Stillbirth

Stillbirth is when the baby is born dead: showing no signs of life and not even taking their first breath after 24 weeks of pregnancy. Sadly it is a lot more common than most people think. There are about 4,000 stillborn babies every year in the UK, this means around about 11 babies are stillborn every day in the UK. Stillbirth is 10 times more common than cot death.

Stillbirth is a very emotional and confusing experience especially when there is no answer to why your baby died. A person going through this may be offered counselling, where they can be gvien an empathic, safe place to express your feelings and to help them find a way to cope with life after the lost of a baby. There is support available for mothers, fathers and close family members. SANDS is a national charity supporting anyone affected by the death of a baby; the charity runs a helpline and funds research into the causes of stillbirth.

If you have had a stillbirth and need someone to talk too, you can call the SANDS confidential helpline on 020 7436 5881, or you can email them confidentially ([email protected]). The helpline is open from 9.30am-5.30pm, Monday to Friday. It is also open later on Tuesday and Thursday evenings, from 6pm-10pm. If you need to find a support group in your area then you can find them on the NHS website.

What causes a stillbirth?

Sadly 30% of stillbirths have no known cause even when all tests and the post-mortem have been performed. The term for this is Sudden Antenatal Death Syndrome or SADS, a phrase coined by Cacciatore and Collins in 2000. Such stillbirths remain unexplained because there is a lack of research into stillbirth and its causes. Some known conditions that can cause stillbirth or may be associated with stillbirth include:

  • Bleeding (haemorrhage) before labour
  • Problems with the placenta, such as it detaching from the womb before baby is born (placental abruption), or it not work properly and not getting enough oxygen and nutrients to the baby, thus affecting the baby’s growth (intra-uterine growth restriction is associated with one-third of all stillbirths).
  • A problem with the umbilical cord. The cord attaches your baby to the placenta and may slip down through the entrance of the womb before the baby is born. This is known as cord prolapse and it occurs in about 1 in 200 births. In other cases the umbilical may wrap around the baby’s neck.
  • Pre-eclampsia: this is a condition that can cause high blood pressure in the mother. Mild pre-eclampsia can affect up to 10% of first time pregnancies and more severe pre-eclampsia can affect 1-2 % of pregnancies.
  • A genetic physical defect in the baby.
  • A liver disorder in the mother called obstetric cholestasis which occurs 1 in 200 of pregnancies.
  • Diabetes in the mother.
  • Infection in the mother that also affects the baby: this affects 7% of stillbirth. The infection may come from the vagina into the womb (uterus) or maybe passed from mother to baby through the placenta.

Infections that can cause stillbirth include:

  • Coxsackie virus: This can cause hand, foot and mouth disease in humans.
  • Cytomegalovirus: a common virus from the herpes family of viruses that often cause few symptoms in the mothers.
  • Herpes simplex: this virus causes leptospirosis.
  • Leptospirosis: a bacterial infection that is caught from animals such as cows, pigs, dogs and rats.
  • Listeriosis: this is an infection that comes from eating food that as been contaminated by the bacteria called Listeria monocytogenes (listeria). It may cause vomiting and diarrhoea in the mother.
  • Lyme disease: a bacterial infection that is spread by infected ticks.
  • Malaria: a tropical disease that spread by mosquitoes.
  • Parvovirus B19: which causes slapped cheek syndrome, a common childhood infection.
  • Q fever: a bacterial caught from animals such as sheep, goats and cows.
  • Rubella (German measles): this is now rare as most pregnant women have had the MMR vaccine to protect against rubella.
  • ‘Flu: the seasonal ‘flu vaccine should be given to all pregnant women irrespective of their stage of pregnancy.
  • Toxoplasmosis: an infection caused by a parasite that is found in soil and cat faeces.

While a woman should never feel she is responsible, other factors that may increase risk of having a stillirth include:

  • Having twins or a multiple pregnancy
  • Being younger than 20 years of age
  • Having diabetes, high blood or a blood clotting disorder
  • Being obese, having a body mass index (BMI) of other 30
  • Being a smoker: when you smoke your blood is unable to carry as much oxygen as usual. The reduction in the amount of oxygen in your blood is likely to result in your baby’s growth being restricted and smaller babies are at greater risk of illness and being stillborn.

Sometime stillbirth happens even when none of the above are applicable. This can make it even more distressing because there are no answers.

When does stillborn happen?

Stillborn usually happens before labour starts and is usually found with ultrasound, which shows the baby, even when there is no heart beat found. If no heartbeat is found, the sonographer would ask for a second opinion and look for other signs that suggest the baby has died. Sometimes the mother will feel the baby move after the death as been confirmed, this is called passive foetal movement and  happens when the mother moves position, but sadly is not an indication that the baby is alive.

When a baby has died before labour starts, labour is nearly always induced by medication because it is safer then a caesarean section for the mother. If the mother is otherwise healthy, labour may be delayed for a little while if this is what the mother wishes. However, labour may need to be induced immediately if the:

  • Mother has severe onset pre-eclampsia
  • Mother has a life-threatening infection which makes her immune system overreact, causing blood to clot and widespread inflammation.
  • The bag of water around the baby (the amniotic sac) has broken

Labour is induced is by inserting a pessary (tablet) or gel into the vagina or by swallowing a tablet. Occasionally, medication is given through a drip into the mothers arm. 9 out of 10 women will give birth within 24hrs. In some cases a caesarean section will be necessary. A caesarean is a surgical procedure, a way to deliver the baby through a cut in the mother’s abdomen. The cut is normally made just below the bikini line.

Sometimes the baby dies in labour or just before the baby is born.

What to expert after a stillbirth

When a baby is stillborn, the mother’s body will feel different and may feel somewhat empty. It can begin to produce breast milk as the body still attempts to provide nutrition, which can be uncomfortable and distressing. There are medicines that can stop the breast milk from producing called Dopamine Agonist but some mothers may let their milk dry up without medication.

The parents will be given time to hold their baby after the stillbirth and will have quiet time with their baby.  It is up to the parents if they want this. The parents of the baby may wish to take photos, foot prints, hand prints and take a lock of hair, as well as naming their baby, as this may help with the grieving process but everything is optional and left to the parents to decide how it is best for them to proceed.

The mother may be introduced to a bereavement support officer or a bereavement midwife. They are there to help with any paperwork and will be there to explain choices about the baby’s funeral. The mother is usually offered bereavement counselling which can be a great source of support, and can help with learning how to cope with life after the loss of her baby. A counsellor may help you to tell other children the sad news. Counselling has helped a lot of parents.

The mother may be offered some tests to try and find the cause of the stillbirth; testing does not mean they will definitely find a cause but it may give an idea why. The tests that may be performed include:

  • Blood test: which may show that the mother has pre-eclampsia or rarely, diabetes.
  • Testing for infections: 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.

There are also tests that can be carried out on the baby to try and find the cause of death or any condition that may have contributed to the death. A post-mortem may be carried out by a perinatal pathologist if this is what the parents want; it cannot go ahead without written consent from the mother of the baby. The examination that is carried out involve a number of tests, they are:

  • Examining the baby’s organs in detail
  • Looking at blood and tissue sample
  • Carrying out diagnostic genetic testing to see whether the baby has a genetic disease

The healthcare professional will ask which tests the mother wants to be carried out by the perinatal. Sometimes the post-mortem may find something that can affect future pregnancies, so it can be a good idea to have this done.

The parents of the baby will have to register their baby stillborn. The law states that all babies (stillborn) after 24 weeks of pregnancy have to be registered. This can help with the grieving process as it is acknowledging the birth of their baby and it is also important for statistical records. Stillbirths are usually registered within 42 days and cannot be registered after three months. If a name is decided it cannot be changed after the stillborn is registered.

Does having a stillborn have any affect on the future pregnancies?

The results of the post-mortem will give an idea if there could be a problem with future pregnancies. All women who have experienced stillbirth will be monitored closely during any future pregnancies and births.

Lowering the risk of stillbirth

A third of stillbirths remain unexplained, meaning the baby involved appears to be healthy. Stillbirth can happen to a healthy woman but there are things that can be done to lower the risk of stillbirth, including:

    • Stopping smoking: smoking increases the risk of stillbirth.
    • Avoiding alcohol while pregnant: Excessive alcohol consumption can seriously affect your baby’s development and increases the risk of miscarriage during the first three months.
    • Avoiding recreational drugs: illegal drugs, such as cannabis, cocaine, ecstasy and heroin can harm your baby
    • Monitoring your baby’s movements

 

  • Reporting any tummy pain or vaginal bleeding that you have.

 

  • Protecting yourself against infections and avoiding certain foods: some types of fish or cheese and you should make sure that all meat and poultry is cooked thoroughly.
  • Attending all your antenatal appointments. 

 

http://www.nhs.uk/conditions/Stillbirth/Pages/Definition.aspx

by SJ, Mummy to Matthew and Baby Angel

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