Experiencing a stillbirth
Sadly, although stillbirth (perinatal death) is less common in the UK today than in times gone by, there are still circumstances in which a baby will die before or during labour. It is, understandably, a devastating event and parents will be given support, guidance and help as they go through the difficult process following the stillbirth, trying to understand why it happened and how best to cope with grief.
A baby is considered to be stillborn after 24 weeks gestation. If a baby dies before this, it is considered to be a miscarriage. In 2015, in the UK it was estimated that one in every 227 births was a stillbirth. The good news is that these figures are reducing and work is being done to help healthcare professionals identify how to prevent more occurrences of stillbirth.
Causes of stillbirth
Some cases of stillbirth can be attributed to developmental or genetic problems which mean that the baby would not survive if born.
Perinatal death is also associated with placental complications that can affect the supply of blood and nutrients to the baby.
However, it may also that be the case that an in-utero death will not be known.
Generally, a number of causes are thought to contribute to stillbirth and these include:
- Placental abruption – where the placenta separates from the womb
- Bleeding during labour – a haemorrhage before or during labour
- Complications linked with pre-eclampsia – high blood pressure in the mother
- Cord prolapse – when the umbilical cord slips through the womb entrance or knots around baby
- Intrahepatic cholestasis – liver disorder in the mother
- Genetic condition in the baby
- Pre-existing diabetes
- Infection to mother or baby – bacterial or viral
- Incidents or trauma during birth
In some pregnancies there may also be other factors that could increase the risk of a baby being stillborn and include:
- A twin or multiple pregnancy
- A baby with a low growth development
- A mother over the age of 35
- Smoking, drinking or misuse of drugs
- Obesity in mother
- Pre-existing medical condition such as epilepsy
Some actions that may help prevent a stillbirth
In all pregnancies, the wellbeing of the mum-to-be and the baby are regularly monitored. These important antenatal checks give the midwife the opportunity to check the baby’s growth and development. If there is an unexpected change it could be that there is a problem with the baby. So, it’s important to attend antenatal appointments and discuss any concerns with the midwife.
Today, in the UK, there is an increased awareness of the role pregnant mothers have in monitoring fetal movement. Doing so can quickly identify if there is a change in a baby’s behaviour in the womb. A marked drop off in baby’s movements could be a sign that it is in distress. If there are concerns, a midwife or hospital should be informed immediately so that fetal monitoring can be put in place.
Stillbirth discovered before labour
If a baby has died in the womb before term support and advice will be in place to help the parents understand what has happened. Parents will be asked to think about, and make a decision regarding, giving birth. Some women choose to wait for the labour to take place naturally or labour can be induced. It is extremely rare for a stillborn baby to be delivered by caesarean.
The death of a baby is likely to be a terrible shock and it may be difficult to think about making immediate decisions. Parents will be given all the time they need; in most cases there is unlikely to be any risk to the mother’s health.
Going through a stillbirth labour
It is far less common for a baby die during labour. If it this does happen, it usually arises from complications or an emergency during the birthing procedures. It is, understandably, shocking and extremely frightening.
If a problem is identified during labour, priority will immediately escalate and more staff will enter the room to assist. It will become a medical emergency as the staff prioritise and attempt to save the baby’s life.
If the baby is distressed due to being obstructed in the birth canal, the umbilical cord has been compromised, or the cord is wrapped around the baby’s neck, this will be considered urgent as the supply of oxygen to the baby could be affected and cause trauma.
Ultimately, if the efforts and interventions of the medical staff are unsuccessful, the baby may die.
Seeing your baby
After the labour same parents wish to see, hold or touch their baby. This will be a personal and emotional experience. There is no right of wrong way to behave and parents will be given all the support and care they need at that time.
Some parents may feel unsure about seeing their baby; the hospital staff may offer to describe him or her and parents can change their mind if they then want physical contact with their baby. These are difficult times for parents, and it may be difficult to prepare for the feelings which will arise. Maternity staff are fully trained and well-used to these situations, they will offer all the support required.
Sometimes midwives will offer to take photographs, or to cut a lock of baby’s hair. This can be an opportunity for parents to have a physical memory of their baby.
Parents will be given time to spend with their baby and the hospital staff will be sensitive to their needs.
After the birth
Although the event of a baby’s death will be terribly difficult to comes to terms with, parents are obliged to carry out some administrative and legal duties as well as make arrangements for a funeral.
Firstly, a Medical Certificate of Stillbirth will be issued by the hospital or a midwife. By law, parents are required to formally register their baby within 42 days in England and Wales or within 21 days in Scotland. There is no requirement in Northern Ireland.
At this point parents can choose to officially name the baby; a Certificate of Registration of Stillbirth will then be issued. Many parents find this comforting and evidence of their baby’s brief but important existence.
Lastly, a certificate for burial or cremation will be issued.
Many hospitals offer to arrange a funeral for the baby and the staff will take time to talk through the options. Parents should advise the hospital if, for religious reasons, the funeral must be arranged very quickly. However, parents are free to make private arrangements for a service or ceremony that is personal to them.
Some parents find it helpful to speak with a hospital chaplain, who can be there to provide comfort and advice at this a difficult time.
Above all, parents will be given the time and space to make plans and choices about how they want to mark the occasion of their baby’s passing.
Understanding what happened and getting support
In many cases, it may not be possible to know the reason why a baby is stillborn. The hospital will offer an investigation of the placenta, the mother’s blood or to carry out a post-mortem to try to discover the reasons and causes of the stillbirth. These are sensitive issues and it will be entirely the choice of the parents, who will be given the opportunity to discuss this in detail with hospital staff.
Parents will also need to take time to look after themselves following the birth. Taking time off work may be a good idea and making choices about who visits and when you tell people will need to be made.
Sands (Stillbirth & neonatal death charity) is a charity dedicated to helping mothers and parents affected by the death of their baby due to stillbirth. They have a number of services and bereavement support systems in place to help.
Mostly, it is important that parents take time to grieve and come to terms with the feelings they will have about going through this emotional and extremely difficult experience.