Every expectant woman wishes to carry their pregnancy to full-term without any complications. However, sometimes stillbirths do occur putting an end to the expectations. Stillbirth is the heartbreaking loss of a baby after 24 weeks of pregnancy. It is a devastating experience, often leaving parents with many unanswered questions. While doctors sometimes identify a clear cause, in many cases, the reason remains unknown. Here is what you need to know about stillbirths.
What increases the risk of stillbirth?
Certain factors can raise the risk of stillbirths, some beyond your control, and others that can be influenced through lifestyle choices or medical intervention. Some of the unchangeable risk factors include being very young (under 20) or older (over 35), a history of stillbirth or pregnancy complications, like preeclampsia, carrying multiples (twins, etc.), carrying a baby beyond 41 weeks, having a smaller baby, known as Fetal Growth Restriction, low education levels, reduced fetal movement, underlying health conditions, such as thyroid issues, blood clotting disorders, or infections (e.g., malaria, COVID-19) and autoimmune diseases (e.g., lupus), kidney disease, or liver conditions (cholestasis).
Changeable risk factors can include high blood pressure or obesity, smoking more than 10 cigarettes a day, drinking alcohol or using drugs and living in areas with limited healthcare access or higher levels of deprivation.
What causes stillbirth?
There is no one-size-fits-all answer to this question. However, some common causes can include; Placenta problems: This could be placental abruption (where the placenta separates from the uterus) or poor placental function.
Health issues with the baby: These could include developmental problems or infections that interfere with growth and well-being.
Maternal health conditions: Issues like poorly controlled diabetes, high blood pressure or bleeding before baby is born can increase the risk of stillbirth. However, in many cases the exact cause remains unclear.
How can I tell that I could be having a stillbirth?
The most noticeable sign of a stillbirth is a lack of fetal movement. If you notice a significant reduction or complete cessation of movement, it is crucial to contact your doctor immediately.
How is stillbirth diagnosed?
If you are concerned, your doctor will likely check for a fetal heartbeat and may perform an ultrasound to confirm whether a stillbirth has occurred. Ultrasound is the most accurate way to detect the absence of a heartbeat or any other potential issues.
What happens after the diagnosis?
Once the diagnosis is made, you and your family should be given time to process. While privacy is important, you should not feel isolated – support should be available, and healthcare providers will answer questions and guide you through decisions, including birth plans, pain relief options, and ways to make memories with your baby.
If needed, extra time before proceeding with labor can be granted – typically up to 48 hours – unless medical concerns require quicker intervention. For those who experience health risks like heavy bleeding or high blood pressure, doctors may recommend expedited delivery to avoid further complications.
The doctor will discuss delivery options with you. Labor is typically induced using medication to start contractions, though some women may choose to wait for labor to begin naturally. In certain cases, a Cesarean section may be needed, depending on the situation.
Emotional and practical support following a stillbirth
Losing a baby is a deeply emotional experience, and emotional support is critical. You will be offered counseling and access to mental health resources to help you navigate this incredibly painful time.
The news should be delivered in a private, calm environment to allow for processing. Clear and direct language should be used, with a professional interpreter if necessary. Written information and contact details for ongoing support should also be provided.
Physical and emotional recovery after a stillbirth
After delivery, you may experience bleeding, cramping, and fatigue, similar to what you would experience after any birth. However, if you notice heavy bleeding, fever, or any other signs of infection, it’s vital to seek immediate medical attention.
In addition to physical recovery, emotional health must be carefully monitored. Many women may face postpartum depression (PPD), which can manifest as sadness, trouble bonding with other children, excessive crying, or difficulty sleeping. If you’re struggling, seeking support from a counselor or mental health professional is essential.
Investigating the cause of stillbirth
While some causes of stillbirth can be identified through tests, in many cases, the reasons remain unclear. Your healthcare team will likely conduct an investigation, including examining the placenta or performing a post-mortem on the baby, to determine what happened. Understanding the cause, if possible, can help you and your doctors in future pregnancies.
Memory making after a stillbirth
While the loss is devastating, families are encouraged to make memories with their baby. This could include taking photographs, making handprints, or spending time with the baby to honor their memory.
Caring for your health after a stillbirth
After a stillbirth, it is crucial to take steps to care for your health, especially if you plan to try for another pregnancy. Your healthcare team will closely monitor factors like blood pressure, thyroid function, and other conditions that could impact future pregnancies. This ensures that any potential risks are identified early.
When you decide to become pregnant again, you will receive more frequent monitoring and additional screenings to keep a close eye on both your health and the baby’s development. This may include regular ultrasounds and possibly medication to help reduce the risks of complications.
It is also important to consider the duration between pregnancies. Research suggests waiting at least 6 months after a stillbirth before trying to conceive again. This allows your body time to heal physically and emotionally, while also reducing the risk of complications such as preterm birth or low birth weight.
For those considering pregnancy again, preconception care is essential. Your healthcare provider may recommend specific steps, including managing any existing medical conditions, adopting a healthy lifestyle, and possibly using contraception until you feel ready to try for another baby. This proactive approach helps optimize your health and prepares your body for a future pregnancy.
Generally, though a stillbirth is an unimaginable loss, know that you are not alone. Whether through physical care, emotional support, or family and community networks, there are resources to help you cope with your grief and help prepare for a healthier future. Above all, remember that grieving is a personal journey, and healing takes time, but with the right support, it is possible to move forward.
By Dr Joan Okemo, Consultant Obstetrician Gynaecologist at Aga Khan University Hospital Nairobi
