Stillbirth After the months of anticipation, it's hard to imagine anything more devastating than the loss of a newborn child.

In this article

Why do stillbirths happen? Risk factors

Warning signs If the worst happens

Next steps Coping

Stillbirth is the term used to describe when a baby dies, either in the womb or during labour, and is delivered on or after the 24th week of pregnancy.

In 50 per cent of cases the reasons for death are unknown

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 50 per cent of cases the reasons for death are unknown.

Where the cause of death is identified, the most common reason (15 per cent) is because of physical defects. Other possible causes include a birth trauma, for example the umbilical cord can become wrapped around a baby's neck.

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

There's a need for more research into the medical conditions that cause stillbirth. However, better antenatal care has been identified as crucial in improving a newborn's chance of survival, especially with regard to monitoring the baby. The Confidential Enquiry into Stillbirths and Deaths in Infancy (CESDI) - now known as the Confidential Enquiry into Maternal and Child Health (CEMACH) - found that in a review of 122 cases of stillbirth in 1996-97, 45 per cent had 'sub-optimal care'.

Many stillbirths are preceded by growth restriction or a reduction of foetal movement over a period of 24 hours or more.

Never feel you're bothering health staff, even if no problem is found

If you've any concerns that your baby's gone quiet, don't hesitate to contact a midwife or GP. Never feel you're bothering health staff, even if no problem is found. Some women may go into spontaneous labour, so it's vital to seek immediate help at the first sign of any bleeding.

When 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 will be offered a slow-acting oral tablet to soften the neck of the womb and induce labour, and will often be able to go 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.

One of the many difficult aspects for parents is grieving for a child only they knew.

At most hospitals, if a baby's 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, even after an autopsy, but it may yield information that could lower the risks in future pregnancies.

The placenta's often examined for any indications as to why the baby died. For example, the placenta may be more mature than it should be, resulting in malnourishment. 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 will advise you about your legal responsibilities in the event of a stillbirth. If your baby was born after 24 weeks, their body must be buried or cremated, and the baby's stillbirth must be registered. A proper funeral has been shown to help couples going through the trauma of losing a child.

There's an excellent factsheet explaining what to do when a child dies on the Great Ormond Street Hospital for Children website.

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. Very commonly, losing a baby results in a deterioration of a couple's sexual 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.

In all cases, it's vital to take things at your own pace and not try to 'get over' the experience and return to your everyday routine before you're ready.

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