1. What is stillbirth?
2. What are stillbirth facts?
3. What is the frequency of stillbirth compared to SIDS (Sudden Infant Death Syndrome)?
4. What causes stillbirth?
5. What is "unexplained" stillbirth?
6. What are some risk factors for "unexplained" stillbirths?
7. Is stillbirth preventable?
8. What can you do to reduce the risk of stillbirth?
9. What happens after stillbirth occurs?

1. What is stillbirth?

Stillbirths are the deaths of unborn babies. There is no international standard definition for stillbirths. In the United States, a baby who dies after 20 weeks of pregnancy is considered a stillborn. The World Health Organization (WHO) defines stillbirth as death of a baby after 22 weeks of pregnancy or when the baby weighs more than 500 grams.

2. What are stillbirth facts?

Stillbirth Facts:

• One in every 150 births results in a stillborn. This number may be higher due to lack of consistent standard of stillbirth reporting.
• Worldwide, 4.5 million stillbirths occur each year. 12,000 women deliver a stillborn each day. (World Health Organization)
• In the U.S., of the 4 million births a year, there are 26,000 stillbirths. 70 women deliver a stillborn each day. (National Institutes of Health)
• Stillbirths per year roughly equal all infant deaths during first year of life (Centers for Disease Control and Prevention)
• Nationwide, between 1985-2002 stillbirths decreased only 18% compared with a 34% reduction in infant mortality rates. The drop in stillbirth rate is mainly due to better diagnoses and treatment of pregnancy complications such as diabetes, preeclampsia, and blood clotting disorders. (National Institutes of Health)
• African-American women have more than twice the risk of stillbirth than that of white women.
• African-American women 35 years and older have a risk of stillbirth 4-5 times higher than the national average.
• 60% of fetal deaths happen after 28 weeks gestation. The majority of stillbirths occur at or near full term.
• Many stillbirths at term happen in otherwise healthy, low-risk pregnancies
• The cause of death for up to half of stillbirths is undetermined due to a low autopsy rate and no standard data collection.
• In more than half of the states in the U.S., there are no birth or death certificates for stillborns, making stillbirths "invisible."

3. What is the frequency of stillbirth compared to SIDS (Sudden Infant Death Syndrome)?

70 lives a day are lost to stillbirth compared to 7 lives a day lost to SIDS. That is a 10 fold difference.

4. What causes stillbirth?

The cause of death for about half of all stillbirths is undetermined or unexplored. There are no standard guidelines for autopsies and data collection when stillbirths occur.

Some of the most common contributing factors for diagnosable stillbirths are:

• Bacterial or viral infections
• Birth defects and abnormal chromosomes
• Placental problems such as bleeding behind placenta "placental abruption"
• Umbilical cord knots, twists, and compressions
• Intrauterine growth restriction when babies are not growing appropriately

5. What is "unexplained" stillbirth?

Unexplained stillbirths are not unexplored. An unexplained stillbirth happens when thorough postmortem evaluation and autopsies are done and no definitive cause is found. One fourth to half of stillbirths is unexplained. Unexplained stillbirth is the most common category of stillbirth for pregnancy at 28 weeks or later. Fetal deaths do not happen suddenly. Studies show that 50% of unexplained stillbirths are associated with intrauterine growth restriction, where babies are not growing at an appropriate rate; thus there may be a window of opportunity for intervention.

6. What are some risk factors for unexplained stillbirths?

The risk of unexplained stillbirth increases in moms with:

• Previous stillbirth
• Post-term pregnancy
• Cigarette smoking
• Advanced maternal age
• Pre-pregnancy obesity
• Medical conditions such as diabetes, high blood pressure, blood clotting disorders when not detected or treated, lupus
• African-American descent

Other significant fetal risk factors include:

• Growth restricted babies
• Severe birth defects
• Decreased fetal movement
• Decreased blood flow measured by Doppler-ultrasound

7. Is stillbirth preventable?

Prenatal care screening for hypertension and diabetes, advanced maternal age, obesity, smoking, lower socioeconomic status is essential in stillbirth prevention.

Even low risk pregnancies with decreased fetal movements are known for higher risk of fetal distress in labor, for suboptimal growth in utero, and for increased risk of stillbirth.

Medical research supports kick counting as an effective and reliable way to screen fetal well-being during the third trimester in both low- and high-risk pregnancies. If a woman feels less than 10 kicks in 2 hours during the time when the baby is usually active or if there is a significant change in the kick counts pattern, her doctor may recommend further testing. If problems are detected, intervention may be initiated to prevent stillbirth.

The MOMS Study (Study of Maternal Observations and Memories of Stillbirths), with 5000 moms who experienced stillbirths, has found that more than half of the mothers (nearly three quarter had unexplained stillbirths in the third trimester) reported their first reason to believe their baby was not doing well was a reduction in fetal activity. Half of the affected mothers had perceived a gradual reduction of fetal movement several days before the diagnosed fetal death.

8. What can you do to reduce the risk of stillbirth?

At this time, many stillbirths cannot be predicted and the causes are not completely understood. Many stillbirths happen in otherwise low-risk pregnancies. There are a few things pregnant women can do to help reduce the risk of stillbirth:

Discuss Kick Count with your obstetrical provider.

• Your provider may recommend monitoring your baby's activity at around 24-26 weeks if it is a high-risk pregnancy and 28 weeks for a normal pregnancy. If you feel less than 10 kicks (fetal movement) during a two-hour period of the day when your baby is usually most active, or if the baby is moving less than usual, contact your doctor immediately. Do not wait 24 hours.
• Do not smoke, drink alcohol or use drugs (unless prescribed by your doctor).
• Report any vaginal bleeding, leakage, fever or sharp pain.
• If you are past due, discuss delivery options with your doctor. Pregnancy longer than 42 weeks are at increased risk for stillbirth.

9. What happens after stillbirth occurs?

If stillbirth occurs before labor:

• You can wait to go into labor naturally. However, it may take weeks for labor to begin. Your doctor may recommend delivery since serious health consequence can happen if your stillborn is not delivered for an extended amount of time.
• Your doctor can induce labor. This is the most preferred method.
• You can discuss the option of a cesarean section with your doctor.
• An autopsy and placenta evaluation can help in determining the cause of death and may help in stillbirth prevention for the subsequent pregnancies.

Your doctor can help you make a decision best for you and your emotional well-being. Allow yourself time to heal physically and emotionally. Allow family, friends, and support groups to help you get through your sadness and regain your strength.