What causes a baby to be born stillborn

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 choices. 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: Definition, Causes & Prevention

Overview

What is a stillbirth?

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?

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?

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 choices. 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?

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.

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.

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.

Prevention

Can a stillbirth be prevented?

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?

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?

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

How long after a stillbirth should I get pregnant again?

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.

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?

What can I do to cope with a stillbirth?

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

No name, no benefits: stillborn parents have no rights | Estonia

Parents of stillborn children consider it unfair that they cannot give the child an official name and are not entitled to benefits and compensation. Minister of Social Affairs Signe Riisalo promises to bring the issue of childbirth allowance to the government for discussion.

Agnes' second pregnancy went well. She was glad that her son Bjorn would have a brother. “I immediately felt pregnant,” says Agnes Pitka.

"We were very calm, prepared, told our son that he was already an adult and would soon have a brother. There were no hints that something was wrong," adds Agnes' husband Matti Orav.

Their baby was due on Mother's Day, May 10th.

"Last Mother's Day was wonderful. The sun was shining, it was warm. That was the last day I felt the baby move," Agnes recalls.

Then she took a picture of her belly, but the sensations were not the same. She now realizes that by then the baby was dead.

“I went to bed that evening and didn’t feel him. It was unusual, he always moved before I fell asleep. The next day I put my eldest son to bed and realized that everything was bad,” the woman recalls.

At that time, Agnes still hoped that she was just tired of the long wait, but she called the midwife, and she told her to urgently come for a check-up. In May, the state of emergency was still in effect, and she had to travel alone.

"She looked and didn't tell me anything, got up and left. The second doctor came and they mentioned that the heart was not working. I asked if the baby was dead and they said yes," continues Agnes.

She was sent home. The next day, she had to return to the hospital to give birth to her dead baby.

"The next day I took Agnes to the hospital, and I went with my son to the village. The child fell asleep on the way. I thought about what Agnes was doing, how difficult it was for her, but there was nothing I could do. And then I cried" , - Matti admits.

They talked to Agnes by phone. After the birth, the father named the boy Miykael.

Only a few photographs now remind parents of him: one photograph was secretly taken by his mother during an ultrasound examination, and the second after his birth, as the crisis counselor advised her to do. My father was able to see Miikael and say goodbye to him only in the crematorium. The parents have not yet committed the ashes of the boy to the ground.

Doctors investigated the causes of death, but received no answers. It is worth noting that in about half of the cases, the cause of intrauterine fetal death remains unknown.

Matti and Agnes are not alone in their tragedy. Last year, 28 children were born dead in Estonia, in previous years their number reached 50.

After the death of a child, grieving and shocked parents find themselves in a labyrinth of incredible bureaucracy, unexpected and unfair. For example, a stillborn child cannot be officially given a name, is not entered in the Population Register and is not assigned a personal code.

Many of these children are buried in the so-called Silence Cemetery in Harju Risti. The gravestone is the only place where you can write the name of the child.

Comrades in misfortune are united by the NGO "Children of Silence", led by Triina Tints, who also survived the death of her child before his birth.

"Sounds like a small thing, but it's important for parents to have their child's name officially recorded. Not just on the gravestone," Tints says.

Marika Lass, a social worker at the Ida-Tallinn Central Hospital, who helps families through the period of grief, also faces the desire of parents to give a name to a stillborn child every time. These parents have virtually no rights.

"Every time we see helplessness and confusion. We explain that the name of the child can be written on the monument, but it will not be in the registers" - Lass believes that this state of affairs cannot be given any reasonable explanation.

Agnes Pitka also calls this circumstance the most unpleasant. “I wanted to register the birth of my child, that I have two children. But he is not in the Population Register,” she states.

If her son had had time to take at least one breath after the birth, then he would have been given a name and a personal code, and the family would have received state childbirth benefits.

In case of intrauterine death of the fetus, a death certificate is not issued, as this requires a personal code. In such cases, only a death notice is issued, and even officials do not navigate their bureaucracy.

"When I went for a death notice, they asked me what the child's name was. I had to explain that my child did not have a name, and I came for a death notice. They looked like a fool, because I came for a death certificate of a child, What was your name? I eventually received this piece of paper, my name and gender of the child were written on it, "says Agnes.

The next surprise was the fact that the father's name is also not written anywhere. “That is, it was as if the father did not exist. I was not the only one who made this child,” Agnes is indignant.

"Such nuances come to light, a person should not do this. To prove whether you had a child or not. And it's so difficult, why complicate people's life even more," Matti wonders.

Ten years ago, stillborn children could be given a name, given a personal code and entered in the Population Register. Then the law was changed, and stillborn children officially became nameless.

"This was due to the fact that if a stillborn child is allowed to be entered in the Population Register, then this possibility should be from the 22nd week of pregnancy. But parents of very premature babies may not want to give a name or draw up any other documents ", - explains the head of the department of population and family policy of the Ministry of the Interior Lea Danilson-Yarg.

According to international standards, birth is the birth of a child after the 22nd week of pregnancy. It is by this time that all vital organs are formed in the fetus. Otherwise, we are talking about abortion. In Estonia, about half of stillborn babies are full-term, and parents want them to have a name.

It was Danilson-Jarg's department that began to look into the matter after ERR raised the issue of unequal treatment of families last November. Then the process was headed by the Minister of Population Riina Solman, who recognized the shortcomings and promised to look for a solution. But the government changed, and the post of Minister of Population was abolished.

Unnamed children

The Population Register is administered by the Ministry of the Interior. According to Danilson-Yarg, the issue of the names of stillborn children can be solved in a different way, without the Population Register.

"The population register is not the only way to give a baby a name. Currently, stillborn babies after the 22nd week of pregnancy are given a death notice. And it has a name and a unique code in its data set. So, according to the Naming Law , parents can always give their child a name, the only question is where this name is documented,” says Danilson-Yarg.

It is noteworthy that last year, when the notorious Naming Law was being approved, the Ministry of the Interior clearly wanted to deprive stillborn children of the right to a name, but the Ministry of Social Affairs did not approve it. The controversial law has not yet been adopted, last week the new government returned it to the Ministry of the Interior.

And if an official claims that it is possible to give a name, then in practice everything is not so.

"The systems are inflexible. We tried in our system to give the child a name and put it on the death notice, but the system doesn't allow it," says social worker Marika Lass.

"The name does not appear on the death certificate, since the deceased does not have a personal code and connection with the Population Register. However, a name can be added to the notice of the cause of perinatal death and to the notice of death using the instructions. Such an opportunity for parents is a health worker must offer before filling out the death notice, because the name does not automatically appear on it. The second nuance is that even if the name is written in the notice, this information does not fall into any databases, "explains the head of the Department of Child Welfare of the Ministry social affairs Hanna Vseviov.

The absence of a name in the register and a personal code is not just a matter of emotions. Numerous practical problems of families are connected with this.

"If a child lives for some time after birth, then parents can give him a name, receive a birth allowance, apply for a funeral allowance. Families in which a child was born dead become victims of gaps in the law and bureaucracy," states Triinu Tints from NGO "Children of Silence".

Benefits - for the living

The question is also about money. Families who, in anticipation of the birth of a child, bought the necessary things and counted on benefits when planning the budget, are left with nothing.

"Of course, we counted on the birth allowance and the maternity salary. Financially, it was a blow," admits Matti Orav.

"Most of the rights, various vacations, benefits, are related to the existence of the child. If the child is born dead, then the parents do not have rights to receive most benefits," Hanna Vseviov confirms.

The government encourages families to have children less than three years apart. In this case, the mother's salary remains at the level at which it was after the birth of the first child. If the child is born dead, then it does not affect the calculation of benefits. This means that if the family, after a traumatic experience, decides to have a child again, then the calculation of the three-year period will begin from the time of the birth of a living child, and not a dead one. It turns out that families who have lost a child are punished doubly.

The situation should change in April next year, when amendments come into force to correct gaps in the law, and time can again be taken into account from the moment of the birth of a dead child.

At the same time, the state gives with one hand and takes with the other. If now maternity and birth leave lasts 140 days, then the new law will not have such a concept and it will be replaced by the term "parental leave". The mother's right to leave in the event of the death of the child will end 30 days after the tragic event.

"It's not fair. If a child is stillborn or dies late, then the family needs time to recover. If the law requires the mother to return to work after 30 days, then this is an unfair law," Lass said.

At the same time, the Ministry of Social Affairs says that the families were simply met halfway, and according to the law, the right to 140-day leave should not apply to them at all.

"In fact, at present there are no legal grounds for paying maternity benefits to these families and providing leave. That is, if there is no ground, then there is a child, but there is no right either. We tried to mitigate this purely for practical reasons, so as not demand the return of benefits, but in fact there are no legal grounds for this at all," Vseviov said.

When a child is stillborn, the family does not receive state benefits, even if they have incurred the costs.

"I loaned my first child's stroller to a friend of mine, so I won't have to see it again. I just gave away the rest of the things," says Agnes.

The topic was passed from the Minister of Population to the Minister of Social Affairs, Signe Riisalo. According to Vseviov, the new minister promised to bring the issue to the discussion of the government.

Missing Fathers

By law, families with a stillborn child cannot take 30 days of paternity leave. Such amendments to the law came into force in July last year. After the news portal ERR highlighted the problem at the end of last year, the Department of Social Insurance, which deals with the payment of benefits and compensations, decided to review the current practice and pay benefits also to the fathers of stillborn children. Last July, 11 dead babies were born in Estonia. Since the state does not have data on them, the search for fathers turned out to be a difficult task.

"We managed to contact three fathers out of 11, they were paid compensation. For the Social Insurance Department, the situation is complicated by the fact that there is no information about these children and fathers," says Vseviov, adding that the only way to find the fathers is to go to hospitals .

From April next year, fathers of stillborn children will also be entitled to 30 days' leave and appropriate compensation.

Various solutions

For parents, it is not a matter of principle for benefits, but for the right to a name. In the ministries involved in the issue, the vision of solving the problem differs.

"We proposed to the Ministry of Social Affairs to supplement the data set with the name of the father. We do not see the possibility of restoring such a mark in the Population Register. The issue should be resolved as soon as possible through a death notice so that the unique code that is entered in it would be the basis for the payment of various benefits and compensation," a spokeswoman for the Interior Ministry said.

"It seems to me that we are now going in circles, looking for a solution and reviewing various registers and ways of transmitting data, but in fact we have a place that allows us to solve all these problems. We will definitely come up with a proposal to enter data on such children in the Register population,” says Vseviov of the Ministry of Social Affairs, referring to the restoration of the old order.

Agnes Pitka and Matti Orav most of all want their child to receive an official name - Miikael Orav - at least in hindsight.

"He was born at 41 weeks. He was human," explains Agnes.

The Ministry of Social Affairs promises to listen to the wishes of the parents.

"I don't see any reason why it would be impossible. After all, we write laws for the people," says Vseviov.

possible causes, pregnancy management, childbirth, consequences for the woman and medical advice

A stillborn is a child who was stillborn or died during childbirth at or after 24 weeks of gestation. Until this time, premature birth is considered a miscarriage, the fetus is frozen, and the dead fetus is disposed of as biological waste. The longer the pregnancy, the more difficult it is for a woman to accept the death of a child. Features of the course of pregnancy, types of delivery and the consequences of the birth of a dead child will be considered further.

How to recognize fetal death during pregnancy?

In addition to regular visits to the gynecologist, a pregnant woman is able to independently assess the viability of her child by constantly monitoring his movements. In the first pregnancy, a woman begins to feel the movements of the fetus after twenty weeks, in subsequent ones - after sixteen. From this moment on, you should always record how often and intensively the baby moves. If there are any deviations from the usual regimen, this is an occasion to urgently consult a doctor. Especially when the cessation or reduction of movements is accompanied by bleeding.

The doctor will first listen to the fetal heartbeat. If it is not heard, the woman will be sent for an ultrasound examination, where the ultrasound specialist will accurately determine whether the child is alive. It may even be possible to find out the cause of the child's death by identifying pathologies that are incompatible with life.

Delivery

After the intrauterine death of the child is established and reliably confirmed, the woman is given a referral for the necessary tests and is prepared for delivery.

If we are talking about a short period, then it will be an abortion, which is relatively easy and painless for most women, since the procedure is carried out under anesthesia, and the woman wakes up already without a fetus.

If the gestational age has crossed the threshold of twenty-four weeks, then the pregnant woman will have to undergo a serious test, physical and psychological. After preparation, the woman will be injected with the hormone oxytocin, which will provoke uterine contractions and the onset of natural childbirth. After going through contractions and attempts, as in the case of ordinary childbirth, a woman will be resolved from a stillborn child.

Death during childbirth

Another option is the death of the child during childbirth. Such cases are carefully investigated, as there are many possible causes of death of a child in childbirth. From natural, physiological, for example, the birth of a premature non-viable fetus or having multiple pathologies. To the negligence of the maternity hospital staff, who, with their unskilled actions, or inaction, provoked the death of the baby. In this case, the perpetrators will receive a well-deserved punishment.

After such tragic events, some parents want to see their child and say goodbye. You should not rush to such a decision, a child born much prematurely, or having multiple malformations, can cause great harm to the psyche and fear of future pregnancies. It might be worth talking to a psychologist about it. If parents are sure of their choice, hospital staff should not prevent them from saying goodbye to a stillborn child.

He was born dead: why?

A stillborn child was born in the family, what should I do? First, find out why. A baby can be stillborn for a variety of reasons. They need to be found out. For this, a forensic medical examination is prescribed. During the examination, samples of the placenta and umbilical cord are examined, genetic analyzes and an autopsy of the baby are carried out. It will be difficult for parents, but you need to understand that finding out why the child was born dead is the only way. In addition, research can be useful for the future of the family. If the child was not viable due to genetic abnormalities, then before planning the next pregnancy, it is imperative to consult a geneticist, perhaps there is a defect in the genes of one of the parents that will not allow them to become biological parents, and it will be better to consider alternatives.

If a stillborn baby was born due to an accidental mutation or infection, then after appropriate treatment, you can continue trying to give birth to a healthy baby.

Autopsy

An autopsy is an obligatory item in the study of the causes of death of a child. Parents have the right to refuse it for personal, religious or any other beliefs. The staff of the maternity hospital is obliged to provide them with full information about the procedure, its goals and the results that it can give. You should not think too long, because the sooner an autopsy is performed, the more comprehensive information can be gleaned from it.

Causes

There may be several reasons for the appearance of a stillborn child:

Delay in the development of the fetus. This may be due to the failure of the placenta or deviations in the formation of the fetus itself.
Placental abruption. In the case of this pathology, nutrients cease to flow from the mother to the fetus, and it dies.
Congenital anomalies of the fetus. They are caused by genetic abnormalities and chromosomal defects, they are usually multiple and do not allow the child to survive.
Infections and viruses. Sexually transmitted diseases are of particular danger, so it is very important to undergo all examinations and, if necessary, treatment in preparation for pregnancy or at its first stages. This will protect the unborn child from developmental disorders.
Inferiority of the umbilical cord. Through the umbilical cord, the fetus receives oxygen and nutrients, if it is insolvent, then hypoxia and fetal death can be a possible complication.
Profound prematurity. Currently, the obligation of doctors to nurse children weighing 500 g or more is enshrined at the legislative level, but due to their immaturity, this is not always possible.
Preeclampsia.
Rh-conflict of mother and child, when the mother has a negative Rh factor, and the father and child have a positive one. The mechanism of development of this pathology is not fully understood. For some reason, some women develop it, while others do not. In any case, vaccines have now been developed that must be administered at certain stages of pregnancy and after childbirth, and you also need to regularly donate blood for antibodies.
Other causes such as hypoxia during childbirth, cord entanglement, birth trauma.

Risk group

No one is immune from fetal death, but there are risk factors that must be taken into account:

If a woman has already had unsuccessful pregnancies and the first child is stillborn.
Woman suffering from hypertension and pre-eclampsia.
A woman has a history of chronic diseases: diabetes, pyelonephritis, thrombophilia, endocrine disorders.
Serious complications of pregnancy.
Bad habits: smoking, alcoholism, drug addiction.
Multiple pregnancy. The greater the number of children, the greater the risk of stillborn children. Why is the maternity hospital so scrupulous about multiple pregnancies? Precisely because various risks are increasing.
The pregnant woman is obese.
Pregnancy occurred as a result of IVF.
Too young or too old.

How to prevent

When planning a pregnancy, both parents-to-be should be examined and, if necessary, treated.

In the presence of chronic diseases, it is necessary to warn the gynecologist about this as early as possible, so that he knows what nuances to pay attention to. If a pregnant woman takes medications, it is necessary to coordinate this with the doctor and, possibly, replace it with safer ones for the fetus.

Be sure to take folic acid from the first days of pregnancy and multivitamins as prescribed by your doctor.

In case of problems with obesity, weight loss is the best preparation for pregnancy.

Bad habits should also be left for a later period.

Bleeding should be taken very seriously and should not be expected to go away on its own. You should immediately consult a doctor, perhaps it is placental abruption.

It is good if a pregnant woman has the habit of counting fetal movements every day. This will allow you to notice the slightest deviations from the normal activity of the fetus.

What to do next

Parents must obtain documents for a stillborn child. In this case, no benefits are provided, except for sick leave for pregnancy and childbirth, but it is necessary to confirm the fact of his birth.

Where do stillborn babies go? Parents themselves decide whether to bury or cremate their child and organize the ritual.

If the family is poor, you can apply to the social security authorities for material assistance for burial.

How to cope with pain

Of course, it is extremely difficult for a mother to go through such an event in her life. A stillborn child was born in the family, how to live on? Returning to a normal lifestyle is not easy, especially if everything was prepared for the child: a stroller was bought, a crib was assembled, things were washed and ironed for discharge from the hospital. The father of the child and other relatives should support the woman as much as possible, and make the discharge from the hospital as traumatic as possible. It may be better to remove all reminders of the child from the house, but it is worth gently discussing these issues with the woman and asking her opinion, because she may perceive this as a betrayal.

A man needs to show patience and care, because his wife will be in deepest stress at first. Perhaps the family should see a psychologist. The specialist will help to accept and survive the loss, tune in to the future. The main thing is not to move away from each other and support in such a difficult situation.

What happens to the body

Rehabilitation of a woman after the birth of a stillborn child is similar to the consequences of conventional childbirth. In the first few days, the so-called lochia, bloody discharge, will abundantly come out of the vagina. Pain, similar to menstruation, in the lower abdomen indicates a contraction of the uterus.

The most unpleasant thing will be the arrival of the milk. The body is ready to feed the baby. You can just wait and be patient until it burns out on its own, or use medication to stop lactation.

Psychologically, it will be easier to lie apart from mothers who have given birth, who will feed and be touched by their children. It is better to leave the hospital as soon as possible if there are no health problems.

6-8 weeks after discharge, you need to come to a scheduled examination by a gynecologist. He will evaluate how the uterus has contracted, what kind of discharge will be at that time, whether there are any inflammatory processes.

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