What is Stillbirth?
What causes this tragic pregnancy aftermath? Could it be prevented?
You carry your precious child in your womb for nine long months. But when you go into labour and finally deliver your baby, there is no life. No heartbeat, sound or movement. Even worse, the reason for your child’s death is unknown, leaving you baffled beyond belief, wondering why such a crushing and cruel thing could happen and if you are to blame for your baby’s untimely demise.
Yes, stillbirth happens, even in seemingly normal pregnancies, and not always with a clear-cut reason. According to the World Health Organization (WHO), an estimated 2.6 million stillbirths occur annually around the world, with 98% of them taking place in low- and middle-income countries. Half of all stillbirths occur during labour and delivery. WHO also reported.
Unfortunately, why stillbirth happens is not always explainable. It a most devastating loss that hits unexpectedly, says the American Pregnancy Association, and the cause cannot be determined in about one third of stillbirths despite extensive tests and efforts to find out why. The good news is, the chances of having another stillbirth are minuscule, and most women who have experienced it will go on to deliver healthy babies.
What is stillbirth: defined and classified
Obstetrician-gynecologist Katleen del Prado, a perinatologist and a high risk pregnancy specialist in private practice in Lucena City, Quezon, Philippines, defines stillbirth as “the delivery of a baby without a heartbeat beyond five months of pregnancy. Less than five months or a foetus less than 500 grams, we classify as a miscarriage.”
Stillbirth can be early, late or term, depending on when it happens. It’s an early stillbirth if the foetal death occurs between weeks 20 and 27 of the pregnancy, a late stillbirth if it occurs between weeks 28 and 36 of the pregnancy, and a term stillbirth if it occurs during week 37 or beyond of the pregnancy.
Causes of stillbirth
There are many possible causes of stillbirth, said Dr. del Prado. Basically, it is any problem or condition that keeps the mother, the foetus/baby, and the placenta (including the umbilical cord that connects them) from being healthy and functioning well. These three are essential to maintaining life.
Some of the known causes of stillbirth are:
- complications during labour and delivery
- maternal conditions (like high blood pressure or diabetes)
- birth defects or abnormalities
- placental problems (like placental abruption or when the placenta separates from the womb)
- problems with the umbilical cord
- growth restriction (baby’s growth slows or stops during pregnancy)
- postdate pregnancy (when a pregnancy lasts longer than 42 weeks)
There are certain factors that increase the risk of stillbirth and other adverse pregnancy outcomes. These are:
- inadequate prenatal care
- a previous stillbirth or pregnancy loss
- alcohol and drug abuse
- age of the pregnant woman (being under 15 or over 35)
Now that you know the causes and risk factors of stillbirth, take action to keep yourself and your baby healthy throughout your pregnancy. Follow these recommendations as they can help prevent having a stillborn baby:
- Be present for all your prenatal appointments.
- Take all prescribed medication and heed your doctor’s orders.
- Avoid alcohol and do not smoke.
- Stay away from people who are sick and avoid overly crowded places.
- Choose and prepare your meals well. Steer clear of raw or undercooked food and all edibles that can make you ill.
- Practice proper hygiene to avoid infections.
- Sleep on your side, and not on your back, especially from week 28 of your pregnancy and onwards.
Monitor foetal movement
In addition, it would be wise to familiarise yourself with the way your baby moves. “The most important initial sign is for the mother to monitor the foetal movements,” explained Dr. del Prado. “Normally, the foetus sleeps but it can easily be awakened by stimulation such as a voice, touching the abdomen, after coughing and after eating.”
Sense and observe, for example, what time of the day your baby is most active and how many times he/she moves in an hour. Do this repeatedly until you get a good feel of how your baby moves. If the movements suddenly stop, slow down significantly or there is no reaction even after stimulation, inform your doctor immediately.
Another reason to contact your doctor without delay is when there is vaginal bleeding or vaginal discharge that is not normal for you, particularly when it’s late into the pregnancy. This could indicate an infection, problems with the placenta, or the start of labour.
Dr. del Prado urges mums who have had stillborn babies to know and understand why their baby died. This could help them with closure and moving on, and at the same time, help doctors respond better when faced with a similar situation in the future.
“Your babies have become your angels in heaven. Your role does not stop there. Whether you want another child or no longer, we have to investigate the cause of your baby dying inside. Ideally, an autopsy of the stillborn baby and an examination of the placenta would be done. Ask your doctor about the possible cause of death because we can do something if these conditions can be resolved before or during pregnancy,” she said.
To those who want to try again and get pregnant despite experiencing stillbirth, Dr. del Prado highly recommends preconception counseling with a maternal-foetal medicine specialist (also called a perinatologist) or a high risk pregnancy expert while still in the planning stage of pregnancy. This way, there will be ample time to prepare the body, address all pregnancy-related concerns, manage existing health problems and risk factors, and reduce the chances of poor perinatal (before and after birth) outcomes.
Obstetrician-gynecologist Katleen del Prado, MD, FPOGS, FPSMFM is a perinatologist and high risk pregnancy specialist who practices in Lucena City, Quezon, Philippines. You can find her on Facebook: Katleen Del Prado, MD-ObGyn