When a Baby is Stillborn
What is stillbirth?
The medical definition of stillbirth is the birth of a baby who is born without any signs of life at or after 24 weeks pregnancy. The baby may have died during pregnancy (called intrauterine death), labour or birth. Stillbirth is uncommon. In the UK, just over one in 200 births ends in stillbirth, which equates to around 4000 per year.
What happens when a baby dies in the uterus?
When a baby dies in the uterus (womb), the devastating truth is that the mum still has to go through with the birth. The loss of your baby will have come as a great shock. You may not be thinking about yourself at all, but doctors still have to advise you about what’s best for your health.
They should be sensitive to your feelings while explaining what happens next. Your labour will usually have to be started artificially (induction). Your doctors will discuss this with you and give you time to absorb what they have said before starting to induce your labour.
Some parents want to have the induction as soon as possible. Others prefer to wait for a few days so that they have time to take in what has happened and to see if labour starts by itself.
You may feel too numb to make a decision. All the while, your doctors will be concerned about your health. If they think there’s a chance you may have an infection, they’ll advise you to have an induction straight away. Whether you are induced or go into labour naturally, you will be admitted to the labour ward at hospital.
If you are expecting twins or more, and the death of one baby has been discovered, your doctor may advise you not to be induced. A lot will depend on whether or not the babies share a placenta, and at what stage the loss occurred. Your doctor may say it’s best to give your other baby or babies a chance to develop and mature a bit longer in your uterus.
Your babies can then be born at the same time, when it’s best for your remaining, healthy baby or babies. Some parents are upset by the idea of carrying the babies together in this way, although others find it comforting.
What happens when a baby dies during birth?
It’s uncommon that a baby dies unexpectedly during labour or birth. When something goes wrong, it is a highly traumatic and frightening experience for parents. They may not understand what is going on, as hospital staff may be too busy dealing with the emergency to explain things clearly.
Later, it may be discovered that an abnormality or an infection led to the stillbirth. However, in most cases it’s because of something that happened during labour or birth. A problem with the placenta or umbilical cord, such as a knot in the cord, may mean the baby did not have enough oxygen.
What causes a baby to be stillborn?
It’s not always possible to find out what has led to the death of a baby. It’s the one question that parents want answered, why their baby died. Unfortunately, in just under a third (28 per cent) of cases, doctors cannot tell them.
However, we do know of some factors that may lead to stillbirth:
- A baby simply did not grow enough in the uterus.
- A genetic or physical defect in the baby. This means the baby’s brain, heart or other organ has not developed properly.
- Heavy bleeding after 24 weeks of pregnancy. This can happen when the placenta begins to separate from the lining of the uterus. It is called a placental abruption.
- Pre-eclampsia, which can reduce blood flow to the baby via the placenta. This condition is associated with placental abruption.
- An illness suffered by the mum, such as diabetes, the liver condition obstetric cholestasis, or a blood-clotting problem.
- A problem with the way the baby is born. A baby’s shoulders may get stuck as he leaves the birth canal (shoulder dystocia), severely reducing oxygen flow to him.
- Infections, such as listeriosis, salmonella or toxoplasmosis.
Many stillborn babies are premature or smaller than they should be for their stage of pregnancy.
What happens after a baby is stillborn?
You may be asked if you would like to see, touch or hold your baby. This is a highly individual decision. Some parents may find it a help in the longer term to see their baby, others not.
Your instincts may be to see and cuddle your baby, but worries about what he or she might look like could hold you back. To help you to decide what is right for you, the midwife or doctor can describe your baby to you. Maybe one partner could look first, or you and your partner could look at a photograph of your baby. Some people know instinctively that they don’t want to see their baby, while others choose not to for religious or cultural reasons.
Many parents find comfort in creating memories of their baby. Photographs, hand or foot prints or a lock of hair become cherished keepsakes, giving parents a focus for their grief. Some parents want to wash and dress their baby. These are overwhelming, natural instincts. However, sadly, it’s not always practical for this to happen. If a baby is very premature or died some time ago, his skin will be too fragile for this type of handling.
Decisions about what to do in this situation are very personal. There is no right or wrong way to respond. One parent may have different wishes to the other, or they may both need time to think about what would be best for them.
Some parents or members of their family want to observe religious rituals to mark the loss of the baby.
Most maternity wards have a bereavement room or quiet room where parents and their families can be together after their loss. Others may prefer to visit the hospital chapel or a multi-faith room. Whatever you ultimately decide to do in the hours or days after your loss, the hospital staff should support you in your decision and respect your wishes. Some hospitals have a bereavement midwife who is specially trained to give support.
Is it possible to find out what went wrong?
If doctors aren’t sure what caused a baby’s death it can sometimes be discovered by various investigations. These may include testing the mum’s blood, examining the placenta, or carrying out a post mortem examination (autopsy) of the baby. A post mortem examination may:
- identify a cause or causes of death;
- provide information about your baby’s development;
- provide information about health problems which will help your doctor to care for you in a future pregnancy;
- confirm the baby’s sex.
Not all parents agree to tests and a post mortem. It’s up to you whether you give the go-ahead. A post mortem will only be done with your written consent.
You can refuse for whatever reason you like, be it personal, religious or cultural. Sometimes, even with these investigations, a reason for stillbirth cannot be found. It can be very upsetting not to have an answer to all your questions. It’s hard to come to terms with how such a devastating event can happen, apparently for no reason.
You should be given plenty of information about the post mortem. Doctors will tell you why it may help, what will happen to your baby and how he may look afterwards. Do make it clear if you’d rather not know the details. You may decide you want to say goodbye to your baby before the post mortem. But in many cases, you’ll be able to see your baby again afterwards, if you want to.
The important thing is to take time over your decision, and be sure about how and when you want to say goodbye to your baby. Whatever you decide about the post mortem, your views and wishes should be respected. If you go ahead, you should be told when the results are likely to be available. You’ll be given an appointment to discuss them with your doctor.
What does it mean for my next pregnancy?
The decision to try for another baby can be difficult. It may be the last thing on your mind, or it may be all you can think about. For some mums, there is an overwhelming urge to be pregnant again as soon as possible.
You may be offered a check-up six weeks after your previous pregnancy ended, which may take place at the hospital with a consultant obstetrician. This is a good chance to ask questions that have occurred to you now you’ve had time to think. If you’re ready to talk about it, it also gives you a chance to discuss trying for another pregnancy. At times you may have a six week check-up with your GP and then follow up with a hospital appointment at a later date, when they may have more information for you.
Waiting a while, perhaps six months or so, before trying to conceive again does give your body a chance to recover. Because of this, it may also give your next baby a good start. Some parents wish to plan their next pregnancy so that none of the significant dates coincide with those of the baby they’re grieving for.
If you’ve had an unexplained stillbirth, it may be comforting to know that there’s no reason why it should happen again. If your baby had a genetic abnormality you may be referred for genetic counselling. This process will enable you to discuss your options for a future pregnancy.
If you had health problem last time then you and your doctor may be able to work together to reduce your risk of another stillbirth. This is especially the case if there was a problem with the placenta or your baby’s growth. Extra monitoring and tests can reduce the chance of you experiencing another loss.
If you do get pregnant again in the future, it’s likely to be an anxious time for you. It may bring back lots of unwelcome memories and emotions related to your loss. Your anxiety is perfectly understandable. This pregnancy may feel like the longest nine months of your life. You’ll probably feel uneasy until your baby is safely in your arms.
The Mariposa Trust has a special division called GrowingYou which offers support to anyone who has lost a baby, who is now pregnant again (or thinking of becoming pregnant again). Visit the GrowingYou website, or contact via Twitter @GrowingYouInt or facebook.com/GrowingYouInt, our hope is that the team will make you feel less alone, and will help bring you much needed support.
Some mums are happy to return to the same hospital and the same medical team. Others prefer to ask their GP to refer them to another consultant or another hospital.
All information on this website, and advice and support offered by the charity team is on a non-medical basis. The charity advises that anyone going through baby loss, medical treatment or health issues, should seek advice from their own GP, Consultant, Midwife or Healthcare Professional.Download the Saying Goodbye Support Leaflet (PDF)