Stillbirth

by | June 23, 2020

A stillbirth causes great sorrow. It is important to know that there is rarely something you could have done to avoid it. At birth, the baby is often dead before birth, and is usually born vaginally.

Stillbirth

How do I know the baby is dead?

Stillbirth is defined by the World Health Organization (WHO) as the birth of a dead child from week 22. Previous death of the fetus is termed miscarriage. Stillbirths happen fortunately is rare, but when that happens the child is often dead before birth. As a rule, there are no risks in the pregnant person in advance, and usually there are no warning signs.

If you have a condition that increases the risk of stillbirth, or if you feel that fetal movements are diminishing or ceasing, you should contact your doctor or midwife to clarify if everything is working properly. The doctor and midwife can listen for fetal sounds. If you are uncertain about the condition, you will be referred for ultrasound, or cardiotocography – a study that captures the cardiac activity of the fetus. The diagnosis should be confirmed by two doctors.

In Sweden, it is estimated that 3–4 out of 1,000 births are stillbirths. That is, a total of 440 cases per year, which is a low number compared to other countries. The risk of death in pregnancy is greatest during the last weeks before birth.

What’s the reason?

The most common cause of fetal death is that the child receives too little nutrition from the placenta. It is usually not possible to prove, but in some cases it can be detected, for example, when there is a lack of increase in the SF measurements from the pubic bone to the upper edge of the uterus, which is a sign that there has been less amniotic fluid and that the child has stopped growing.. Ultrasound can detect this condition. In these cases, the pregnant woman is advised to take it easy and make more frequent maternity checks.

Premature discharge of the placenta and pregnancy poisoning may in some cases be the cause. Otherwise, malformations, chromosome abnormalities, infection, maternal illness, coagulation disorders, umbilical cord complications and twins complications are among the explanations. In about 25% of cases, the cause of death remains unknown.

Although the risk factors are often unknown, they exist. There is an increased risk of fetal death in pregnancies with growth retardation, maternal older than 35 years, obesity and obesity, previous stillbirth, previous cesarean section, multiple childbirth, poor socioeconomic conditions, low education, smoking and abuse. Coagulation disorders in the mother, diabetes and high blood pressure are also conditions associated with increased risk.

What happens at stillbirth?

If the fetus dies before birth, it can be born in different ways. It is usually not necessary to release the fetus immediately, unless you have a medical complication. Often the birth of oneself begins within one to two weeks after the fetus dies. Many people want to give birth earlier and in Sweden it is the practice that the parent couple is involved and determines the time of birth start. Most stillbirths are done vaginally unless there are special reasons to have a caesarean section. You will receive appropriate pain treatment without inhibiting the pain. The hospitals are trying to offer a single room in the maternity ward, and it is encouraged that the child’s father is present.

What happens after the birth?

Parents and siblings are urged to spend time with the dead child – that they see it and keep it. Parents are encouraged to involve family and friends in what has happened. Photographs, footprints and handprints of the child should be taken, preferably a small haircut. This can be collected in a memory binder. The death toll affects more than the family, and it may be appropriate to place the obituary before the funeral. Parents can also help put the child in the coffin, or use their own clothes. Often, separate burial is recommended for the child, either in his own grave or family grave.

After the birth of a dead child, doctors often ask for permission to autopsy the child and examine the placenta to determine what went wrong. The investigation may also involve genetic testing. The results of these studies can clarify if there is any risk in future pregnancies and it can give you an answer as to why the baby died.

The examination of the child after birth has no consequences for the plans you have for the burial of the child.

If stillbirth is due to a genetic disease (hereditary defect), it may be advisable to refer you to an expert in genetics who may take multiple samples to give clear advice on the risks of any future pregnancies.

Discomfort and challenges after birth

After a stillbirth, you may experience swollen breasts, depression and other problems. Getting over what has happened both physically and emotionally can be overwhelming.

A stillbirth is an emotionally painful experience. You and your family may need professional help to get you through this difficult time.

Guilt is a common reaction. But know that a stillbirth rarely, if ever, depends on something you did or did not do. It is normal to experience deep sadness, anger and confusion. The loss of the child can be a strain on the marriage / relationship. For this reason too, it can be good to get professional psychological help.

What happens in a new pregnancy?

In most cases, there are no risk factors for stillbirth, so there is no increased risk of it happening again. Nevertheless, doctors and midwives will closely monitor the growth of the child. More frequent checks are required. In such cases, doctors may choose to take the pregnant nurse. If you have lost a child in the past, it is natural to be worried that it will happen again. Talk about it with your doctor and midwife, with your family or with others you may be comfortable with.