Stillbirth

Stillbirth is the term used to describe loss of a baby before birth, with death occuring in the uterus or during labour, on or after the 24th week of pregnancy.

Why do stillbirths happen?

The cause of many stillbirths is unclear, and while there's increasing evidence of a strong link between stillbirth and poor growth in the womb, in many cases the reasons for death are unknown.

Where the cause of death is identified, the most common reason is because of congenital problems that mean the baby cannot survive. Other possible causes include a birth trauma, for example the umbilical cord can become wrapped around a baby's neck.

Risk factors for still birth

Very rarely, stillbirths can occur unexpectedly in healthy pregnancies, but there are also several known risk factors, including:

• Multiple pregnancies
• Smoking during pregnancy
• Pre-existing health problems, such as high blood pressure or diabetes
• Eclampsia in the mother

Good maternity care has been identified as important in reducing the risks of stillbirth. The Centre for Maternal and Child Enquiries (CMACE) - found that in a review of 122 cases of stillbirth in 1996-97, 45 per cent had 'sub-optimal care' antenatally or during labour.

Warning signs

Many stillbirths happen after the baby has shown signs of growing very slowly, or if the baby appears to have stopped moving as much for a period of 24 hours or more. If you have any concerns your baby seems to have gone quiet, don't hesitate to contact a midwife or GP. Never feel you're bothering health staff, even if no problem is found.

You should also seek immediate advice if you start to bleed from the vagina, or if you have any signs that you’re going into labour early.

When it’s known a baby has died in the womb, the vast majority of women opt for an induced labour. Caesarean sections aren't recommended because there's a high risk of bleeding. Women are offered a slow-acting oral tablet to soften the neck of the womb and induce labour, and then there may be the option to return home to wait for the onset of labour (usually within about 48 hours).

Maternity units try to create a quiet and low-key environment for a women delivering a stillborn child, with as few staff as possible, perhaps just one midwife.

The majority of parents want to see and hold their baby after delivery. Some find it helpful to take a photo of their child. Experience has shown that this can help make the baby's existence and death a reality that can be shared with family and friends.

Next steps

At most hospitals, if a baby is stillborn the parents are asked for their consent for a post mortem. It's entirely their choice. A full explanation as to why a baby has died may not be possible, but the investigation may show up information that could lower the risks in future pregnancies.

The placenta is often examined for any indications as to why the baby died. For example, the placenta show signs it may have ceased to nourish the baby adequately. The mother may also be offered blood tests to determine if an underlying disease, such as the autoimmune disease lupus, caused the stillbirth.

Bereavement counsellors at the hospital can advise about legal responsibilities in the event of a stillbirth. If your baby was born after 24 weeks, the body must be buried or cremated, and the baby's stillbirth must be registered. A funeral, religious or otherwise, can be a source of comfort and support, and a means of acknowledging the importance and sadness of the loss.

Coping with the death of a baby

You'll be offered bereavement counselling and, although you may not feel like it at the time, it helps to have someone to talk to who isn't a friend or relative. Although a stillbirth may initially draw a couple together, it also places severe stress on the relationship. SANDS, the Stillbirth and Neonatal Death Society, can help by putting families in touch with each other, and it offers skilled advice and information.

Take things at your own pace without any expectation that you ought to try to 'get over' the experience, or return to your everyday routine before you're ready.