Stillbirth Awareness

Key Points

  • Some pregnant people are more likely than others to have a stillbirth. Reducing risk factors may help you prevent stillbirth.
  • We don’t know what causes all stillbirths. Some known causes include infections, birth defects, and pregnancy complications.
  • The most common symptom of stillbirth is when you stop feeling your baby moving and kicking.
  • Grief and bereavement resources are available to support you and your family if you experience a stillbirth.
  • Most people who have a stillbirth and get pregnant again have a healthy pregnancy and healthy baby.

What Is Stillbirth?

Stillbirth is when a baby dies in the womb after 20 weeks of pregnancy. Most stillbirths happen before a pregnant person goes into labor, but a small number can happen during labor and birth. In most cases a healthcare provider will diagnose the stillbirth and take steps to intervene before the due date. Stillbirth and miscarriage both describe pregnancy loss, but they happen at different points in time. A miscarriage is the loss of a baby before 20 weeks of pregnancy. Stillbirth is the loss of a baby at or after 20 weeks of pregnancy.

How Common Is Stillbirth?

Stillbirth affects 20,000 or more U.S families every year. In Washington, the stillbirth rate is similar to the national rate (57 per 10,000 births).

Certain groups experience stillbirth more frequently than others. In Washington, this includes people who are American Indian/Alaska Native, Black, and Native Hawaiian/Pacific Islander. Stillbirth is also significantly higher for pregnant people older than 40.

Who Is At Risk Of Having A Stillbirth?

Risk factors are things that increase the risk for a disease or condition. Some risk factors are things that can’t change, like having a history of stillbirth in a previous pregnancy. Other risk factors are things that can change, like quitting smoking.

Risk factors for stillbirth include

Medical Conditions

  • Higher weight
  • Diabetes
  • High blood pressure
  • Substance use

Pregnancy conditions and history

  • having never given birth before
  • having a miscarriage or stillbirth in a previous pregnancy
  • having a pregnancy with multiples (twin or more)
  • having a pregnancy after the age of 40
  • having intrahepatic cholestasis of pregnancy

Environment and Resource Access

  • Living in an environment with limited access to prenatal care
  • having limited access to social support

Health Disparities And Racism

Stillbirths happen more often among people that give birth who are American Indian/Alaska Native, Black, and Native Hawaiian/Pacific Islander compared to other racial and ethnic groups.

Being a person of color is not a cause for having a stillbirth. However, communities of color are affected by racism. People from racial or ethnic minority groups who live in a racist society are more likely to experience chronic stress and experience inequity and mistreatment when receiving health care. These factors, among others, impact pregnancy related health conditions including having a preterm or low birthweight baby.

Healthcare providers have an obligation to provide safe and quality maternity care that respects a person’s values and beliefs, no matter their race, sexual identity, or religious background. Many community organizations, doulas, and birth workers in Washington, including those involved in the Birth Equity Project, work to reduce the racism experienced by pregnant people of color.

What Causes Stillbirth?

While there is still a lot we don’t know about what causes stillbirths, the most common known potential causes include:

Infections in the birth parent or baby

Problems with the placenta or umbilical cord

  • Placental problems (infections, blood clots, inflammation) cause about 24% of stillbirths.
  • Umbilical cord problems cause about 10% of stillbirths. This can include having a knot in the cord or the cord being pinched so the baby does not get enough oxygen.

Complications during pregnancy

  • Being pregnant for longer than 42 weeks
  • Diabetes, higher weight, high blood pressure, preterm labor or premature rupture of the membranes
  • The blood of the fetus passing into the blood of the pregnant parent
  • Trauma or injuries (like from a car accident)
  • Health conditions like lupus, thrombophilias and thyroid disorders.

Conditions in the baby

  • Birth defects and genetic conditions
  • Fetal growth restriction (fetus not growing at the rate expected)
  • Not getting enough oxygen during labor and birth
  • Rh disease: A disease that occurs during pregnancy. This disease happens when your blood is Rh-negative and your baby’s blood is Rh-positive. This means your blood and your baby’s blood are incompatible, so it’s not safe for them to mix together. It may also happen if the birth parent and baby have different blood types. Rh disease can be prevented. Almost all people will have a blood test to learn their blood type early in pregnancy

Can I Prevent Stillbirth?

While some stillbirths are preventable, not all are. Even individuals who have a low risk may experience stillbirth. The best way to prevent stillbirth is to have as healthy a pregnancy as possible.

Steps for a Healthy Pregnancy

  • Get Recommended Vaccines: Vaccinations recommended during pregnancy can help protect you against infections that can harm you and your developing baby.

    If a pregnant person catches COVID-19, there is a higher risk of stillbirth. However, getting vaccinated against COVID-19 can help protect you. Research suggests that COVID-19 vaccination was associated with a 15% decrease in stillbirth risk.
  • Get the Nutrients You Need: Vitamins and minerals play important roles in all of your body functions. Eating healthy foods and taking a prenatal vitamin every day should supply all the vitamins and minerals you need during pregnancy. When you are pregnant you need 600 micrograms of folic acid each day. Folic acid is an important vitamin that can prevent birth defects.

    Resources: Nutrition During Pregnancy | ACOG |Folic Acid Recommendations
  • Manage Diabetes: Gestational diabetes, which is diabetes that occurs during pregnancy, is linked to a higher risk of stillbirth. Diabetes can affect how the placenta grows and works, which can increase the chances of stillbirth.

    Resources: Management of Diabetes in Pregnancy

Tracking Baby’s Movement (Kick Counts)

Sometime between 16 and 28 weeks of pregnancy, you’ll probably start to feel your baby move. Tracking (counting) your baby’s kicks can help you be more aware of fetal movements. Changes in fetal movement may be an early sign of distress. If you think your baby is moving less than usual, call your doctor or midwife.

Many apps and guides exist to help track fetal movement:

What if I Suspect My Baby Is Stillborn?

The most common symptom of stillbirth is when you stop feeling your baby moving and kicking. Some people can also experience cramps, pain, or vaginal bleeding. Call your health care provider right away, or go to the emergency room, if you experience any of these symptoms.

When you visit your health care provider , they will use an ultrasound to see if the baby’s heart has stopped beating. An ultrasound uses sound waves and a computer screen to show a picture of the baby in the womb.Your provider will also discuss recommendations for giving birth, genetic counseling, and recommendations for future pregnancies.

What Happens If I Have A Stillbirth?

If you experienced a stillbirth your healthcare provider will talk with you about the options for delivery. When and how you give birth will depend on how far along you are in your pregnancy and what you think is best for you and your family.

Your provider may recommend:

  • Dilation and evacuation (D&E): This is a surgical procedure where the provider removes tissue from the lining of the uterus.
  • Inducing labor: This is when your provider gives you medicine or breaks your water to make labor start.
  • Cesarean birth (c-section): This is a surgery where your doctor makes a cut in your belly and uterus to deliver the baby.

Your provider may check the baby, the placenta, and the umbilical cord to try and figure out why the baby died. Your provider may also ask you to do tests to help figure out what happened. Tests can include:

  • Amniocentesis (amnio): Your provider will take some amniotic fluid from around the baby in the uterus to determine if there is a genetic condition or infection that may have caused the stillbirth
  • Autopsy: This is a physical examination of your baby’s body. The provider will check for birth defects or other conditions
  • Genetic Tests

After delivery, do what feels right for you and your family. You may want to spend time alone with your baby and other family members. You can name your baby, hold your baby, bathe and clothe them and take part in cultural or religious traditions, like baptism. Some families take pictures of their baby, make footprints or save locks of hair. You may be able to keep things from the hospital, like blankets, that were used with your baby. Keepsakes like these can help you and your family remember your baby.

Resources For Loss And Grieving

Having a stillborn baby is a painful loss. Parents who have a stillbirth need time to grieve. You may cope with grief in different ways, and you may need help dealing with others as you grieve. These resources can help in the grieving process.

Emotional Recovery And Support

It’s normal to experience a wide range of emotions after a stillbirth. You may move from feeling shell-shocked or intensely sad to being filled with rage or feeling numb.

Experiencing a stillbirth can put you at risk for depression, anxiety, and PTSD. Though there is no “normal” way to feel after a stillbirth, you should let your doctor or midwife know if you’re experiencing symptoms such as:

  • Feeling persistently sad or hopeless
  • Having trouble sleeping
  • Having trouble eating or eating more than usual
  • Losing interest in the things you normally enjoy
  • Feeling worthless
  • Having thoughts of harming yourself

You can also call or text the Perinatal Support Washington Warm Line (1-888-404-7763) or the 988 Suicide & Crisis Lifeline.

Getting Pregnant Again After Stillbirth

If you decide that you want to get pregnant again, you may be worried about losing another baby. These kinds of feelings are normal, and they may be hard to shake completely. But the comforting truth is that the vast majority of people who experience a stillbirth go on to have healthy pregnancies and babies.

Your health care provider will keep a watchful eye on you to make sure things are progressing normally. You may receive more frequent tests to assess the baby’s heart rate and movement.