A baby who dies in utero after 20 weeks of pregnancy, or one who dies during delivery, is stillborn. Any family death is devastating, but a stillborn baby can be especially tragic because it often happens suddenly and can occur in a previously uncomplicated pregnancy. However, it is extremely rare. Only 1 percent of pregnancies end in stillbirths, and more than half of those occur before the 28th week of pregnancy.
There are many complex reasons why a baby might be stillborn, from genetic abnormalities to problems with the placenta. Sometimes there appears to be no explanation at all, even after the baby is delivered and examined. The most common medical conditions associated with stillborn babies are infection (10 percent) and placental abruption (14 percent). Older mothers, mothers who smoke or drink alcohol, and mothers who are obese are more likely to have stillbirths.
If your baby dies before you go into labor, you will probably know it without a doubt. Your uterus will feel still and heavy without the usual movements of your baby. If you notice any significant decrease in your baby's activity--fewer than 10 movements in 2 hours is certainly cause for concern at this stage in your pregnancy--contact your provider immediately to see if you need a medical intervention to save your baby's life. Your provider will immediately check for your baby's heartbeat. If your baby dies, you will probably start labor naturally within a couple of weeks. You may want to carry your baby for as long as possible. Many women, however, are too upset to continue the pregnancy. If that is how you feel, your provider may suggest inducing your labor right away or in a day or so when you've had a chance to prepare yourself. A vaginal delivery is still preferable to a cesarean, which poses more health risks.
During the labor and delivery, you may ask for pain medicines, such as opioids or an epidural when you need it. Don't be afraid to ask for information from your nurses, your provider, and whoever examines your baby and the placenta following birth. Although very difficult to think about at the time, autopsy and examination of the placenta may yield important data. Some research suggests that the more information a woman has about her stillbirth, along with a chance to name her baby and hold her to say good-bye, the better able she is to grieve afterward.
There is no single way to accept this dreadful loss. You and your partner will want support from friends and family. It may help to join a bereavement group or see a therapist. A memorial or funeral service will help you and your families to grieve, though you may find that many people, even those caring for you most directly, feel awkward. They may encourage you to "move on," but of course you won't be able to for a long time. To you this child was a real presence, a life within you, and you'll have a long way to go before the pain lessens. Keep a journal and a few mementos of this life you carried--a footprint, a lock of hair, a photograph--and don't be afraid to look at them from time to time. This baby was a part of you and a part of your family, however briefly, and deserves to be remembered.
Originally published in You & Your Baby: Pregnancy.
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