Stillbirth

A large proportion of stillbirths seem to occur in otherwise healthy babies and the cause of some remains unexplained.

Information written and reviewed by Certified Doctors.

Contents

Causes

A large proportion of stillbirths seem to occur in otherwise healthy babies and the cause of some remains unexplained.

However, many stillbirths are linked to placental complications. This means that for some reason the placenta (the organ that links the baby’s blood supply to the mother’s and nourishes the baby in the womb) is not functioning properly.

A poorly functioning placenta may be the direct cause of the stillbirth, or it may have contributed to the baby’s death because the baby’s growth and development have been held back.

If there have been problems with the placenta, stillborn babies are usually born perfectly formed - though often small. With more research it is hoped that placental causes may become better understood, leading to better detection of placental problems and better care for these babies.

Other conditions that can cause stillbirth or may be associated with stillbirth include:

  • bleeding (haemorrhage) before or during labour
  • placenta abruption - when the placenta separates from the womb before the baby is born.
  • pre-eclampsia - a condition that causes high blood pressure in the mother
  • a problem with the umbilical cord, which attaches the placenta to the baby’s tummy button; the cord can slip down through the entrance of the womb before the baby is born (known as cord prolapse), or it can be wrapped around the baby’s neck
  • Intrahepatic cholestasis of pregnancy (ICP) or [obstetric cholestasis] - a liver disorder during pregnancy, which is characterised by severe itching.
  • a genetic physical defect in the baby
  • gestational diabetes - a type of diabetes developed by the mother during pregnancy
  • infection in the mother that also affects the baby (see below)

Infections

Around one in ten stillbirths is caused by an infection. The most common kind of infection is a bacterial infection that travels from the vagina into the womb (uterus). These bacteria include group B Streptococcus, Escherichia coli (E.coli), Klebsiella, Enterococcus, Haemophilus influenza, Chlamydia, and mycoplasma/ureaplasma.

Some bacterial infections - for example, Chlamydia and mycoplasma/ureaplasma, which are sexually transmitted infections - can be prevented using barrier contraception (such as condoms).

Other infections that can cause stillbirths include:

  • rubella – commonly known as German measles
  • flu - it is recommended that all pregnant women have the seasonal flu vaccine irrespective of their stage of pregnancy
  • parvovirus B19 - which causes slapped cheek syndrome, a common childhood infection which is dangerous for pregnant women
  • coxsackie virus, which can cause hand, foot and mouth disease in humans
  • cytomegalovirus - a common virus spread through bodily fluids, such as saliva or urine, which often causes few symptoms in the mother
  • herpes simplex - the virus that causes cold sores
  • listeriosis - an infection that usually develops after eating food contaminated by bacteria called Listeria monocytogenes (listeria); it may cause vomiting and diarrhoea in the mother (see preventing stillbirth for more information about the foods to avoid during pregnancy)
  • leptospirosis- a bacterial infection spread by animals such as mice and rats, which can be caught by getting contaminated soil or water in your mouth, nose, eyes or open cuts.
  • Lyme disease - a bacterial infection spread by infected ticks
  • Q fever - a bacterial infection caught from animals such as sheep, goats and cows
  • toxoplasmosis - an infection caused by a parasite found in soil and cat faeces
  • malaria - a serious tropical disease spread by mosquitoes

Increased risk

There are also a number of things that may increase your risk of having a stillborn baby, including:

  • [having twins or a multiple pregnancy]
  • having a baby who does not reach his or her growth potential in the womb (see below)
  • being over 35 years of age
  • having gestational diabetes, high blood pressure or a blood-clotting disorder
  • smoking, drinking alcohol or misusing drugs while pregnant
  • being obese (having a [body mass index] of over 30)
  • having a pre-existing physical health condition such as epilepsy

Growth potential

Midwives check the growth and wellbeing of your baby at every antenatal appointment. They use a tape measure to work out the distance from the pubic bone to the top of the uterus (womb). They plot your baby’s growth on a chart to ensure he or she is continuing to grow.

Every baby is different and should grow to the size that’s normal for him or her. But all babies should continue to grow steadily throughout the pregnancy. Some babies are naturally small, usually because their mothers are small,. If a baby seems to be smaller than it should be, or his or her growth pattern tails off as the pregnancy continues, this is described as ‘growth restriction’, being ‘small for gestational age’ or not reaching his or her ‘growth potential’..

If a baby does not reach his or her growth potential in the womb this may be because the placenta is not working properly. This increases the risk of stillbirth.

Problems with a baby’s growth should be picked up during antenatal appointments. However, it’s important to be aware of your baby’s movements in order to try to spot any problems as early as possible (see preventing stillbirth for more information about this).

Diagnosis

Your baby's wellbeing will be monitored during your antenatal appointments, so any problems will usually be picked up before labour starts.

If it's suspected that your baby may have died, cardiotocography (CTG) or an ultrasound scan will be carried out to check your baby's heartbeat. A doctor will usually be asked to confirm that the baby has died.

Sometimes, after the baby’s death has been confirmed, a mother may still feel her baby moving. This can happen when the mother changes position and is called passive movement. In this case the mother may be offered another ultrasound scan.

Finding out your baby has died is devastating. You should be offered support and your options explained to you. If you are alone in hospital, you can ask the staff to contact someone close to you and ask them to come in to be with you.

Read more about getting help after a stillbirth.

Giving birth

If a baby dies before labour starts, the mother is usually offered medication to start labour. This is safer for the mother than having a caesarean section.

If there is no medical reason for the baby to be born straight away, the mother may decide to wait for labour to start naturally. This decision doesn't usually need to be made immediately and it may be possible to go home for a day or two first.

Natural labour

If the mother decides to wait for labour to begin naturally, she will need regular blood tests after 48 hours.

Waiting for labour to begin naturally also increases the chance of the baby deteriorating in the womb. This can affect how the baby looks when he or she is born, and can make it more difficult to find out what caused the death.

Induced labour

If the health of the mother is at risk, labour is nearly always induced using medication. This may been done immediately if:

  • the mother has severe pre-eclampsia - a condition which causes high blood pressure
  • the mother has a serious infection
  • the bag of waters around the baby (the amniotic sac) has broken

Labour can be induced by inserting a pessary tablet or gel into the vagina, or by swallowing a tablet. This usually takes some time to work. Most women go home during this time, with an appointment to come back to the hospital 24 to 36 hours later. Sometimes, medication is given through a drip into a vein in the mother’s arm.

Caesarean

In a very few cases, a [caesarean section] may be necessary. A caesarean is a surgical procedure to deliver the baby through a cut in the mother’s abdomen (tummy).

Prevention

Not all stillbirths can be prevented. However there are some things which you can do to reduce your risk.

These include:

  • stopping smoking
  • avoiding [alcohol and drugs during pregnancy] - these can seriously affect your baby’s development, as well as increasing the risk of miscarriage and stillbirth
  • attending all your [antenatal appointments] so that midwives can monitor the growth and wellbeing of your baby
  • ensuring you are a healthy weight before trying to get pregnant
  • protecting yourself against infections (see the causes of stillbirth) and avoiding certain foods
  • reporting any tummy pain or vaginal bleeding that you have to your midwife on the same day
  • monitoring your baby's movements and reporting any concerns you have to your midwife straight away
  • reporting any itching to your midwife

Some of these are discussed in more detail below.

Your weight

Obesity is a risk factor for stillbirth.

Obesity is defined as a body mass index (BMI) of over 30. You can check your BMI using the healthy weight calculator. However, if you're pregnant the calculator may not be accurate so you should consult your midwife or doctor instead.

The best way to protect your health and your baby’s wellbeing is to lose weight before you become pregnant. By reaching a healthy weight, you cut your risk of all the problems associated with obesity in pregnancy. Your doctor can give you advice about how to lose weight.

If you're obese when you become pregnant, your midwife or doctor can give you advice about improving your health while pregnant.

Eating healthily and activities such as walking and swimming are good for all pregnant women. If you were not active before becoming pregnant, you should consult your midwife or doctor before starting a new exercise programme while you're pregnant.

Read more about [obesity and pregnancy] and [exercise during pregnancy].

Monitoring your baby's movements

You will usually start feeling some movement between weeks 16 and 20 of your pregnancy, although it can be later than this. These movements may be felt as a kick, flutter, swish or roll.

The number of movements tends to increase until 32 weeks of pregnancy and then stay about the same, although the type of movement may change as you get nearer to your due date

You should continue to feel your baby move up to and during labour.

If you notice your baby is moving less than usual or if you have noticed a change in the pattern of movements, it may be the first sign that your baby is unwell and therefore it is essential that you contact your midwife or local maternity unit immediately so that your baby’s wellbeing can be assessed.

There is no specific number of movements which is normal. What is important is noticing and telling your midwife about any reduction or change in your baby’s normal movements.

Avoiding certain foods

Some foods should be avoided during pregnancy. For example, you should not eat some types of fish or cheese, and you should make sure that all meat and poultry is cooked thoroughly.

Read more about the [foods to avoid during pregnancy].

Attending antenatal appointments and reporting any concerns

During your antenatal appointments, your midwife or doctor will monitor the development of your baby. They will monitor your baby’s growth and position.

You will also be offered tests including blood pressure tests and urine tests. These are used to detect any illnesses or conditions, such as pre-eclampsia, that may cause complications for you or your baby. Any necessary treatment can be provided promptly and efficiently.

Read more about [antenatal care].

Getting help

A stillbirth can be emotionally traumatic for both the mother and father, as well as other family members, but help and support is available.

Many people experience feelings of guilt or anxiety following the loss of their baby. Some parents suffer from depression or experience post-traumatic stress disorder.

You may find it helpful to discuss your feelings with your doctor, community midwife or health visitor, or with other parents who have lost a baby.

Support groups

Support groups can also help if you have had a stillbirth.

Sands, the Stillbirth and neonatal death charity, provides support for anyone affected by the death of a baby. The charity runs a helpline, provides information and support literature and funds research into the causes of stillbirth.

Read more about [bereavement] and [dealing with loss].

Introduction

A stillbirth is a baby born dead after 24 completed weeks of pregnancy.

If the baby dies before 24 completed weeks, it is known as a miscarriage or late fetal loss.

Stillbirth is more common than many people think.

What causes stillbirth?

Around two thirds of stillbirths are linked to placental complications. This means that for some reason the placenta (the organ that links the baby’s blood supply to the mother’s and nourishes the baby in the womb) is not functioning properly.

About ten percent of stillborn babies have some kind of congenital abnormality. A small percentage of stillbirths are caused by problems with the mother's health, for example pre-eclampsia, or other problems including cord accidents and infections.

Read more about causes of stillbirth.

What happens when a death is suspected?

If it's suspected that your baby may have died during your pregnancy, cardiotocography (CTG) or an ultrasound scan can be used to check if your baby's heart has stopped.

If your baby’s death is confirmed and there is no immediate risk to your health, you will usually be given time to think about what you want to do next. You may be able to choose whether you would like to wait for labour to begin naturally, or if you want it to be started with medication (induced).

If your health is at risk, the baby may need to be delivered as soon as possible.

It is rare for a stillborn baby to be delivered by [caesarean section].

Read more about how stillbirths happen.

After a stillbirth

After a stillbirth, many parents want to see and hold their baby. You may also wish to give your baby a name and to create memories by, for example, taking photographs or a lock of hair. It is completely up to you what you want to do.

Finding out why a stillbirth has happened can be helpful if you want to get pregnant in the future, so you will be offered tests to try to find out why your baby died.

You will also be offered an opportunity to discuss having a post mortem examination of your baby. A post mortem will not be done without your consent.

A senior doctor will discuss the results of the post mortem (if you had one) and any other tests in a follow-up appointment several weeks after the birth. You may also want to discuss any possible effects on future pregnancies.

Read more about what happens after a stillbirth.

Help and support

Stillbirth and late miscarriage can be devastating for the parents of the baby and also affect wider family members, including children and friends.

You may find it helpful to discuss your feelings with your doctor, community midwife or health visitor, or with other parents who have lost a baby.

There are many support groups for bereaved parents and their families. Some of these groups are run by parents who have experienced stillbirth or by healthcare professionals, such as baby loss support workers or specialist midwives.

Read more about stillbirth support and [coping with stillbirth].

Can stillbirths be prevented?

Not all stillbirths can be prevented. However there are some things which you can do to reduce your risk of having a stillbirth, such as:

  • stopping smoking
  • avoiding [alcohol and drugs during pregnancy] - these can seriously affect your baby’s development, as well as increasing the risk of miscarriage and stillbirth
  • attending all your [antenatal appointments] so that midwives can monitor the growth and wellbeing of your baby

Read more about preventing stillbirth.

Afterwards

After a stillbirth, many parents want to see and hold their baby. This is entirely up to you. You will be given some quiet time with your baby if this is what you want.

You can also take photographs of your baby and collect mementos, such as a lock of hair, foot prints or hand prints, or the blanket that your baby was wrapped in at birth.

If you're not sure whether you want to take any mementos of your baby home, it is usually possible for them to be stored with your hospital records. If your hospital does not keep paper records, you may be given these mementos in a sealed envelope to store at home. This means you will be able to look at them if you ever decide you want to.

You may also want to name your baby. However, not everyone does this and, again, it is up to you.

Bereavement support

You may be introduced to a bereavement support officer or a bereavement midwife. They usually work in hospitals or as part of the local council. They can help with any paperwork that needs to be completed and explain choices you can make about your baby’s funeral. They will also act as a point of contact for other healthcare professionals.

Read more about support after a stillbirth.

Finding the cause

You will be offered tests to find the cause of the stillbirth. You don't need to have these, but the results may help avoid problems in any future pregnancies.

The tests you're offered may include:

  • blood tests - which can show whether the mother has pre-eclampsia, obstetric cholestasis, or rarely, diabetes
  • specialist examination of the umbilical cord, membranes and placenta (the structures that attach you to your baby and support your baby in pregnancy)
  • testing for infection - a sample of urine, blood or cells from the vagina or cervix (the neck of the womb) can be tested
  • thyroid function test - to see whether the mother has a condition that affects her thyroid gland
  • skin tests on your baby

More in-depth tests can also be carried out on your baby to try to establish the cause of death or any conditions that might have contributed to your baby’s death. This is called a post-mortem.

Post-mortem

A post-mortem is an examination of your baby’s body and is undertaken by a specialist doctor called a perinatal pathologist. The examination can provide more information about why your baby died, which may be particularly important if you plan to become pregnant in the future.

A post-mortem cannot go ahead without your written consent and you will be asked if you want your baby to have one. The procedure can involve tests such as examining your baby’s organs in detail, looking at blood and tissue samples, and carrying out genetic testing to see whether your baby had a genetic disease (a disorder resulting from changes, or mutations, in an individual’s DNA).

The healthcare professional who asks for your consent will explain the different options so you can decide whether you want your baby to have a post-mortem and, if you do, which tests you want the perinatal pathologist to carry out.

Follow-up

You will usually have a follow-up appointment to check your health and discuss the results of the tests and post-mortem (if these are carried out) a few weeks after you leave hospital.

This appointment is also a good opportunity to talk with your doctor about possible future pregnancies. For example, you may want to ask about the chances of having another stillbirth and any measures you could take to reduce the risk.

Before attending this appointment, you may find it helpful to write down any questions you have for your doctor.

Content supplied by NHS Choices