If you’re reading this because you’ve experienced a stillbirth, please know that our hearts go out to you. The loss of your baby is profound, and your grief is valid. This guide aims to help you understand what happened, what to expect, and how to navigate this difficult journey.
What is Stillbirth?
Stillbirth is generally defined as the death of a baby at or after 20 weeks of pregnancy, before or during delivery. In the United States, stillbirth occurs in about 1 in 160 pregnancies, affecting approximately 24,000 families each year. While this statistic may make you feel less alone, we recognize that your experience is uniquely yours, and your grief is personal.
Why Did This Happen?
This question weighs heavily on parents’ minds. It’s important to understand that stillbirth is not your fault. Many parents, especially mothers, struggle with feelings of guilt or responsibility, but stillbirth is rarely caused by something a parent did or didn’t do.
Several factors can contribute to stillbirth:
- Placental problems: Issues with the placenta, like placental abruption (when the placenta separates from the uterine wall) or other placental insufficiencies, are common causes.
- Genetic factors and birth defects: Some stillbirths are related to chromosomal abnormalities or congenital anomalies.
- Growth restriction: When a baby doesn’t grow as expected during pregnancy, there’s an increased risk of stillbirth.
- Infections: Certain infections during pregnancy can lead to stillbirth.
- Umbilical cord complications: Problems with the umbilical cord, such as a knot or compression, can sometimes cause stillbirth.
- Pre-existing conditions like diabetes, high blood pressure, or autoimmune disorders
Despite thorough investigation, the cause of stillbirth remains unknown in about 30-40% of cases. This can be particularly difficult to accept, but it doesn’t mean you won’t have any answers.
What Happens After Diagnosis
making decisions about baby
After a stillbirth is diagnosed, you’ll have decisions to make about how and when to give birth. Unless there are urgent medical concerns, you don’t need to rush these decisions. Many parents appreciate having time to process the news before proceeding.
Most often, vaginal birth is recommended, even if you’ve had a cesarean birth in the past. Your healthcare provider will discuss options for labor induction if you choose not to wait for labor to begin naturally. Pain management options, including epidural anesthesia, will be available to you just as they would be for any birth.
Creating Memories With Your Baby
The time you spend with your baby after birth is precious. Research has shown that creating memories and having tangible reminders can be crucial for the grieving process. Here are some possibilities to consider:
- Seeing and holding your baby: Many parents find comfort in spending time with their baby. The hospital staff can clean and wrap your baby before bringing them to you. Some parents worry about what their baby will look like – hospital staff can help prepare you and show you your baby’s most beautiful features.
- Photographs: Professional or staff-taken photographs provide lasting memories. Many hospitals work with volunteer organizations like Now I Lay Me Down to Sleep, which provide professional photography services at no cost. Consider taking photos of your baby’s hands, feet, face, and of you holding your baby.
- Hand and footprints: The hospital can make prints of your baby’s hands and feet. These can be kept as they are or incorporated into jewelry or other keepsakes later.
- Lock of hair: If possible, saving a lock of your baby’s hair can be a meaningful keepsake.
- Naming your baby: Giving your baby a name acknowledges their significance in your life.
- Bathing and dressing your baby: Some parents find it meaningful to bathe and dress their baby in special clothes.
- Religious or cultural rituals: If you have specific religious or cultural traditions, discuss these with your healthcare team.
- Memory boxes: Many hospitals provide memory boxes that may include items like a blanket, hat, identification bracelet, measuring tape showing your baby’s length, crib card, and other mementos.
You can decide which of these options feel right for you. There is no right or wrong way to create memories with your baby.
Saying Goodbye
Deciding when and how to say goodbye to your baby is deeply personal. Some parents spend just a short time with their baby, while others may spend hours or even a day. The hospital staff can usually accommodate your wishes and will handle your baby with dignity and respect when it’s time to say goodbye.
Understanding the Evaluation Process
A thorough evaluation after stillbirth can help determine why your baby died and may provide important information for future pregnancies. While no evaluation can guarantee answers, many families find that having as much information as possible helps with their grieving process.
The Importance of a Comprehensive Evaluation
Research shows that a thorough examination can identify a probable or possible cause in 60-70% of stillbirths. Even when no definitive cause is found, the evaluation can rule out many possibilities and provide reassurance. The information gathered may also help guide care in future pregnancies.
Maternal Evaluation
Your healthcare provider will likely recommend several tests:
- Complete blood count: To check for anemia, infection, or platelet abnormalities
- Blood glucose or A1C test: To check for undiagnosed diabetes or poor glucose control
- Thyroid function tests: In cases where thyroid disease is suspected
- Kleihauer-Betke test or flow cytometry: To detect fetomaternal hemorrhage (baby’s blood cells in your circulation), which can sometimes cause stillbirth
- Blood antibody screen: To check for red blood cell antibodies that could affect a baby
- Testing for antiphospholipid syndrome: Including lupus anticoagulant, anticardiolipin, and anti-beta2-glycoprotein I antibodies, especially in cases with growth restriction or preeclampsia
- Tests for infection: Based on clinical symptoms or findings, these might include tests for syphilis, cytomegalovirus, parvovirus B19, or listeria
In some situations, your provider might recommend additional specialized tests based on your medical history or specific findings.
Placental Examination
The placenta often provides the most valuable information about what happened. A thorough placental examination includes:
- Gross (visual) examination: Looking at the size, shape, and any obvious abnormalities of the placenta, umbilical cord, and membranes
- Microscopic examination: Examining tissue samples under a microscope to identify inflammation, infection, blood flow problems, or other issues
Placental examination can reveal issues such as placental abruption (separation), blood clots, inflammation from infection, or problems with maternal blood vessels that might have reduced blood flow to your baby.
Fetal Evaluation
External Examination
A careful external examination of your baby can identify:
- Any visible abnormalities or characteristics that might suggest a genetic condition
- Signs that might point to infection or other problems
- Growth patterns (measurements of weight, length, and head circumference)
Autopsy
While difficult to think about, an autopsy often provides crucial information. This examination can:
- Identify internal abnormalities not visible externally
- Detect evidence of infection or other conditions
- Help determine if growth issues affected specific organs
- Find evidence of oxygen deprivation or other problems
You can specify limitations to the autopsy if there are aspects you’re uncomfortable with. Some parents request a limited autopsy focusing only on certain body areas, or may decline autopsy entirely. These decisions are deeply personal, and your healthcare team should respect your choices.
Genetic Testing
Genetic testing has become increasingly important in stillbirth evaluation:
- Chromosomal microarray: This advanced test can detect small genetic abnormalities that might not be visible with traditional karyotyping. It’s particularly valuable because it can be performed even when cells are no longer viable for culture.
- Standard karyotype: This looks at the chromosomes to identify conditions like Down syndrome or other chromosomal abnormalities.
- Specific gene testing: In some cases, testing for specific genetic conditions might be recommended based on findings.
Samples for genetic testing can be collected from the baby, umbilical cord, or placenta. If possible, collecting samples before delivery may provide the best chance for successful testing.
Imaging Studies
- X-rays or other imaging: May be used to identify skeletal abnormalities or other issues
- MRI: Sometimes used when parents decline autopsy or to supplement autopsy findings
Discussing Results
After all tests are completed, your healthcare provider should schedule a follow-up appointment to discuss the results. This typically happens several weeks after the stillbirth when most test results are available. During this appointment:
- Ask for clear explanations of findings in non-medical language
- Bring someone supportive with you if possible
- Consider writing down questions in advance
- Ask about implications for future pregnancies
- Request written summaries of findings for your records
If No Cause Is Found
In about 30-40% of stillbirths, even after thorough evaluation, no definite cause can be identified. This can be particularly difficult to accept. If this happens:
- Remember this doesn’t mean no one tried hard enough to find a cause
- Understand that this doesn’t necessarily mean a higher risk in future pregnancies
- Recognize that even without a specific cause, the evaluation may have ruled out many possibilities
- Know that medical understanding of stillbirth continues to advance
All of these evaluations are your choice. Some parents find that understanding the cause, if possible, helps them process their grief and plan for future pregnancies. Your healthcare providers should explain the purpose and process of each evaluation, answer your questions, and support whatever decisions you make.
Physical Recovery
Your body will go through the same postpartum recovery process as after any birth. You may experience:
- Vaginal bleeding (lochia) for 4-8 weeks
- Breast engorgement and milk production
- Tight fitting bras (sports bra), minimize nipple stimulation, cold packs or compresses can help reduce milk production
- Some choose to pump breastmilk to donate to NICU or other babies in need in memory of their child.
- Abdominal cramping as your uterus contracts back to its pre-pregnancy size
- Hormonal fluctuations that can affect your mood and emotions
- Physical fatigue from the birthing process and grief
Your healthcare provider can offer options to suppress milk production if you wish. Wearing a supportive bra, applying cold compresses, and avoiding breast stimulation can help minimize discomfort until your milk production naturally decreases.
The Grief Journey
Understanding Grief
Grief after stillbirth is complex. You’re not only mourning the loss of your baby but also the future you had imagined. Your grief may include:
- Shock and numbness: Especially in the early days, you may feel disconnected from reality.
- Intense sadness: Waves of sadness may come unexpectedly and intensely.
- Anger: You may feel angry at the situation, healthcare providers, or even at other parents with healthy babies.
- Guilt: Despite knowing intellectually that you didn’t cause the stillbirth, feelings of guilt are common.
- Anxiety: You may experience increased anxiety, including fears about future pregnancies.
- Physical symptoms: Grief can manifest physically through fatigue, sleep disturbances, or appetite changes.
Each Parent’s Grief is Unique
Parents often grieve differently. One parent might express emotions openly while another appears more stoic or focuses on practical matters. These differences can sometimes create tension. Remember that there’s no “right way” to grieve, and recognizing and respecting each other’s grieving style can help you support each other through this difficult time.
The Impact on Your Relationship
The stress of loss can strain relationships, but many couples find that navigating grief together ultimately strengthens their bond. Open communication about your needs and feelings is essential. Consider seeking support together through counseling or support groups specifically for bereaved parents.
Supporting Other Children
If you have other children, they will also experience grief in their own way. Children’s understanding of death varies by age, but even very young children can sense when something is wrong. Honest, age-appropriate explanations using simple language are generally best. Reassure them that they are loved and that the baby’s death was not their fault.
Finding Support
You don’t have to navigate this journey alone. Support can come from many sources:
- Healthcare providers: Your obstetric team, particularly those with training in bereavement care
- Mental health professionals: Therapists or counselors specializing in grief and loss
- Support groups: Connecting with other parents who have experienced stillbirth
- Family and friends: Those who can provide practical and emotional support
- Online communities: Forums and social media groups for bereaved parents
- Faith communities: Religious or spiritual guidance if this is meaningful to you
Organizations like Share Pregnancy & Infant Loss Support, The Compassionate Friends, and Postpartum Support International offer resources specifically for families experiencing stillbirth.
Honoring Your Baby’s Memory
Many parents find comfort in creating ways to honor their baby’s memory:
- Memorial services or ceremonies: Whether religious or secular
- Creating or purchasing memorial items: Such as jewelry, garden stones, or custom artwork
- Planting a tree or garden: A living memorial that grows over time
- Charitable donations or volunteer work: In your baby’s name
- Marking significant dates: Such as the due date, birth date, or other milestones
- Including your baby in family traditions: Such as hanging a special ornament during holidays
Looking to the Future
Returning to Daily Life
The thought of returning to work, social activities, or other aspects of “normal” life may feel impossible right now. When you do return, you might find that some days are manageable while others are overwhelming. Be gentle with yourself during this transition. Consider:
- Communicating your needs: Let colleagues and friends know what feels supportive
- Starting with a modified schedule: If possible
- Having a plan: For handling difficult questions or situations
- Creating space: For moments when grief feels overwhelming
Considering Another Pregnancy
Thoughts about future pregnancies often arise after stillbirth. There’s no “right time” to consider another pregnancy—this is deeply personal. Some parents feel ready relatively soon, while others need more time, and others decide not to pursue another pregnancy. A subsequent pregnancy after loss brings complex emotions: hope mingled with fear, joy alongside grief.
If you do decide to try again:
- Most parents who have experienced stillbirth go on to have healthy subsequent pregnancies.
- Your healthcare provider might recommend additional monitoring during future pregnancies.
- The emotions during a pregnancy after loss can be intense; seek support from providers familiar with pregnancy after loss.
- Remember that a new baby doesn’t replace the baby you lost—your stillborn baby will always be part of your family.
A Note from Dr. Sterling
Many parents grieve not only their baby but also the future they had imagined—first steps never taken, birthdays never celebrated, graduations never attended. While this grief is natural and valid, some find comfort in an alternative perspective: Some lives are very short but have exactly the impact they were meant to have. Every human being doesn’t live for 80+ years; some have brief lives that profoundly touch those around them. Your baby has forever changed you—the way you see the world, how you connect with others, perhaps even your purpose in life. As long as you live, you carry your child with you. Through your transformed heart, your actions, and the compassion you share with others, your baby continues to influence the world. Their impact ripples outward through you, touching lives in ways you may never fully realize. Their life, though brief, was complete in its own way and served its unique purpose in the tapestry of existence.
Hugs,
Dr. Sterling
Final Thoughts
The path of grief is not linear. You may find that grief comes in waves, sometimes when you least expect it. Over time, most parents find that the raw pain softens, making space for both grief and joy to coexist. Your baby’s life, however brief, has meaning and has changed you forever.
Remember that whatever you’re feeling is valid. There is no timeline for grief, no “getting over it.” Instead, many parents speak of learning to carry their grief differently as time passes. Your baby will always be part of you and your family.
Sources
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Heazell AEP, Siassakos D, Blencowe H, et al. Stillbirths: economic and psychosocial consequences. The Lancet, 2016.
Horey D, Flenady V, Heazell AEP, Khong TY. Interventions for supporting parents’ decisions about autopsy after stillbirth. Cochrane Database of Systematic Reviews, 2013.
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