Stillbirth

A stillbirth is when baby dies after 24 weeks of pregnancy. 1 in 200 births are stillborn.

What are the causes of stillbirth?

In majority of cases, there is no cause found. Some causes include:

• Placenta complications e.g. abnormal placenta function, placenta abruption
• Infection 
• Fetal maternal haemorrhage (blood lost from fetus into maternal circulation)
• Medical conditions e.g. pre-existing diabetes, pre-eclampsia, obstetric cholestasis
• Genetic problems in baby 
• Cord prolapse 

How is stillbirth diagnosed?

This is diagnosed on an ultrasound scan, where the baby’s heart is confirmed to have stopped beating. There may still be feelings of baby movement even though a stillbirth has been diagnosed as this is related to baby shifting in the amniotic fluid. 

What tests can I do to try and find a cause?

Doing tests may not be able to pinpoint a cause most of the time. If a cause is found, there may or may not be things you can do in subsequent pregnancies to reduce the chance of this happening again. 

Tests are optional and you can discuss with your partner/family as to which ones you would like done. Tests that your gynaecologist may recommend include:

• Blood tests: to look for complications of pre-eclampsia, infection, fetal maternal hemorrhage, diabetes, thyroid disease, lupus, thrombophilia (blood clotting disorder) etc. Some of these tests may need to be repeated 6 weeks later.
• Vaginal, urine and placenta samples: to look for infection
• Placenta examination: to look for placenta abnormalities under the microscope 
• Genetic test: tissue samples taken from baby to look for chromosomal abnormalities
• Postmortem: autopsy of baby to look for a possible cause of death

How do I deliver my child?

This depends on your health situation, pregnancy and personal preference. You will be able to discuss this with your gynaecologist. Your choices include:

• Waiting

This means waiting for labour to start naturally. If you have signs of infection, pre-eclampsia, placenta abruption, blood clotting abnormalities or your waters have leaked, this is not recommended. It is also not recommended to delay labour for too long as you may develop complications in the meantime. Your baby’s appearance may also deteriorate.

• Induction of labour 

This involves putting tablets into your vagina to induce contractions with the aim of a vaginal delivery. You may experience bleeding and breaking of water bag during this process. You will be asked to push when you are fully dilated. 

• Caesarean section

Vaginal birth is recommended for most women (even if you have had a C-section before) because there are fewer risks compared to C-section to both you (in terms of surgical complications and physical recovery) and your future pregnancies. Although the thought of it can be distressing, you will be supported throughout this process and pain relief options will be available.

What do I do after my baby is born?

Whether to see your baby immediately after birth, a little while after birth, or not at all is entirely your choice. There is no right or wrong answer, and you should discuss this with your partner and family members and do what feels right to you. Whatever you choose, you will be supported by your gynaecologist and midwife. If you wish to have mementos e.g. hand/footprints, this can be arranged. 

You may be given medications to stop your breast milk from coming in. You will also be offered additional emotional support to help you through this process.

What do I need to look out for?

You will have bleeding and pain for the next few days which should settle in a few weeks. You may still experience breast milk coming in – apply ice packs and wear tight-fitting bras to help with this. You will be given a follow-up appointment with your gynaecologist for a check, and a review of your tests (if performed).

Having a stillbirth is one of the most difficult things that a mother can experience. Do allow yourself time to grieve and seek support from your partner, family members and friends. If you find difficulty in coping, do speak with your gynaecologist who will be able to arrange for counselling sessions. Support groups can be a great source of comfort. 

When can I try for my next pregnancy? Is there anything I can do to prevent this from happening again? 

You can try for your next pregnancy as soon as you and your partner are physically and emotionally ready. Choose a reliable birth control method if you do not wish to get pregnant. Let your gynaecologist know early of your stillbirth history. Preconception care is important. Depending on the cause (if any was found), there may need to be adjustments in your pregnancy care.