Answers to Your Questions About Stillbirth

A stillbirth occurs when a fetus dies after 20 weeks of pregnancy.

For many people, a stillbirth may occur before labor begins, but stillbirth can also occur during labor. This is rarer today thanks to medical advances and the availability of fetal monitoring during the birthing process.

Stillbirths are divided into three categories:

• Early: occurs between 20 and 27 weeks of pregnancy
• Late: occurs between 28 and 36 weeks of pregnancy
• Term: a stillbirth of an early or full-term fetus, typically after the 37th week of pregnancy

Many people have no signs or symptoms of stillbirth at first, so you may not know that you are experiencing one.

Some people may have the following signs or symptoms:

• cramps
• pain
• vaginal bleeding
• decreased movement or no movement

These signs may indicate several problems during pregnancy. Call your doctor or midwife immediately if you experience any of them.

A change in movements, specifically, may also be an early sign — and sometimes the only warning sign — that your baby needs help.

If you notice decreased movement or are not feeling movement at all, go to the hospital. You and your baby need to be checked immediately.

A stillbirth can happen before labor begins. You may notice the fetus has stopped moving or kicking, or you may experience cramping and spotting.

Your doctor or midwife may suspect a stillbirth when they do not find a heart rate during a prenatal exam.

In either case, your OB-GYN or midwife may order an ultrasound. This test can confirm whether the baby’s heart is still beating or has stopped.

A fetus without a heart rate has died.

No, a stillborn fetus has not survived. Their heart has stopped beating, and they are no longer alive.

Both the terms “stillbirth” and “miscarriage” describe pregnancy loss. The two terms are used at different periods of pregnancy to describe the loss.

A stillbirth is typically considered any fetal loss after 20 weeks of pregnancy.

A miscarriage is used to classify fetal loss before 20 weeks of pregnancy.

Some stillbirths occur before labor begins. When this happens, you need medical help to deliver the fetus out of your uterus.

After a stillbirth is discovered, your OB-GYN, midwife, or another healthcare professional will discuss your options based on your health, the stage of your pregnancy, and your personal wishes.

Some people need to end the pregnancy right away; others may be able to wait and take some time to consider their choices.

Options for delivering a stillbirth may include:

• Dilation and evacuation (D&E): If you’re in the second trimester, you may choose to have a dilation and evacuation (D&E). During this procedure, a doctor or surgeon dilates or opens your cervix, which is the opening between your vaginal canal and uterus. They then use gentle suction to remove the pregnancy tissue from the uterus.
• Induction: If a stillbirth occurs late in the second trimester or in the third trimester, you may elect to induce labor. To do so, you take medications. Your healthcare professional will most likely break your water. You then deliver the stillborn fetus vaginally.
• Spontaneous labor: In some cases, you may be able to wait until you naturally begin labor. Most people go into labor within 2 weeks of fetal death. If you don’t, an induction may be considered.
• Cesarean delivery (C-section): A cesarean delivery is also an option. During this surgery, a doctor cuts into your abdomen and uterus and removes the fetus from the uterus. This is major surgery. It’s rarely required when delivering after a stillbirth.

Maybe. A change in your baby’s movements can be an early sign that your baby needs help. It may be the ONLY warning sign.

It’s important to go to the hospital immediately if you notice any changes in your baby’s movements or if you are concerned about their movement.

If you get treatment quickly, sometimes there is a window of opportunity in which your baby’s life may be saved. Some examples of movement changes include less movement, weaker movements, or an unusually rapid increase in movement.

Since hospitals are open 24/7, you and your baby can be checked at any time. Don’t wait until the next day or until your next scheduled appointment. Go immediately. Trust your instincts.

If you’ve had a stillbirth before, you can work with your medical team to understand what, if any, medical conditions or health issues may have contributed to the stillbirth.

Likewise, an autopsy after a previous stillbirth and genetic testing may reveal possible issues a future fetus may experience.

However, in many cases, the cause of a stillbirth is never known. That makes preventing a stillbirth difficult. Prenatal care and fetal monitoring during labor are two ways to give yourself some extra assurance.

Yes, sometimes there are warning signs that a baby is in crisis. One main sign is a decrease or change in a baby’s movement in the womb.

If you notice any change in your baby’s movement, go to the hospital immediately. You cannot assess your baby’s condition from home. No app or home Doppler is sufficient.

Hearing a heartbeat is not enough to ensure your baby is well. Seek medical care at the hospital if you detect a decrease or change in movement or if you feel like something is wrong. Healthcare professionals can assess you and your baby’s condition and provide emergency care if necessary.

Other signs of stillbirth include cramping, spotting, or bleeding.

However, these signs or symptoms may appear after the stillbirth has already occurred. Recognizing the warning signs is important, but it may not mean you can save the pregnancy. In many cases, the pregnancy is already lost by the time you’re showing symptoms.

A stillbirth can happen to anyone, but some people are more likely to have one than others. This is largely due to identifiable risk factors, such as:

• Race: In the United States, Black mothers are twice as likely to have a stillbirth than white or Hispanic women.
• Age: People over 35 years old have a higher risk of miscarriage. They also have a higher risk of conditions that can increase the risk of stillbirth, such as preeclampsia.
• Health: People with obesity, diabetes, or high blood pressure may experience stillbirth more frequently.
• Multiples: Having twins, triplets, or another set of multiples can increase the risk of stillbirth.
• Lower income: People with fewer resources often experience limited access to healthcare, leaving them without access to the prenatal care they need to prevent and monitor for stillbirth. This limited access may also mean less social and emotional support, both of which are necessary for a healthy pregnancy.
• A history of pregnancy loss: While most people who experience stillbirth will have a successful pregnancy in the future, previous stillbirth or miscarriage may increase the risk of a future one, too.
• Substance use: People who smoke cigarettes, drink alcohol, use recreational drugs, or misuse prescription medications while pregnant are more likely to experience a stillbirth.

The reasons for stillbirth are largely unknown. A cause cannot always be identified. But when a cause is found, it may be:

• a birth defect or genetic disorder of the fetus
• a pregnancy complication, such as placental abruption
• umbilical cord problems, such as a knot or pinch that cuts off blood supply to the fetus
• infections
• health conditions in the pregnant person
• complications during labor and delivery

Your doctor or midwife may recommend one or more medical tests to understand why a pregnancy loss has occurred. It’s your choice to do these exams or not.

These tests may include:

• autopsy of the fetus
• blood work
• genetic testing
• imaging tests of the fetus, including X-ray or MRI

What infections can cause stillbirth?

Some viruses or infections can increase the risk of stillbirth. These infections include:

• Fifth disease: A viral disease, Fifth disease is caused by parvovirus B19. It’s typically a childhood infection, but it can be fatal for a developing fetus.
• Sexually transmitted infections (STIs): STIs like syphilis can lead to stillbirth if a pregnant person has them.
• Cytomegalovirus (CMV): CMV is a type of herpes virus. It’s commonly transmitted in children. For most adults, CMV is not an issue, but in pregnant people, a CMV infection can lead to stillbirth.
• Listeriosis: A listeria infection can develop after you eat contaminated food, such as unpasteurized dairy products, raw vegetables, melons, and more.
• Malaria: Malaria is a life threatening infection that can cause stillbirth.
• Toxoplasmosis: Toxoplasmosis is caused by a parasite carried by cats and transferred to humans via contact with cat feces and contaminated food or dirt. It’s a common infection that most people usually fight off, but it may cause birth defects or stillbirth in a fetus.

What medical conditions can cause stillbirth?

Some health issues or conditions may increase a pregnant person’s risk of stillbirth. These include:

• high blood pressure
• kidney disease
• diabetes
• lupus
• antiphospholipid syndrome, an autoimmune condition that affects the way blood clots
• intrahepatic cholestasis of pregnancy, a condition that can cause a buildup of bilirubin

A person with a history of pregnancy complications, such as premature birth and preeclampsia, may also have a higher risk of stillbirth.

The loss of a pregnancy can be profoundly devastating. Grief, anger, and sadness are all natural responses to a stillbirth.

It’s natural to mourn this loss, and you may need resources to help you do this. Consider these options:

• Rely on a partner: If you have a partner, you may both be grieving, and sometimes that needs to be done separately. However, talking with a partner or other person you trust can help you process emotions and feelings.
• Seek local support groups: Your doctor, midwife, or another healthcare professional can connect you with local support groups through an organization or hospital education group.
• Call a therapist: These mental health care professionals are trained to help people deal with the complicated emotions of loss and life. You may choose to talk with a therapist alone or with a partner.
• Find help online: National advocacy organizations frequently have support groups for their communities. One such support group is Share Your Story from the March of Dimes.

Most people who have a pregnancy loss can have a successful future pregnancy. However, it’s natural to be anxious as you consider future pregnancy possibilities.

Talk with your midwife or doctor about understanding the risks and potential outcomes. They may suggest a few steps for the best possible outcome, including:

• genetic counseling to screen for genetic disorders
• prepregnancy counseling with a maternal-fetal specialist, a professional who’s experienced in caring for high risk pregnancies
• an amniocentesis once pregnant
• other tests or evaluations if you have a known health condition that increases the risk of stillbirth

Yes, it’s possible a stillbirth can occur during labor. However, with the use of fetal monitoring systems, this is rare.

Monitoring equipment can help your OB-GYN, midwife, and labor and delivery care team identify problems so they can take steps to prevent a stillbirth.

Some problems during labor and delivery can lead to a loss. These include:

• problems with the placenta
• problems with the umbilical cord
• lack of oxygen to the fetus
• infection