What is stillbirth and its causes?

Stillbirth is one of those topics that’s really difficult to talk about. As a result, there’s not always a lot of conversation around what it is and why it happens. Unfortunately, stillbirth does happen and we want to provide you with information around it. That said, this may be difficult to read for some parents. Please use your own judgement around what might be upsetting or triggering for you.

What is stillbirth?

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We often hear a lot about miscarriages but there’s not as much openness around stillbirth. In Australia, the loss of the baby before 20 weeks is considered a miscarriage. The death of a fetus is considered a stillbirth if it occurs at 20 weeks or if the baby is over 400 grams. This differs from the international definition of stillbirth established by the WHO. The WHO defines stillbirths as “those occurring in the third trimester – born at 28 weeks gestation or more, and/or weighing 1,000 grams or more.”

Generally, there are three categories of stillbirths.

• Early: occurring between 20-27 weeks of pregnancy
• Late: occurring between 28-36 weeks of pregnancy
• Term: occurring after 37 weeks of pregnancy

Stillbirth means that the baby was born already deceased. More often than not, the baby died during pregnancy. A baby that dies during delivery is also considered stillborn. Australia is one of the safest places to give birth and stillbirth is rare but it, sadly, still does happen. According to AIHW, between seven to eight babies per every 1,000 born result in a stillbirth. There’s some good news, though. Neonatal deaths of babies at 28 weeks gestation or more have declined. In Australia, stillbirths that occur after the 28 week mark are considered late gestation stillbirths.

The most common warning signs of a stillbirth are feeling less movement, cramps, pain, and vaginal bleeding. If you have any concerns it is imperative that you contact your care provider immediately.

When to see a doctor

The following symptoms could be signs of an increased risk of stillbirth and should be taken seriously:

• Decreased movement or changes in movement
• Any hard blows to your abdomen like falls or car accidents
• Cramping and/or pain in your abdomen and/or back
• Dizziness, changes in vision, and intense headaches that don’t go away
• Swelling in your extremities (hands, legs, arms, feet, etc.)
• Bleeding
• Nausea or vomiting that affects your ability to keep food and water down
• Fevers and chills

What causes stillbirth?

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It can be really difficult not to spend time worrying that you’ll do something to lead to stillbirth as a pregnant person. It’s important to note that the causes of stillbirths are very rarely due to any act of the pregnant person. It’s important to note that the majority of stillbirths do not occur during labour itself. It’s estimated that 83% of stillbirths occur before the onset of labour and it is highly unlikely that labour itself will cause a baby to be stillborn.

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Congenital anomalies and chromosomal abnormalities

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An estimated 25% of stillbirths are caused by congenital anomalies (also known as birth defects.) The WHO defines these as “structural or functional anomalies that occur during intrauterine life.” Not all congenital anomalies lead to stillbirth. In these circumstances, stillbirth is the way the body responds to a baby that is unlikely to survive after birth. Genetic testing in early pregnancy can help diagnose the potential for certain genetic disorders. Prenatal testing typically involves an ultrasound and blood testing. This can be a really helpful way for pregnant people to assuage concerns about stillbirth due to these types of anomalies and abnormalities.

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Placenta issues

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The placenta is an organ that a pregnant person’s body creates specifically for that pregnancy. The placenta connects to the umbilical cord and is responsible for delivering oxygen and nutrients to the baby, filtering out infections, and serves as a reservoir of additional blood supply for the baby. It’s important to note that in most cases the placenta operates as it’s intended. Placenta issues are more likely in cases of smoking, drug use, a history of diabetes, and high blood pressure. There are two main placenta issues that can lead to stillbirth.

• Placental abruption: This occurs when the placenta separates from the uterine wall prior to birth. Placental abruption doesn’t always lead to stillbirth. Signs include bleeding (not always), pain, contractions, and/or belly or back pain and tenderness. Preeclampsia increases the risk of placental abruption. Your care provider will monitor you closely for preeclampsia throughout pregnancy.
• Placental insufficiency: This is when the placenta doesn’t attach well enough to the uterine wall. This can result in not enough oxygen or nutrition reaching the baby.

Infections

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According to the NHS, viral and bacterial infections can affect fetuses in two ways: they can travel from the vagina into the uterus or they can cause systemic infections in the mother creating risks to the unborn fetus. Infection causes between 10% to 25% of stillbirths in developed countries. An infection may cause stillbirth due to the mother becoming severely ill. High fevers, respiratory distress, or systemic reactions to the illness can cause stillbirth even if the fetus is never infected. In rare cases, the placenta may be affected by systemic illness in the mother resulting in a lack of sufficient oxygen and nutrients reaching the fetus. Stillbirth may occur if the virus or bacteria does reach the baby causing damage to vital tissue and/or organs.

Lifestyle factors

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There are certain behaviours that have been attributed to an increased risk of stillbirth. These behaviours include using alcohol, drugs, and smoking. Other factors include malnutrition during pregnancy and inadequate prenatal care.

Pre-existing conditions

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According to UNICEF, an estimated 10% of stillbirths globally are caused by maternal underlying health conditions. These include diabetes, heart disease, thyroid disease, and obesity. It’s important to note that while these conditions increase the risk of stillbirth, many women with underlying conditions have successful pregnancies.

It’s absolutely heartbreaking to go through a stillbirth. Many women feel shame about their stillborn babies and feel that they were responsible in some way. The vast majority of stillbirths are not due to lifestyle factors but rather genetic anomalies and maternal infections. These circumstances are outside of our control. It’s imperative that those experiencing a stillbirth care for their bodies and minds as they process this trauma.

If you or someone you know needs support after experiencing stillbirth, please visit Stillbirth Foundation Australia.
For more information on mental health conditions in pregnancy visit COPE or contact lifeline 24/7 on 131114 

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