A stillbirth is when a baby sadly dies after 24 weeks of pregnancy. Before 24 weeks, it is classed as a miscarriage. Coping with the death of a baby is obviously a devastating thing to go through, and despite it being something that affects lots of families, it's still very much taboo, which can make you feel very alienated if it has happened to you. However, there is a wealth of support out there. The most important thing in the immediate aftermath of the loss of your child is to treat yourself with the utmost kindness and seek support wherever you feel able and most comfortable.
What causes stillbirth?
Stillbirth is more common than many people realise. Around one in every 200 pregnancies ends in stillbirth – 11 babies are stillborn in the UK every day.
In around a third of cases, there is no identifiable cause, but many things can be a factor.
Around a third of stillbirths are caused by a problem with the placenta, which can start to deteriorate and prevent the baby growing properly. Placental abruption (when the placenta comes away from the womb wall) can also cause stillbirth.
Problems with the umbilical cord
Some cases are caused by an issue with the umbilical cord, such as a prolapse (where the cord slips through the entrance of the womb) or the cord becoming looped around the baby's neck.
One in 10 stillbirths are caused by an infection. These can include:
- Group B streptococcus
- Lyme disease
Genetic conditions can play a part and, rarely, something that occurs during labour and birth (such as shoulder dystocia, where the baby's shoulder gets stuck) can restrict the baby's oxygen supply enough to cause a stillbirth.
What increases your risk of stillbirth?
Women are at greater statistical risk of suffering a stillbirth if they:
- Have a pre-existing condition, such as epilepsy
- Are obese before pregnancy
- Are carrying twins or more
- Smoke, drink excessively or abuse drugs
- Are an older mother
It's worth remembering that all these things only represent a very tiny increase in risk.
What are the “symptoms” of stillbirth?
Often there are no signs at all that a baby is in trouble but there are some symptoms you should look out for.
Changes in your baby's movements
You should be monitoring your baby's movements, especially in the third trimester. If you notice any sudden increase or decrease in kicks, or just have the sense something is not right, don't wait – call your midwife straight away and go and get checked out. If the baby is in distress they may be able to find out why and deliver him or her early.
Leaking fluid or discharge from the vagina
If you suspect what you're leaking is amniotic fluid and not urine, you should go straight to hospital where they can monitor it. Occasionally, leaking waters can lead to premature birth and sometimes complications, so you need to seek help at once.
Discharge that is any colour other than white, or has a bad smell, should also be reported to your midwife quickly. This can be a sign of infection, which can pass to the baby and result in premature birth, and sometimes stillbirth.
Swelling, headaches and blurred vision
All of these are symptoms of pre-eclampsia (see above), which presents with high blood pressure and protein in the urine. If you think you could have pre-eclampsia, get yourself to hospital immediately. If it's confirmed, they may put you on bed rest and will monitor you to see if your baby needs to be delivered early.
This can be a sign of obstetric cholestasis (see above), a condition that affects the liver in pregnancy, and which occasionally causes stillbirth. The itching can occur anywhere but is often worse on the soles of feet and palms of hands.
Can stillbirth be prevented?
If you've suffered a stillbirth, know that in all likelihood there was nothing you could have done to change the outcome.
There are some things you can do to reduce the risk, however – these include:
- Eating healthily, not smoking, drinking or taking drugs and following all the usual dos and don'ts of pregnancy
- Monitoring your baby's movements in the third trimester so you will notice if there's a change.
- Attending all your antenatal appointments, particularly if you have any additional health issues such as diabetes or gestational diabetes.
What happens when a stillbirth is suspected?If everything's gone perfectly well throughout the pregnancy, there's just no reason to believe random tragedy is going to strike. It doesn't make sense. Nobody prepares you for that possibility. It's just not on your radar.
Sometimes a baby dies during labour but more often, women discover their baby has died at a routine scan or appointment, or they go to hospital as they are worried about lack of movement and find out at that stage.
If you go to hospital with concerns, or something is picked up at an appointment, they’ll look for a heartbeat. If none is found, they will do an ultrasound and sometimes that confirms that the baby has sadly died. Sometimes, very cruelly, women will feel the baby moving after this. This is usually due to the mother changing position and isn’t the baby at all, but another ultrasound will usually be offered to be absolutely certain.
Once it is known your baby has died, you may be offered an induction. However, if there is no medical reason to bring labour on, you may be given the option to wait and allow labour to happen naturally – you may need regular blood tests to check on your own health though. It’s also worth knowing that the baby's body may start to deteriorate a little during this time so some women opt for an induced labour to avoid this.
What happens straight after a stillbirth?
Times have changed enormously since stillborn children were swiftly taken away at birth.
You will have the chance to hold him or her and some parents even choose to take their baby home for a while. There's no legal reason why you can't do this and it helps lots of people build memories.
Some give their baby a bath and dress him or her in a special outfit they have chosen or spend a night with the baby in the cot next to them.
Hospitals will usually take prints of your baby's hands and feet, as well as photographs for you to keep and you can ask for help starting a memory box.
No matter what your wishes or concerns may be, be assured that everyone around you will want to do all they can to support you and make sure your wishes are heard.
What does a stillborn baby look like?
Many parents are nervous about seeing their baby, although for the most part, they will look as perfect as any baby – just a lot smaller and maybe darker in colour. If you're worried, you could ask the midwife or your birth partner to tell you a bit about how the baby looks before you see him or her for yourself.
Post-mortem results after stillbirth
Parents only get a firm answer in 60-80% of stillborn post-mortems. Knowing the cause helps some parents to begin to find closure – the senselessness of a baby dying for no reason can be impossible to accept – and in some cases, information is discovered which may be useful if you choose to try for another baby.
However, a post-mortem will obviously delay a funeral and the grieving process.
Sands (the stillbirth and neonatal death charity) has fact sheets you can download or send off for which may help you make this difficult decision.
Do I have to register my baby's death?
Babies who were born alive at any stage of pregnancy and then died, and babies who were born after 24 weeks of pregnancy and showed no signs of life, must be registered by the registrar of births and deaths.
Do stillborn babies have a funeral?
By law, stillborn children must be buried or cremated. You don't have to attend this (the hospital and its undertaker can make all the arrangements for you), but many parents find it helpful to mark the loss of their child. There may be religious beliefs you want taken into account, you might want everyone to wear a certain flower or colour that is special to you, or perhaps arrange a charitable collection in your child's memory.
Coping after a stillbirth
There's no right or wrong way to deal with the loss of a baby. Lots of parents say it's more a case of learning to live with what has happened than “getting over it”. Do whatever gets you through the first difficult weeks and months and remember to be kind to yourself.
Your body after a stillbirth
Your body won't know what has happened so you'll experience all the same changes to your body as any new mother, from bleeding following the birth to your milk coming in. Remember that you might be physically quite sore and will need plenty of rest and looking after, so ask for help, accept help and go really easy on yourself.
Sometimes you can be given drugs to stop your milk coming in, so ask the midwives about this. If you choose not to, you might want to ask them about ways to prevent engorgement and mastitis while your body goes through the process of milk being produced and then stopping.
Coping with grief after stillbirth
Everyone grieves differently. The loss of a baby is something so unexpected and the intensity of emotion often comes as a shock. You may have feelings of anger, disbelief, guilt and betrayal as well as a deep sense of loss. Some women find themselves swamped by disturbing thoughts or impulses that ordinarily wouldn't have crossed their minds.
Speak to your GP or the hospital, who should be able to arrange counselling and put you in touch with other sources of support. See below for more contact details of organisations you can turn to.
Coping with the reactions of others to stillbirth
Many women say the thing they found hardest was the reaction of their partners. If they go to pieces it can feel frightening as they are the person on whom you want to lean, but if they don’t appear outwardly as sad, that can be difficult, too. The main thing is to both try to be accepting of the other's grief and behaviour.
Grandparents can be a source of much support, but also worry – they'll be grieving the loss of a grandchild and are also likely to be extremely concerned about you, too. Accept any help that they offer, especially of a practical nature – being able to help in some small way might be a great comfort to them.
If you have any other children, explaining what has happened to them can be very hard. Lots of young children will, at some point, blame themselves so it's important to explain that what happened is nobody's fault. If there is a close friend or relative who can be on hand for extra support for the children, you may find that helpful.
As time moves on, many women say that seeing old friends, or people from your antenatal group is very upsetting – especially if they have babies or are pregnant themselves. You might want to email or ask someone to explain for you that while you value the friendship enormously and that hasn't changed, just at the moment you don't feel you can see them but you'll be in touch.
“I found it really hard to see some of my friends who were pregnant or had recently had babies. In fact, I almost made a break with my past life and started again. I felt like my friends didn't know what to say to me – they didn't want to talk about my son as they thought it might upset me. But what upset me more was people not talking about him like he'd been a real person. I think that's the hardest thing with stillbirth – it's such a personal grief and it can be really hard for others to know how to deal with.”
Stillbirth – dealing with practicalities
It will feel like the world has stopped turning but these are a few of the things you do need to deal with in the weeks after losing a baby.
Rights and benefits after losing a baby
The rights and benefits to which bereaved parents may be entitled are complicated and depend on many things, including the length of the pregnancy, whether your baby was stillborn or lived for a short time after birth, and whether you are employed. It may seem strange or upsetting to think about claiming beneﬁts when your baby has died. But bereavement can cause ﬁnancial strain, so it’s important to ﬁnd out about all the beneﬁts you’re entitled to. Find out more from Sands.
Follow-up appointments after a stillbirth
It's important to attend a six-week postnatal health check-up, and this can also be a chance to discuss how you and your family are coping. If you have a post-mortem, you'll need an appointment to discuss the results of this with a consultant. Some parents find it helpful to have a copy of the mother's pregnancy notes, perhaps as a record of their baby's life. If there is anything you find confusing or illegible in your notes, ask staff at the maternity unit to explain. Only the mother can apply for these notes. She can do this by writing to the NHS Trust or maternity unit where her baby died.
Returning to work after a stillbirth
The decision about when to go back to work will depend on your physical and emotional health, finances, and work-related factors. If your baby was stillborn after 24 weeks, or died after birth, you are entitled to maternity leave and pay. Fathers or partners may also be entitled to one or two weeks' leave. Speak to your employer about what your options are – how much time you can take, if you could start back at work part-time, or do some work from home, if that's possible. You may also wish to consider how to broach the subject with your colleagues – whether you ask your boss to inform people, or send an email in advance of your return explaining the situation and how you feel about discussing it. This will help both you and others to prepare.
Trying for a baby after stillbirth
This may be something you don't even want to think about for a good long while, but it feels different for everyone. Some people know they want to try for another baby as soon as possible while others can’t contemplate it for a long time. You might need to wait a little while for your body to fully recover from your last pregnancy and also for your periods to return. You may also want to talk to your doctor about other factors to consider, such as your age and any medical conditions that you might need to take into account when making your decision.
If no cause was found for your baby's death, or if the cause was not something that might recur, you are very unlikely to suffer another loss. Even if the cause was something that can recur (such as diabetes or pre-eclampsia) doctors should be able to monitor you and take action to avoid this happening again. There will be lots of support for you through your next pregnancy and everyone will understand how anxious you will be. If it will make it easier, you can arrange for your antenatal care and labour to be in a different hospital so you aren't reminded of your loss at every appointment and your next pregnancy can feel like more of a fresh start.
Government announces proposal to give coroners the ability to examine cause of stillbirths
In March 2019, the Ministry of Justice announced a consultation looking into whether there should be inquests into stillborn deaths. At the moment, there cannot be a coronial inquest unless a baby showed signs of life at birth.
The consultation came as a response to calls from bereaved parents, charities and others for a more transparent and independent process for determining the causes of, and learning from, stillbirths.
Some of those calling for change have identified coronial investigations as the way to deliver an improved process. The Chief Coroner for England and Wales has repeated his call for proper consideration of the question whether or not to give coroners powers to investigate stillbirths.
As such, the Ministry of Justice and the Department of Health and Social Care have jointly prepared a consultation seeking the public's views on whether inquests should be introduced for all stillbirths.
The consultation is calling upon a wide range of people and organisations to respond, and are particularly keen to hear from bereaved parents, the organisations that support them or that provide advice to pregnant women, researchers, health professionals and healthcare providers. It is also seeking opinions from those working for coronial services.
If you would like to give your views on whether you think a more comprehensive inquest process would improve the systems for establishing the possible causes of a stillbirth, you can do so by completing the survey.