The Lasting Trauma of Stillbirth

Reviewed by Jacqueline Brooks, MBBCH, MRCPsych

July 24, 2001 -- Eight months into her pregnancy, Shari Green, of Broadview Heights, Ohio, began to feel terrible pains. Her doctor advised her to be hospitalized, and a decision was made to artificially induce the birth.

Unbeknownst to doctors, Green's placenta was in the lower part of the uterus, obstructing the opening to the birth canal. When the birth was induced in the delivery room, pressure on the placenta caused blood vessels feeding the umbilical cord to burst.

"There was blood everywhere," Green recalls. "Within seconds there were ten people in the delivery room trying to figure out what had happened."

Green's child, RyLeigh, bled to death within seconds. "They brought in an ultrasound," she says, "but by that time she was gone."

An estimated 1% of births every year result in stillborn babies -- a tragedy whose horror is impossible to convey for people who experience it, and difficult for friends and relatives to talk about. "It was the worst time in all of our lives," Green says. "There's a stigma attached to talking about it, because people don't know what to say."

Green was lucky to have the support of family and friends, and the consolation of strong religious faith. She became pregnant again soon after, and today her daughter, Mollie, is two.

Not all women do as well. A recent report in the British Journal of Psychiatry finds that a significant number of women who have experienced the trauma of stillbirth will be vulnerable to a serious psychiatric disorder known as post-traumatic stress disorder (PTSD), during a second pregnancy.

PTSD involves distressing and intrusive memories of the trauma, nightmares, avoidance of things that remind them of the event, and a feeling of detachment from others.

In the study, 66 pregnant women who had experienced a previous stillbirth were interviewed for symptoms of PTSD. By the third trimester of the subsequent pregnancy, 20% of the women had a diagnosis of PTSD, according to lead author Penelope Turton, MD, of the department of psychiatry at St. George's Hospital Medical School in London.

"PTSD is a distressing but treatable condition, and women and their doctors should be aware that previous stillbirth is a risk factor in the next pregnancy," Turton tells WebMD.

And the people closest to a mom may have a vital role to play in averting PTSD. "Our study found that perceived lack of support from partner or family at the time of the stillbirth was associated with PTSD in the next pregnancy," Turton tells WebMD.

Psychiatrist Mary Helen Davis, MD, says that friends, relatives and even doctors -- at a loss for how to respond following a stillbirth -- may tell mothers, "What's the problem? Just have another pregnancy."

"A lot of times the loss of a baby to stillbirth is an unrecognized loss," she says. "People may not be aware that a mom can be stuck in an unresolved grief."

Davis says such women are bound to experience fears and concerns about whether the subsequent pregnancy will be successful. And they may experience what she calls "anniversary reactions" -- if the mom lost her child at a particular point in the pregnancy, she is liable to become especially fretful at that point during the subsequent pregnancy.

So when does normal worrying turn into PTSD? Davis says the anxiety associated with normal stress usually resolves in a matter of weeks. If the anxiety is prolonged beyond that, and is accompanied by intrusive thoughts and memories about the trauma, that may be an indication of PTSD.

Davis says psychotherapy can help relieve symptoms of PTSD. And some medications, such as Zoloft, have been approved for both depression and PTSD, and are believed to be safe for use during pregnancy, she says.

Shari Green, who never suffered from PTSD, appears to have resolved her grief. She is active in support groups for other moms who have lost a child to stillbirth, and she urges others to seek out every avenue of help they can, including medical or mental health care.

And, like Davis, she cautions friends of moms who have lost a child from saying what might most easily come to mind: "Don't worry, you're young -- you can have another child."

For Shari and her husband, the memory of RyLeigh is too real to be discarded so easily. Shortly after the death, they buried her at her parent's ranch in Arizona. RyLeigh would have been three on July 15. "We celebrate all her birthdays," her mother says.