What Is Stillbirth?

Stillbirth—clinically known as intrauterine fetal demise—is the death of a baby at or after the 20th week of pregnancy. Before this time, the death of a baby is called a miscarriage or pregnancy loss.

About 1 in every 160 pregnancies results in a stillbirth in the United States. Half of these will take place at 28 weeks of pregnancy or later.

Types

The three types of stillbirth are classified depending on what stage it happens in. These are:

• Early stillbirth: Between 20 and 27 weeks of pregnancy
• Late stillbirth: Between 28 and 36 weeks of pregnancy
• Term stillbirth: At 37 or more completed weeks of pregnancy

Signs and Symptoms

The first sign that something might be wrong is that you stop feeling your baby kick. However, this does not necessarily mean that there will be a stillbirth. Every baby is different, and there is no specific number of movements that is considered normal.

Healthcare providers may instruct you to track fetal kick counts at least once a day later on in your pregnancy. They may also perform fetal monitoring or ultrasounds to check whether your baby is safe, especially if you have already had a stillbirth. 

Don’t worry if your baby has periods where they don’t move. During both day and night, your baby has sleep periods that mostly last between 20 and 40 minutes where they don’t move. These are rarely longer than 90 minutes.

The only way to know for sure whether a stillbirth has happened before birth is to determine if the baby’s heart is beating, which tends to be done with an ultrasound. 

Stillborn Baby Delivery

If a stillbirth happens while the fetus is in the womb, the next step will be to deliver the fetus. If this happens in the second trimester, before the end of week 27 of pregnancy, there is the option called dilation and evacuation, which is a surgical procedure.

This involves healthcare providers first helping to open and dilate the cervix before inserting instruments into the womb to remove the fetus, placenta, and other pregnancy materials. If this is not an option, then healthcare providers will give medicine to start labor. 

Causes

Some factors are known to cause or contribute to stillbirth, and many stillbirths will have more than one cause. The most likely causes of, or contributors to, stillbirth are:

• Pregnancy and labor complications: These include preterm labor, pregnancy with multiple babies (such as twins or triplets), and separation of the placenta from the womb (placental abruption). In studies, these complications were the more common causes of stillbirths before week 24. They are estimated to be the likely cause of 1 in 3 stillbirths.
• Problems with the placenta: An example of this is not enough blood flow to the placenta. In studies, these deaths tended to occur after 24 weeks of pregnancy. They are estimated to be the likely cause of 1 in 4 stillbirths. 
• Infection: This includes infection in the fetus or placenta, or a serious infection in the pregnant person. Infections are much more likely to be the cause of death in stillbirths before week 24 than in those after. It has been estimated that 10% to 20% of all stillbirths in developed countries, such as the United States, can be attributed to infections.
• Birth defects: A genetic or structural birth defect is identified in 1 of every 5 stillborn fetuses.
• Problems with the umbilical cord: One example is, the cord can get knotted or squeezed, cutting off oxygen to the developing fetus. This tends to occur more toward the end of pregnancy.
• High blood pressure disorders: These include chronic high blood pressure and preeclampsia (pregnancy-induced high blood pressure). Stillbirths linked to this factor are thought to be more common at the end of the second trimester and the beginning of the third, compared with other stages of pregnancy.
• Medical complications in the mother: Medical conditions, such as diabetes, were linked with less than 1 in 10 stillbirths.

In some cases, a probable or even possible cause of stillbirth may not be found, even after extensive testing.

According to a study by the  National Institute for Child Health and Human Development, which examined more than 500 stillbirths that occurred in the United States over two and a half years, the causes of stillbirth could not be determined in 1 in 4 cases.

Risk Factors

Several types of risk factors for stillbirth may increase its likelihood during pregnancy. For high-income countries, like the United States, these include:

• Unrecognized fetal growth restriction, where it is not identified that the fetus is small for its age
• Smoking, drinking alcohol, or use of illicit and/or medical drugs, which has been associated with double or even triple the risk of stillbirth
• Being overweight or obese
• Being older than 35 years old
• Low socioeconomic status
• Experiencing stress, including financial and emotional stress, in the year before the delivery
• High blood pressure before pregnancy
• Diabetes before pregnancy
• Previous stillbirth; however, most people who get pregnant after stillbirth will go on to have healthy babies
• Pregnancy with twins, triplets, or other multiples
• Having conceived through assisted reproductive technology, such as in vitro fertilization (IVF)
• Sleeping in a supine position (on your back)
• Never having given birth before
• Race: Stillbirths are more than twice as likely in the pregnancies of Black women than White women in the United States. The cause of this disparity is unclear, but systemic racism and inequalities in health care may be factors.

Prevention

If you have previously had a stillbirth, the risk of a repeated stillbirth can be lowered through careful monitoring and early delivery. Knowing the cause of the previous stillbirth can also help to reduce this risk.

Work with your healthcare provider to reduce behavioral risk factors that could cause or contribute to another stillbirth, such as obesity or smoking.

A stillbirth case-control study in New Zealand, published in 2017, found that going to sleep on your back increased by nearly four times the overall risk of late stillbirth.

The study found that a public health campaign encouraging women to change their sleeping position and not going to sleep on their back in the third trimester had the potential to reduce late stillbirth by approximately 9%.

Being aware of your baby’s movements so you can contact your healthcare professional if there is any change or reduction in movement is recommended by the American College of Obstetricians and Gynecologists (ACOG). While no specific method is recommended, you might use the Count the Kicks app.

A Word From Verywell

Losing a child through stillbirth can be incredibly difficult and painful. This may be made harder because the cause might not be clear, even after extensive investigation.

Seeking support may help you if you have experienced this loss. You can do this by reaching out to loved ones, seeking treatment with your healthcare provider or a therapist, or finding others who have suffered a similar loss through support groups.