Losing your baby between the 20th week of pregnancy and birth is called a stillbirth. Before the 20th week, it’s usually called a miscarriage.
Stillbirth is also classified according to the length of pregnancy:
- 20 to 27 weeks: early stillbirth
- 28 to 36 weeks: late stillbirth
- after 37 weeks: term stillbirth
There are about 24,000 stillbirths a year in the United States, estimates the Centers for Disease Control and Prevention.
Continue reading to learn more about the causes, risk factors, and coping with grief.
Pregnancy and labor complications
Certain circumstances can make things riskier for the baby before birth. Some of these are:
- preterm labor, likely caused by complications in the pregnancy
- pregnancy lasting more than 42 weeks
- carrying multiples
- accident or injury during pregnancy
Pregnancy and labor complications are more commonly a cause of stillbirth when labor occurs before the 24th week.
The placenta provides the baby with oxygen and essential nutrients, so anything that interferes puts the baby at risk. Placenta problems may be responsible for almost a quarter of all stillbirths.
These problems can include poor blood flow, inflammation, and infection. Another condition, placental abruption, is when the placenta separates from the uterine wall before birth.
Birth defects and other conditions in the baby
About 1 of every 10 stillbirths can be attributed to birth defects, estimates the National Institute of Child Health and Human Development. These can include:
- fetal growth restriction
- genetic conditions
- Rh incompatibility
- structural defects
Genetic defects are present at conception. Other birth defects may be due to environmental factors, but the cause isn’t always known.
Serious birth defects or multiple birth defects can make it impossible for the baby to survive.
An infection in the mother, baby, or placenta can lead to stillbirth. Infection as the cause of stillbirth is more common before the 24th week.
Infections that can develop include:
Umbilical cord problems
If the umbilical cord becomes knotted up or squeezed, the baby can’t get enough oxygen. Umbilical cord problems as a cause of stillbirth are more likely to happen late in pregnancy.
The mother’s health can contribute to stillbirth. Two health conditions that more commonly arise at the end of the second trimester and the beginning of the third are preeclampsia and chronic high blood pressure.
Unexplained stillbirths are more likely to occur late in pregnancy. It can be very difficult to accept the unknown, but it’s important you not blame yourself.
Stillbirth can happen to anyone, but risk factors may include a mother who:
- has a health condition, such as high blood pressure or diabetes
- is obese
- is African-American
- is a teenager or older than 35
- had a previous stillbirth
- experienced trauma or high stress in the year before delivery
- lacks access to prenatal care
Using tobacco, marijuana, prescription painkillers, or illegal drugs during pregnancy may double or triple the risk of stillbirth.
You may not experience any signs or symptoms at all, especially early on. Some signs and symptoms are cramping, pain, or bleeding from the vagina. Another sign is that your baby stops moving.
By the time you reach the 26th to 28th week, you can start a daily kick count. All babies are different, so you’ll want to get a feel for how often your baby moves.
Lie on your left side and count kicks, rolls, and even flutters. Record the number of minutes it takes your baby to move 10 times. Repeat this every day at the same time.
If two hours pass and your baby hasn’t moved 10 times, or if there’s suddenly a lot less movement, call your doctor.
Your doctor can perform a nonstress test to check for a fetal heartbeat. Ultrasound imaging can confirm that the heart has stopped beating and your baby isn’t moving.
If your doctor determines your baby has died, you’ll need to discuss your options. If you do nothing, labor will likely start on its own within a few weeks.
Another option is to induce labor. Inducing labor right away may be recommended if you have health issues. You can also discuss a caesarean delivery.
Think about what you want to do after your baby is born. You might want to spend time alone and hold your baby. Some families want to bathe and clothe the baby, or take photos.
These are very personal decisions, so consider what’s right for you and your family. Don’t hesitate to tell your doctor and hospital staff what you want to do.
You don’t have to rush into decisions about whether or not you want a service for your baby. But do let it be known you’re considering these things.
Determining the cause
While your baby is still in your womb, your doctor may perform amniocentesis to check for infection and genetic conditions. After delivery, your doctor will perform a physical examination of your baby, the umbilical cord, and the placenta. An autopsy may also be necessary.
Physical recovery time depends on a number of factors, but it generally takes six to eight weeks. There’s a lot of variation in this, so try not to judge yourself by others’ experiences.
Delivery of the placenta will activate your milk-producing hormones. You may produce milk for 7 to 10 days before it stops. If this is upsetting to you, talk to your doctor about medications that stop lactation.
You’ve experienced an unexpected, significant loss, and you’ll need time to grieve. It’s impossible to predict how long it will take to work through your grief.
It’s important not to blame yourself or feel the need to “get over it.” Grieve in your own way and in your own time. Express your feelings with your partner and other loved ones.
It may also help to journal your feelings. If you’re unable to cope, ask your doctor to recommend a grief counselor.
See your doctor for symptoms of postpartum depression, such as:
- daily depression
- loss of interest in life
- lack of appetite
- inability to sleep
- relationship difficulties
If you’re open to it, share your story and learn from others who understand what you’re going through. You can do this in forums such as StillBirthStories.org and the March of Dimes’ Share Your Story.
Joining a pregnancy loss support group may also help. Ask your doctor if they can recommend an in-person group. You may also be able to find an online support group through Facebook or other social networks or forums.
How to help someone after stillbirth
It’s vitally important you not minimize the loss or feed the person’s guilt in any way. They’re grieving the baby they lost, so don’t talk about future pregnancies unless they bring it up first.
What they need right now is compassion and support. Offer sincere condolences as you would to anyone who has lost a loved one — because that’s what has happened. Don’t try to change the subject. Let them express their feelings, even if you feel they’re being repetitive.
Encourage them to eat well, get plenty of rest, and keep their doctor appointments. Offer to help with household tasks in the first few weeks. Basically, just be there for them.
Yes, you can have a successful pregnancy after a stillbirth.
While you’re at a higher risk for complications than someone who hasn’t had a stillbirth, the chances of a second stillbirth are only about 3 percent, notes the Cleveland Clinic.
Your doctor will tell you when you’re physically ready to get pregnant again, but only you’ll know when you’re emotionally ready.
You may also decide another pregnancy isn’t right for you, and that’s all right, too. You may decide to look into adoption, or you may choose to not expand your family. Whatever decision you make will be the right decision for you.
Many causes and risk factors are out of your control, so stillbirth can’t be completely prevented. But there are some things you can do to lower the risk:
- Have a checkup before you get pregnant again. If you have any risk factors, such as diabetes or high blood pressure, work with your doctor to manage and monitor them during pregnancy.
- If the cause of a previous stillbirth was genetic, meet with a genetic counselor before getting pregnant again.
- Don’t smoke or use alcohol, marijuana, or other drugs while pregnant. If you have a hard time quitting, talk to your doctor.
- Seek medical help right away if you experience bleeding or other signs of trouble during pregnancy.
One of the more important things you can do is to get good prenatal care. If you’re pregnancy is considered high risk, your doctor will monitor you more frequently. If your baby shows signs of distress, emergency measures, such as early delivery, may be able to save your baby’s life.
Physical recovery may take a few months. Women who experience stillbirth can go on to have healthy children.
Be patient with yourself as you work through the stages of grief.