider will take a sample of the umbilical cord to determine if the fetus had genetic problems such as Down’s syndrome.

Your healthcare provider will also review medical records and the circumstances surrounding the stillbirth. With your consent, an autopsy can be performed to determine the cause of fetal death. An autopsy is a surgical procedure performed by a skilled pathologist. Incisions are made carefully to avoid disfigurement, and the incisions are surgically repaired afterward. You have the right to limit the autopsy to eliminate any incisions on your baby that are uncomfortable for you. Be sure to write these requests on the autopsy permission form.

Some hospitals don't perform autopsies, so your baby may have to be transported to another hospital. Be sure you feel comfortable with where your child is being taken. You also have the right to deny an autopsy, if that is your wish.

An autopsy may be legally required in some cases, including when:

A baby died within 24 hours of a surgical operation.
A healthcare provider can't certify the cause of death.
A baby was alive and then died suddenly.

Management and Treatment

What happens after a stillborn baby passes away?

If the fetus passes away before you’re in labor, you have three options:

Induced labor.
Natural birth.
Cesarean section.

Induced labor. Healthcare providers recommend induced labor as the best option after a stillbirth. It should be done immediately if you:

Have severe preeclampsia (high blood pressure).
Have a serious infection.
Have a broken amniotic sac (the bag of water around the fetus).
Have any clotting disorder.

The labor is induced using medicine dispensed in one of five ways:

A tablet inserted into your vagina.
A gel inserted into your vagina.
A swallowed tablet.
A drip into a vein.
A Foley bulb. A mechanical balloon that widens the cervix.

Natural birth. Waiting for birth to happen naturally is an option but, as time goes by, the fetal body may deteriorate in your uterus. The fetus may look different than you expect. The deterioration also makes it more difficult to determine the cause of death.

Cesarean section. A cesarean section is not recommended because it’s not as safe as a natural birth or induced labor.

What happens after a stillborn baby is delivered?

You'll be able to hold your baby, and your healthcare providers will allow you as much time as you need to spend with your child. You may feel uncomfortable with this idea at first.

You may want to ask for any mementos and keepsakes of your child, such as a blanket, a lock of your child’s hair, the hospital ID bracelet, etc. You can take pictures. This may also be uncomfortable, but it may be a cherished possession at a later time and may help you during your grieving process. Most hospitals will issue the family a birth certificate, but make sure you ask and request that it include the baby's handprints and footprints.

Prevention

Can a stillbirth be prevented?

Usually, a stillbirth can't be prevented. It often occurs because the fetus wasn't developing normally. Generally, improving your health, including managing preexisting conditions and lifestyle choices, increases your chances of a successful pregnancy. You’re also less likely to have a stillbirth if, when you know you’re high-risk, you’re carefully monitored through routine ultrasounds and/or fetal heart rate monitoring. If your healthcare provider finds a problem, they can have your baby delivered early if necessary.

How can I reduce my risk of having a stillbirth?

Because the reason why a stillbirth happens isn't always understood, it is difficult to prevent. However, there are some steps you can take to increase your chances of having a healthy baby:

Avoid recreational drugs, smoking and drinking alcohol.
Contact your healthcare provider if there’s any bleeding during the second half of your pregnancy.
Do what’s called a daily “kick count.” Around 26-28 weeks, familiarize yourself with fetal movements. Figure out what’s normal for the fetus. Then, if they stop acting normally, contact your healthcare provider.
Before you get pregnant, work toward a weight that's healthy for you. If you’re already pregnant, talk with your healthcare provider about diet and exercise options.
Protect yourself against infections.
Avoid certain foods including some types of fish and some types of cheese. Also, double-check to make sure that any meat or poultry you eat is thoroughly cooked.
Report any stomach pain, itching, or vaginal bleeding immediately.
Sleep on your side, not your back. If you’ve been pregnant for 28 weeks or more, sleeping on your back can double the risk of stillbirth. It’s not completely clear why that makes a difference, but experts suspect that it has something to do with the flow of blood and oxygen to the fetus.
Get routine tests, including your blood pressure and urine. These will help your healthcare provider see if there are any illnesses or conditions that may affect the health of your baby.

Can the food I eat prevent stillbirth?

Unfortunately, eating or avoiding a specific food can’t guarantee you won’t have a stillbirth. However, there are some foods you should stay away from to improve the chances of a healthy pregnancy in general. Avoid the following:

Mold-ripened soft cheeses and soft blue cheeses.
Unpasteurized milk and unpasteurized milk products.
Raw or undercooked meat.
Liver products.
Pâté.
Game meats.
Raw or partially cooked eggs.
Duck, goose or quail eggs.
Swordfish, marlin, shark and raw shellfish.
Limit caffeinated drinks and herbal teas.

Outlook / Prognosis

When should I see my healthcare provider after the natural birth or induced labor?

You’ll likely have a follow-up appointment with your healthcare provider a few weeks later. At that time the post-mortem and test results will be discussed and you can voice concerns about future pregnancies.

Can I get pregnant after I've delivered a stillborn baby?

Yes. Most people who deliver stillborn babies go on to have normal pregnancies and births. If the stillbirth was caused by a birth defect or umbilical cord problem, the chances of another stillbirth is slight. If the cause was an illness the pregnant person has or a genetic disorder, the risk is somewhat higher. The chance that your next pregnancy will result in stillbirth is about 3%, which means that most post-stillbirth pregnancies result in healthy babies.

How long after a stillbirth should I get pregnant again?

Discuss the timing of your next pregnancy with your healthcare provider to make sure you are physically ready to begin a new pregnancy. Some healthcare providers recommend waiting a certain amount of time (from six months to one year) before trying to conceive again. Some studies have shown that people who wait at least one year to conceive may have less depression and anxiety during a later pregnancy.

Statistics show that about 60% of couples take up to six months to conceive after delivery of a stillborn baby, and another 30% take up to 12 months. Don't be surprised if things don't happen quickly.

Living With

Is a funeral necessary after a stillbirth?

After the death of your baby, one of the first decisions you will be faced with is whether or not to need to arrange a funeral.

The type of arrangements you make may play an important role in the grieving process. It is a decision that only you and the other parent can make together. You may find that you need time to make your decisions and arrangements. It is quite common for families to take up to a week (and sometimes longer) to make arrangements. This is okay.

No matter what your choice is, you have the right to change your mind. Be sure you ask whoever is carrying out your arrangements about how long you have to make any changes.

How should I communicate with my other children after a stillbirth?

You may find your children are a comfort, a worry, or just too hard to deal with. These are normal reactions. Take time to grieve and say goodbye to the child you lost. You will eventually feel normal feelings for your living children again, and the bond you have with them may possibly become stronger.

No matter how much you may want to shelter your children from pain, they can sense the emotion around them. Honesty is the best way to help your children cope with this painful experience. Children have a different understanding of death at different developmental stages.

What can I do to cope with a stillbirth?

Take as much time as you need to heal physically and emotionally after a stillbirth. Regardless of the stage of pregnancy during which your loss occurred, you are still a parent and the life you nurtured was real. It is completely normal for you to experience depression and post-traumatic stress disorder (PTSD). Above all, don't blame yourself. Give yourself time to cope, grieve and accept your devastating loss.

Counseling is available. Pregnancy loss support groups may also be a good resource for both parents. Ask your healthcare provider for more information about counseling and support groups.

What questions should I ask my healthcare provider after a stillbirth?

What was the cause of the stillbirth?
Is there anything else I can do to prevent a stillbirth in the future?
Do you recommend a psychiatrist?
Do you recommend a counselor?
Do you recommend a support group?
How soon do you recommend I get pregnant again?
Does this hospital keep records of stillbirths?
Can I get a copy of the records/birth certificate?
When should I return for another appointment?
How will I be cared for in the next pregnancy?

A note from Cleveland Clinic

A stillbirth can be devastating. It can be overwhelming and depressing for the parents, their children, the grandparents, and other family members and friends. The grieving can be even worse when a stillbirth happens for no known reason. Remember that it’s normal to have difficulty coping. Access mental health professionals if you need help.

Stay in contact with your healthcare providers before, during and after your pregnancy. Share your worries and ask questions. Do your best to avoid risk factors such as smoking and drinking. Also, remember that if you’ve had a stillbirth, you can get pregnant again. There is a 3% chance of another stillbirth.

Stillbirth - Causes - NHS

A large proportion of stillbirths happen in otherwise healthy babies, and the reason often can't be explained. But there are some causes we do know about.

Complications with the placenta

Many stillbirths are linked to complications with the placenta. The placenta is the organ that links the baby's blood supply to the mother's and nourishes the baby in the womb.

If there have been problems with the placenta, stillborn babies are usually born perfectly formed, although often small.

With more research, it's hoped that placental causes may be better understood, leading to improved detection and better care for these babies.

Other causes of stillbirth

Other conditions that can cause or may be associated with stillbirth include:

bleeding (haemorrhage) before or during labour
placental abruption – where the placenta separates from the womb before the baby is born (there may be bleeding or abdominal pain)
pre-eclampsia – a condition that causes high blood pressure in the mother
a problem with the umbilical cord, which attaches the placenta to the baby's tummy button – the cord can slip down through the entrance of the womb before the baby is born (cord prolapse) or can be wrapped around the baby and become knotted
intrahepatic cholestasis of pregnancy (ICP) or obstetric cholestasis – a liver disorder associated with severe itching during pregnancy
a genetic physical defect in the baby
pre-existing diabetes
an infection in the mother that also affects the baby

Infections

Usually this will be a bacterial infection that travels from the vagina into the womb (uterus). These bacteria include group B streptococcus, E. coli, klebsiella, enterococcus, Haemophilus influenza, chlamydia, and mycoplasma or ureaplasma.

Some bacterial infections, such as chlamydia and mycoplasma or ureaplasma, which are sexually transmitted infections, can be prevented by using condoms during sex.

Other infections that can cause stillbirths include:

rubella – commonly known as German measles
flu – it's recommended that all pregnant women have the seasonal flu vaccine, regardless of stage of pregnancy
parvovirus B19 – this causes slapped cheek syndrome, a common childhood infection that's dangerous for pregnant women
coxsackie virus – this can cause hand, foot and mouth disease in humans
cytomegalovirus – a common virus spread through bodily fluids, such as saliva or urine, which often causes few symptoms in the mother
herpes simplex – the virus that causes genital herpes and cold sores
listeriosis – an infection that usually develops after eating food contaminated by listeria bacteria (see foods to avoid in pregnancy)
leptospirosis – a bacterial infection spread by animals such as mice and rats
Lyme disease – a bacterial infection spread by infected ticks
Q fever – a bacterial infection caught from animals such as sheep, goats and cows
toxoplasmosis – an infection caused by a parasite found in soil and cat faeces
malaria – a serious tropical disease spread by mosquitoes

Increased risk

There are also a number of things that may increase your risk of having a stillborn baby, including:

having twins or a multiple pregnancy
having a baby who doesn't grow as they should in the womb
being over 35 years of age
smoking, drinking alcohol or misusing drugs while pregnant
being obese – having a body mass index above 30
having a pre-existing physical health condition, such as epilepsy

Your baby's growth

Your midwife will check the growth and wellbeing of your baby at each antenatal appointment and plot the baby's growth on a chart.

Every baby is different and should grow to the size that's normal for them. Some babies are naturally small, but all babies should continue to grow steadily throughout pregnancy.

If a baby is smaller than expected or their growth pattern tails off as the pregnancy continues, it may be because the placenta isn't working properly. This increases the risk of stillbirth.

Problems with a baby's growth should be picked up during antenatal appointments.

Your baby's movements

It's important to be aware of your baby's movements and know what's normal for your baby.

Tell your midwife immediately if you notice the baby's movements slowing down or stopping. Don't wait until the next day.

See preventing stillbirth for more information.

Page last reviewed: 16 March 2021
Next review due: 16 March 2024

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Stillbirth associated with prolonged sleep in late pregnancy

American scientists have found that among stillbearing women there is a high percentage of those who slept more than nine hours a day in late pregnancy. Despite the fact that the authors of the work do not draw conclusions about the dangerous effect of prolonged sleep on fetal survival, they suggest that this relationship may be due to the fact that sleep is characterized by minimal blood pressure, which can adversely affect the course of pregnancy. Article published in journal Birth .

The stillbirth rate in late pregnancy (28 weeks and beyond) is approximately 2.3 percent in developed countries. Among the factors influencing the birth of a stillborn, there are various medical conditions (in particular, preeclampsia - a form of late toxicosis of pregnant women, characterized by high blood pressure), smoking, obesity and the late age of the mother.

In a new study, scientists led by Louise O'Brien of the University of Michigan Medical Department set out to investigate the relationship between women's sleep hygiene in late pregnancy and the likelihood of further stillbirth. The study was conducted in the form of an Internet survey: 633 women took part in it, who provided information on age, socioeconomic status, medical conditions, bad habits, body mass index and other indicators. The researchers also asked women in detail about their sleep hygiene: how much they sleep, how often they wake up at night, and in what position they sleep.

Of all the women who answered the question, 153 had a stillbirth at 28 weeks' gestation or later, and 480 had a live birth or were still pregnant at the time of the interview.

Researchers found that women who reported a stillbirth were 63 percent more likely to report more than 9 hours of sleep in their last month of pregnancy, and were less likely to wake up in the middle of the night.

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