Editor’s note: Child loss is a difficult–yet necessary–topic to discuss. Readers who have experience with stillbirth or another form of child loss may find this article difficult to read.
Here at Natural Womanhood, we’ve covered many aspects of miscarriage, which is a pregnancy loss up through 20 weeks gestation. But we recognize that pregnancy loss after that date occurs too, at which point it’s called stillbirth. For Amanda Duffy, now an ambassador with stillbirth prevention organization Count the Kicks, stillbirth was not even remotely on her radar until her daughter Reese was stillborn less than a day before her scheduled delivery. But what causes stillbirth, and can it be prevented?
In this heartbreaking story, Amanda describes her search for answers to these questions after having to say goodbye to her beautiful, red haired, chubby-cheeked baby girl. Amanda had previously received a diagnosis of polyhydramnios, excess amniotic fluid, and had also noticed decreased fetal movement towards the end of her pregnancy. But when she requested an early delivery, and even though 37 weeks gestation is considered early term, she was advised to wait until 39 weeks gestation to prevent complications associated with “early” delivery.
Even after an ultrasound four days before her scheduled delivery date showed only one tiny flutter of fetal movement over the course of a half hour, her doctor continued to advise waiting until the 39-week mark. Tragically, when Amy returned to the hospital just three days later for lack of fetal movement, the doctor couldn’t detect a heartbeat at all, and after an emergent Cesarean section, baby Reese was found to have her umbilical cord wrapped tightly twice around her neck, a situation noticed in previous ultrasounds. While not all stillbirths can be prevented, it seems that there were multiple red-flags that may have helped to prevent Reese’s death.
What is stillbirth and how common is it?
Stillbirth is defined by the Centers for Disease Prevention (CDC) as pregnancy loss at 20 weeks gestation or later, as opposed to a miscarriage which is defined as pregnancy loss before 20 weeks. While miscarriage is far more common than stillbirth, affecting 10-20% of known pregnancies, stillbirth is far more common than people might think, occurring at a rate of 1 in 160 pregnancies (about 0.6% of pregnancies) and affecting approximately 24,000 babies in the U.S. For comparison, SUID (sudden unexpected infant deaths, including SIDS) affects 3,400 babies in the U.S. each year. Personally, I had long assumed that SIDS was far more common than stillbirth, largely because SIDS was something that I had heard about and been educated about during my pregnancies, while stillbirth was never addressed as a possibility.
What are potential causes and risk factors of stillbirth?
Stillbirth has similar risk factors to miscarriage, such as age, smoking, and pre-existing medical conditions. According to the NIH, the Stillbirth Collaborative Research Network (SCRN) identified the following as the most common causes for stillbirth:
- In about 25% of cases, no cause was able to be identified
- Pregnancy and labor complications such as preterm labor or placental abruption (the premature separation of the placenta from the uterine wall, which can cause life-threatening bleeding for the mom and which can effectively cut off baby’s oxygen and nutrition lifeline, leading to intrauterine death, if not treated immediately)
- Problems with the placenta (25% of cases)
- Birth defects (10% of cases)
- Infection, particularly earlier in pregnancy (10% of cases)
- Problems with the umbilical cord, particularly later in pregnancy (10% of cases)
- High blood pressure, including preeclampsia
- Medical conditions such as diabetes (less than 10% of cases)
Note: percentages are not available for each factor and do not add up to 100%, as many stillbirth cases studied by the SCRN had more than one contributing cause. SCRN researchers also found that experiencing high levels of stress, smoking or using drugs, and race— particularly noting the higher stillborn rate for Black mothers compared to White or Hispanic mothers— were all correlated with a higher incidence of stillbirth.
Perinatal hospice when stillbirth is expected or the baby has a life-limiting medical condition
Like with miscarriages, some stillbirths are caused by genetic abnormalities or fetal conditions that are not preventable, or the cause is unknown. For known genetic abnormalities, even if fetal death is expected, the difficult experience of preparing for the expected death of a baby can be aided and supported through perinatal hospice. Perinatal hospice is a model of care that is used to provide the baby with as much comfort and dignity as possible, and to provide parents with support and the opportunity to make the limited amount of bonding time they have with their child special, even if most, or all, of that time is prior to birth.
Preventing stillbirth
Research published in 2019 suggests that nearly a quarter of stillbirths in the U.S. may be preventable, especially for stillbirths that occur after the onset of labor, as a result of maternal medical complications (like diabetes or high blood pressure), issues with the placenta, pregnancies with multiples, or preterm birth. Stillbirth prevention in these cases may necessitate better management or prevention of maternal medical complications (including infections), earlier identification of conditions like fetal growth restriction (IUGR), and/or taking steps to reduce the risk of, or manage, preterm labor.
One particularly promising case study comes from Scotland. There, the NHS task force on stillbirths reduced the national stillbirth rate by 23% over five years. The task force attributes the drop in stillbirths to the following strategies: assessing pregnancies at risk for fetal growth restriction (IUGR), raising awareness for tracking fetal movement, electronic fetal monitoring during labor, reducing preterm birth incidence, and reducing smoking in pregnancy.
Kick counts are key
Tracking fetal movement is a key step in preventing stillbirth and one that is easy to learn and do at home. The Iowa-based stillbirth prevention organization Count the Kicks reports a 32% decrease in Iowa’s stillborn rate over the first ten years of their campaign. Count the Kicks has an easy-to-use app for tracking fetal movements to help pregnant mothers learn what a normal movement pattern looks like for their baby in order to recognize changes.
Their website also features a “Baby Saves” section in which moms share their personal stories of how tracking fetal movement was the first, and sometimes only sign, that something was wrong. Decreased kick counts led moms to take action, and receive diagnoses including fetal-maternal hemorrhage, hypertension, clotting disorders, infections, fetal distress, umbilical cord issues, and placental abnormalities before it was too late. These stories further highlight the importance of self-advocacy in pregnancy, which was also powerfully highlighted in our recent interview with Stacey Sumereau about her struggle to get the care she needed during her complicated pregnancy.
After a stillbirth
In some ways, the physical healing process after a stillbirth is similar to healing after a miscarriage. But the further along the woman was in her pregnancy at the time of the loss, the more similar her physical recovery will be to the lengthy recovery time needed after a live birth. Her breast milk may still come in, causing physical pain and emotional distress. And if the baby was delivered via Cesarean section, she will have a major abdominal surgery to recuperate from.
The fact that stillbirth is often not recognized as a possible outcome of pregnancy, coupled with its occurrence so much closer to when parents were supposed to be bringing their baby home, can make the grieving process more difficult. Counseling and speaking with a trusted spiritual advisor may be helpful during this time. Parents whose child was stillborn are given the opportunity to hold their child, take pictures, take handprints and footprints, and make funeral arrangements. While this process may be difficult at the time, many parents are grateful for the keepsakes they have to remember their child.
Taking charge of your health
Having the information you need to make informed decisions, improve your health, and know when to look for a second opinion is vital to self-advocacy. Charting to know when conception occurred, understanding your personal risk factors, and tracking fetal movement can all be crucial pieces of information to have when advocating for your child and yourself.
Stillbirth is not your fault
However, it is also important to remember that not all stillbirths are preventable. Sometimes tragedies happen and no one knows what caused the stillbirth. Regardless, a stillbirth is not your fault. And while many women have the frustrating and potentially dangerous experience of being dismissed by their doctors, other women have the upsetting experience of a doctor who pushes for an early delivery over concerns (for instance, suspecting a large baby) that turn out to be incorrect.
Knowing the right course of action to take can be particularly difficult in pregnancy, when the stakes are high and medical imaging and tests cannot always capture the full picture of what is going on inside the womb. While there are steps that can be taken to help decrease the risk of stillbirth, more research is needed to better understand why stillbirths occur, and what can be done to identify risk factors early on.
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