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Illustration by Bailey Mariner

In the United States, 1 in 160 pregnancies ends in a stillbirth. That means about 24,000 pregnancies end in stillbirth every year, according to the Centers for Disease Control and Prevention (CDC).

While so many people are affected by this type of loss, when it happens to you, it’s natural to feel alone. Stillbirth, like all pregnancy loss, is difficult. It can affect many areas of your life and leave you with many questions.

What causes stillbirths? Who’s at risk for a stillbirth? What, if anything, can you do to help prevent stillbirth?

Here are the answers to these questions and many more.

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

In many cases, a stillbirth may occur before labor begins. A 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

It may not be immediately apparent you’re experiencing a stillbirth. Some pregnant people experience cramps, pain, or vaginal bleeding. These signs can indicate several problems during pregnancy. Call your doctor or midwife if you experience any of them.

Some pregnant people first suspect a stillbirth when they stop feeling the baby’s kicks and movements. A fetus that moved a lot before and isn’t moving now may have died.

If your baby does not appear to be moving or is moving less than usual, call your doctor, midwife, or another healthcare professional immediately. They will likely want to see you for a checkup.

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 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.

A miscarriage is used to classify a fetus that dies before 20 weeks.

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

After a stillbirth is discovered, your OB-GYN or midwife will discuss your options. The two of you will take into consideration your health, the pregnancy stage, and your personal wishes.

Some people will 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 will dilate or open your cervix, the opening between your vaginal canal and your uterus. They will 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. You will take medications to begin labor. Your healthcare professional will most likely break your water. You will deliver the stillborn fetus vaginally.
  • Spontaneous labor: In some cases, you may be able to wait until you begin natural labor. Most people will 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 belly and uterus, and removes the fetus from the uterus. This is major surgery. It’s rarely required in the case of a stillbirth.

Maybe. 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 and genetic testing may reveal possible issues a future fetus may experience.

However, in many cases, a cause is never known. That makes preventing a stillbirth nearly impossible. Good prenatal care and fetal monitoring during labor are two ways to give yourself some extra assurance.

Sometimes pregnant people experience symptoms that tip them off to fetal death. These can include a decrease in fetal movement, cramping, spotting, or bleeding.

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

However, you should visit your doctor or midwife if you have any of these signs or 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 age 35 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: Good prenatal care can go a long way to ensuring a healthy pregnancy. People with fewer resources often experience limited access to healthcare, leaving them without access to the 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 drugs while pregnant are more likely to experience a stillbirth.

Racial disparities and stillbirth

The effects of racism, including stress and limited or blocked access to healthcare, can affect all areas of health, including pregnancy and loss.

In the United States, Black women are more than twice as likely to experience a stillbirth than Hispanic or white women. They also have a higher rate of stillbirth when compared with American Indian and Alaskan Native people.

Plus, the underlying health issues that can cause stillbirth, like obesity, diabetes, and high blood pressure, are three times more common among Black mothers than white mothers.

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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: A common infection that most people usually fight off, toxoplasmosis is caused by a parasite carried by cats and transferred to humans via contact with cat feces and contaminated food or dirt. It may be transmitted to a developing fetus and may cause birth defects or stillbirth.

What medical conditions can cause stillbirth?

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

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 normal 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, the two of 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 may be able to connect you with local support groups through an organization or hospital education group.
  • Call a therapist: These healthcare professionals are trained to help people deal with the complicated emotions of loss and life. You may choose to talk with a therapist by yourself 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.

Help finding support if you’ve experienced stillbirth

Talking about your feelings may help you cope with the grief and pain that often accompanies pregnancy loss. These resources may help:

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Most people who have a pregnancy loss will be able to 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

A stillbirth occurs when a developing fetus dies after the 20th week of pregnancy. It’s not always clear why stillbirth occurs. It can be an issue affecting the fetus or the pregnant person. Often, there’s no known reason.

If you’re hoping to become pregnant again after a stillbirth, consult with your midwife or doctor. Tests may help reveal the cause of the stillbirth. Your medical team will know which tests are most likely to help in this situation.

If you have more questions about stillbirth or want to talk with people who have been in a similar situation before, consider reaching out to local support groups or online ones.

You do not have to go through the grief of pregnancy loss and the uncertainty of what comes next alone.