Understanding Stillbirth -- the Basics

Medically Reviewed by Nivin Todd, MD on April 29, 2023
6 min read

Stillbirth is the delivery, after the 20th week of pregnancy, of a baby who has died. Loss of a baby before the 20th week of pregnancy is called a miscarriage.

A baby is stillborn in about 1 in 200 pregnancies. Because many stillbirths happen in what appear to be normal pregnancies, they can be devastating to the parents.

Most women who have a stillbirth will be able to have a healthy baby in their next pregnancy. If the stillbirth was caused by certain chromosomal problems or an umbilical cord problem, the chances of it happening again are small. If the cause was a chronic illness in the mom or a genetic disorder in the parents, the risk is higher. On average, the chance of a successful future pregnancy is more than 90%.

In about half of all cases, the cause of stillbirth is unknown. The causes of a stillbirth that are understood include:

  • Birth defects, with or without a chromosomal abnormality
  • Problems with the umbilical cord; with a prolapsed umbilical cord, the cord comes out of the vagina before the baby, blocking the oxygen supply before the baby can breathe on their own. Or, the cord can knot or wrap tightly around a limb or the baby's neck prior to delivery.
  • Problems with the placenta, which nourishes the baby; in a placental abruption, the placenta separates too soon from the uterine wall.
  • Conditions in the mother like diabetes or high blood pressure, particularly pregnancy-induced high blood pressure, or preeclampsia
  • Intrauterine growth restriction, or IUGR, which puts the fetus at risk of dying from lack of nutrition
  • Severe lack of nutrition
  • Infections during pregnancy
  • Exposure to environmental agents such as pesticides or carbon monoxide
  • A personal or family history of blood clotting conditions like thrombosis, thrombophlebitis, or pulmonary embolism

You may have a higher risk for stillbirth if you have any of these risk factors:

  • A previous stillbirth
  • Alcohol or drug abuse
  • Smoking
  • Obesity
  • Being under age 15 or over age 35

There are usually no warnings before a stillbirth. But the following symptoms could signal a problem:

  • Vaginal bleeding, especially during the second half of pregnancy, may mean there's a problem with your baby. If you have bleeding, call your doctor. But know that many women who have vaginal bleeding during pregnancy have no trouble carrying their babies to term.
  • Lack of movement or a change in the normal activity level of your baby.

Call your doctor if you notice any of the symptoms above.

After the delivery of a stillborn baby, your doctor may ask your permission to examine the baby's body to find out what went wrong. A specially trained doctor called a pathologist will perform an autopsy. This exam may involve special tests, including genetic testing. The results may help you find out your likelihood of a future healthy pregnancy and provide some comfort by answering questions about your baby's death.

This evaluation doesn't need to interfere with any plans you'd like to make for your baby's funeral. Testing is a personal decision to be made after discussing it with your partner, doctor, and supportive family members. You may also find it helpful to talk with a grief counselor for advice and support.

If the stillbirth is due to a genetic disorder, you may be referred to a genetic counselor for further testing. A genetic counselor can review your medical history and provide information about the risk of birth defects in future pregnancies.

If your baby passes away before birth, there are usually several options for delivering the baby. In many cases, there is no need to do this immediately unless you have medical complications. However, your doctor will want to schedule a time in the near future for you to deliver. Most stillborn babies can be delivered vaginally after induction of labor, unless there are specific reasons for cesarean delivery.

If possible, before entering the hospital, consider whether you want special arrangements. You may want a private room or a room away from other women having babies. Think about whether you want to see your baby, give the baby a name, or have photographs taken. This has been a common practice since the 1980s in the belief that doing so helps women adjust to the loss.

After a stillbirth, as with other deliveries, you may experience breast engorgement, discomfort from an episiotomy, depression, and other problems. The combination of recovering physically and emotionally may seem overwhelming.

A stillbirth is an emotionally wrenching experience. A qualified counselor, psychologist, or psychiatrist can help you and your family through this difficult time.

Guilt is a common reaction. Keep in mind that stillbirths are rarely, if ever, caused by something you did or didn't do. It's normal to feel deep grief, anger, and confusion. The loss of your child may strain your marriage. A mental health professional can offer a great deal of help. Also, consider joining a support group where you can talk about your feelings with other parents coping with the death of a baby.

Many stillbirths happen without warning in women without any risk factors. But women at risk for stillbirths -- such as those with diabetes or high blood pressure -- should be watched closely. The baby is checked with every doctor's visit.  Late in pregnancy, the frequency becomes more often, and special monitoring is used - non-stress testing and more frequent ultrasounds. If this exam shows something out of the ordinary, early delivery may prevent a stillbirth. Sometimes, there may be a need for an emergency C-section.

All pregnant women should keep track of the baby's movements several times every day, regardless of other risk factors. This is especially important after the 26th week. If the baby kicks or moves less often, see a doctor right away or go to the hospital.

After a stillbirth, you may want to wait some time before getting pregnant again. Some women who get pregnant in the first 12 months after a stillbirth have high levels of anxiety and depression, both during the pregnancy and up to a year after the birth of a healthy baby.

Depending on the cause of the stillbirth, you may be a "high risk" pregnancy the next time you get pregnant. Seeing a high-risk obstetrician or maternal-fetal medicine specialist may help make the next pregnancy safe and healthy.

Your chances of having a healthy baby are better if you take good care of your health before you get pregnant and you get early, regular, prenatal care. Your doctor will check for infections, review your medical history, and make sure you are treated for any problems.

These steps can help you have a healthy pregnancy:

  • Exercise, eat well, and take 400-800 micrograms of folic acid daily, starting at least 1 to 2 months before getting pregnant.
  • Avoid alcohol and smoking.
  • Take only medications prescribed by your doctor. Never stop any medication without first discussing it with your doctor.
  • Drive carefully and wear a seatbelt.
  • Install a carbon monoxide detector in your home to prevent carbon monoxide poisoning.
  • Avoid food poisoning and other infections. Stay away from ready-to-eat foods such as deli meats and fast foods. If you must eat these foods, be sure they're heated thoroughly. Don't eat soft unpasteurized cheeses, raw foods, or undercooked meats.