Stillbirth. Just saying the word makes me cringe and take a deep breath to avoid feeling nauseated.
Loss after 20 weeks in pregnancy is medically referred to as stillbirth.
Luckily, the risk of this type of loss is rare. The current rate in the US at 6/1000. Still, it’s a common fear among pregnant women.
Here are the most common conditions associated with stillbirth, and what you and your doctor can do to help lower your risk of a bad out come.
High Blood Pressure and Pre-eclampsia
When I was pregnant, my husband came to only a couple of my prenantal visits. Afterward, he remarked, that they seemed pretty pointless. “All they did was weigh you, check your blood pressure, make you pee and listen to the heart beat.” He said. “It only took 5 minutes.”
I explained to him how much valuable information these routine checks actually gives the doctor. The earliest signs of preeclampsia can show up in these numbers. By intervening early in preeclampsia, we can help improve the safety of delivery and prevent bad outcomes.
Hypertension effects all the blood vessels in the body, including the placenta. Over time it can reduce nutrient flow to the baby.
Preeclampsia is a specific type of hypertension that you get only during pregnancy. It is more common in the final weeks of pregnancy which is one of the main reasons we make you come to the doctor more frequently during the last month.
Attending your regular prenatal visits is the best screening for preeclampsia. If you do have hypertension, then your doctor will often do ultrasounds and nonstress tests to make sure that your baby is doing well.
Diabetes
Much as high blood pressure effects the entire body, so does diabetes. If you have diabetes, it is best to meet with your doctor before conception to optimize your health and review your specific risk. Well controlled blood sugars, frequent ultrasounds and nonstress tests are usually implemented to help reduce your risk of complications.
Gestational diabetes that is controlled only by diet, does not increase your risk of still birth. If insulin is required, then gestational diabetics will also need nonstress tests.
Smoking
Smoking is bad. Don’t do it. It is a completely preventable cause of stillbirth.
If you are having difficulty quitting smoking during your pregnancy, then talk to your doctor about medications or counseling that may help you stop.
Cord Accident
As I deliver a baby, 25% percent of the time the cord is wrapped around the neck. Usually it is only loosely draped and I can easily move it out of the way. Sometimes it is tight and I have to clamp it and perform maneuvers to safely deliver the wee one. When I inform the parents, they often look horrified. I reassure them that this is common. The cord is made of a very pliant rubbery tissue that is designed to withstand the pressures of the womb.
One mom recently said that she had been terrified her last few weeks of pregnancy worrying that her baby might get entangled in its cord and die. This had happened to someone she knew. I realize this an extremely common fear.
A stillbirth due to cord accident is very rare, and is usually not due to the cord around the neck. There is not a way on ultrasound to determine if the baby is at risk for cord accident.
The best precaution is to perform daily movement counts after 28 weeks. There are several ways to do this. Each day you want to make sure that the baby has an active time. We recommend our patients to feel for at least 6 distinct movements in an hour. This doesn’t need to be EVERY hour, just pick one hour during the day when baby is normally active. If you don’t get 6 movements, then lay on your side and drink juice. If he still doesn’t move, then call your provider.
Post Dates
The risk of stillbirth begins to increase if a baby goes more than 7 days past its due date. The risk increases exponentially (200 fold ) if the baby goes more than 2 weeks over the due date. For this reason, we usually recommend induction at 7-10 days overdue.
Other
Genetic conditions such as down syndrome and trisomy 18 are another common cause of stillbirth.
A BMI of >40 is associated with an increased risk of stillbirth. Repeat ultrasounds and nonstress tests are also recommended for morbidly obese women.
And still, a small percentage of stillbirths occur for unknown reasons.
Stillbirth is one of the biggest fears of pregnant women. However, it is very rare. Even if you have one the conditions mentioned, your risk is less than 1%. Most of you are already doing everything you can to help prevent it: attending your regular prenatal visits, not smoking and doing your daily fetal movement counts. If you still struggle with fear, talk to your provider about your specific concerns and see Jessica’s article on Fighting Fear in Pregnancy.
I hope these facts help calm your anxiety but please, let us know how we can be praying for you. Do you find yourself fighting this type of fear in your pregnancy?
For more tips and peace-filled advice like this, check out The Pregnancy and Baby Companion books
You talk about how rare stillbirth is, but the truth is it happens. People just don’t Falk about it at of fear of scares people so others sweep it under the rug with comments about how rare it is. Well my son passed away October 4th 2019. I never gas dmijedof done drugs, didnt drink during pregnancy. Had as low risk of pregnancy as possible. Everything was perfect. My son’s movement never changed or became less. I went to sleep with a baby dancing around and woke up to a baby who was no longer with us. There was no reason for my Maverick’s death. It is being called a medical mystery. 80% of the time fullterm stillbirth has no medical or scientific cause. It is like SIDS in the womb. We need to raise awareness and not just hope it doesn’t happen to us or our friend/family. Since Maverick’s loss I know of 8 other people who have suffered this horrific loss.
Hello Everyone,
My wife and I lost our dear baby boy Sullivan to a cord accident at 32 weeks. Sullivan had three knots and the cord was wrapped around his neck three times.
Unfortunately, there is a LOT of misinformation out there about what can and can’t be seen on an ultrasound. Just because current standard medical practice is to NOT look for something, DOESN’T mean they can’t look for nuchal cords, knots and entanglements. It is an out and out LIE that they “can’t” see these things.
While there may not be any way to know that these risks (visible nuchal cords, knots or entanglements) are going to result in a stillbirth, we know that the risks are increased. If risks are increased, additional measures, such as more frequent Non Stress Tests and Ultrasounds can be implemented.
Please refer to the book by Dr. Jason Collins who has spent the past 20 something years researching this very topic:
https://www.amazon.com/Silent-Risk-Issues-about-Umbilical/dp/1499039115/ref=sr_1_1?s=books&ie=UTF8&qid=1484762436&sr=1-1&keywords=silent+risk
I lost Logan at 37 weeks and 3 days, my doctor trusted machines better than my own judgment, of my own body. Now I have to live my entire life with this hole where my entire life should be. Please count the kicks, I DID and still lost Logan. Your body is your own it will tell you if something does not feel right. DO NOT IGNORE IT. My conversation happened on a Friday I was sent home not to worry with this constant push for me to go the full 40 weeks. That’s all the doctor kept saying, knowing there were other factors already against me, like hypertension, and being hospitalized for decelerations in movement. Trust your body ladies…. Please trust it.
But you don’t offer tips for women who have already been through this heartbreaking experience and it already being too late for our babies. You say it’s rare, but I can count on one hand how many women I know personally who have had a stillbirth. I lost my first son at 34 weeks because of a freak accident placental abruption and had to bury him. No parent should EVER have to go through this! so, how about advice also for women who are pregnant AFTER this retching tragedy how to cope, how to relax, how to ENJOY the subsequent pregnancy? Women who had stillbirths no longer have innocent pregnancies. We can’t. we’re just too much in fear. How about some help on that? thanks
I could use some prayers. This is my fourth and final pregnancy. All of our pregnancies have been IVF due to a congenital birth defect of my husband’s. I am feeling especially nervous these last few weeks – I am 36 weeks now – because it just feels too good to be true. After all those cycles and failed cycles I am so close to have the family I wanted – four kids, twin daughters and now, a second son. I comfort myself with Matthew 7:10 but would love extra prayers for a safe delivery.
My son was stillborn at 37wks 2days…I had very high continuous amounts of stress. Occasional fights with my boyfriend, but mostly with a crazy neighbor. She started stalking me shortly and making up lies about my boyfriend, after she found out that I was pregnant. She would tell me that my boyfriend was trying to kiss or flirt with her and say he didnt want our unborn baby and all kinds of nasty things. I caught her on numerous occasions looking into my windows and another neighbor even told me she would sit outside my door listening to what was going on in our apartment…Some nights she would bang on my window and run. I had to call the police on her a couple of times, but still she continued, they did nothing…Saying she was mentally unstable and I should try to avoid her. This caused me to be on edge all the time, always afraid of where she was or if she was sitting outside my door. We decided that it was best that we moved from there, so I had to get our stuff packed, while trying to take care of my 2 boys I already had while my boyfriend was working. I went to the doctor on a Friday and told him I had been having contractions and he didn’t even check to see if I was dilated, just said that my sons head was really low and I could have him any day and that his heart rate was normal. Two days later I was on the way to my baby shower and noticed my contractions were 5mins apart, so we headed to the hospital. But when they hooked me up to the monitors and were trying to find my sons heartbeat, they could not find it….He had passed. From there I was taken to another hospital an hour away where I delivered him. I has a full autopsy done and they did not find anything wrong with him! I did not mention and they did not ask if I was under any stress while I was pregnant… Now 4 years later after beating myself up, asking myself why I saw an article that said more than a couple stressful events in a pregnant girls life , can cause a stillbirth….Is this true?
Maternal blood clotting issues are a risk factor for stillbirth as well.
Many women don’t know they have clotting genes until they have testing done after a stillbirth or recurrent miscarriages. It can be treated w/ low dose aspirin (should be taken under the direction of a doctor so they can advise you on when in 3rd trimester to stop) and/or injections of blood thinners (heparin or lovenox).
The grandmother I probably inherited the Factor V Leiden gene from had 2 full-term stillbirths.
Hi doctor if my mom was a type 2 diabetic has a stillborn and now im pregnat 20weeks and also have type 2 diabetes how will this affect me can this happen to me?? I have been trying to keep blood suguars low at 135 but maybe 2!a week it will be high
I just lost my son at 27 weeks on 5/17/13. We are waiting for autopsy results. The doctor said he had no physical abnormalities. I have antiphospholipid syndrome but it was being controlled with 80mg 2x daily lovenox.
Amber, I am so sorry for your loss. Praying for you. There are no words.
Thank you for the post. It does ease my fear a little bit. I am 35 weeks pregnant and I have just been diagnosed with gestational diabetes and it hasn’t been able to be controlled with diet and exercise. This is my third child, and my first time with GD. My mother works with a woman who just found out at 38 weeks of pregnancy that her baby was a stillborn due to the cord wrapping around the baby’s neck in the womb. So when I heard this, I naturally got more scared because of my GD. Although,I still fear that, I feel a little better knowing that my chances of a stillborn are less than 1%.
Hi Kris, It is so hard when you hear stories. But it helps to know the statistics. I am praying for you these last few weeks. I too had GD. It’s hard but you will make it. Only a few more weeks to go. Hang in there!! Blessings!
My daughter was born still at 22 weeks+5. We were unaware of any issue until the 20-week ultrasound, when she was measuring over 2 weeks behind. I had an amnio and there were no problems. After she was born I chose not go have an autopsy, but did choose to have the placenta analyzed. It was insufficient, under the 5th% for size, but she had no chromosomal abnormalities. I was tested for clotting disorders and none were detected. My son was born 14 months later via c-section at 37 weeks. He had the cord wrapped 4x around his neck and the doctor said he had never seen a longer cord. Is the abnormally long cord an anomaly or should I worry about tha happening in a future pregnancy?
A long cord is not considered an anomaly and should not be recurrent
Dr. Rupe,
My daughter was born still 3 weeks ago. I was 38+5 weeks gesttion. The cord wastightly wrapped twice around her neck. The was attributed as the cause of her dimise.
What to do? Because I was high risk..10 previous losses, I was seen by perinatal every 48 hrs for NST and ultrasound. Fluid levels never decreased, no cord wrapping was seen, and NST testing was excellent. The night she died, she had vigourus play at midnight with a heart rate of 147bpm..I went to sleep and < 4 hrs later she was gone, I woke up to check heart rate at 4am,,because of my fears from previous losses.
So what to do when testing, kick counting, and everything looks good?
Stillbirth still happens to some of us and is devestating. Do the risks increase now even more?
I am so very sorry for your devastating loss. When death happens because of cord accident, it doesn’t increase the risk of it happening again. You will need to talk to your provider about your specific circumstances and risk.
What do you make of the comment posted above by Connie that babies should not have hiccups everyday past 30 weeks. I am 33 weeks 5 days and my baby still have the hiccups 4+ times per day. I talked my doctor into an ultrasound at 30 weeks and they could see no problems with the cord. I have had an awful dreadful feeling that I will lose this baby since at least the second trimester and I am scared to death.
hi
im really worried im 8 weeks pg and just now found out smoking causes still birth. im worried sick out of my mind as im heavily addicted and i want to stop. is it too late to keep from still birth and can my baby be okay? the doc did a ultrasound at 6 weeks 1 day and said its heart beat was around 140 beats per min. is it a safe idea to cold turkey smoking . as ive smoke 16 yrs .
Yes, you can quit cold turkey! If you are having trouble quitting then talk to your doctor about other resources in your community to help you stop.
i lost my daughter at fullterm 40 + 4 in febuary this year. i have no risk factors and baby had no rish factors we just went in at 40 +4 and were told she had died the day before i had no idea. i wish someone had of told me about stillbirth i didnt know it existed these days in the numbers it does. im now 7 weeks with baby no2 going for first uss today and having anxiety attacks since i woke up. ppl need more awareness babies do die its more common then u would think. but none the less good article!
Hi Tarni,
I am so sorry for your loss. I am praying that you will be able to have peace throughout this pregnancy. Thank you for sharing. Excited to join you on your journey!
This information was very helpful, mostly the reminder that stillbirth happens in less than 1%. The doctors where I live throw this term around almost like there talking about what color the babies hair is or if its a boy or girl, makes me SICK! since stress can add to this condition you would think they would get a clue and take the conversation and risks a little more seriously and with a more gentle approach!
Hi! I am a nursing student and mom of 1. I am very interested in this topic. Would you mind sharing your sources related to the risk of stillbirth after the due date? I would like to know the evidence behind the recommendation for induction at 7-10 days past due date. Thank you!
Best wishes in your studies! Sources: ACOG technicial bulletin #107 (August 2009) & Williams Obstetrics, 22nd Edition page 883. In general for all my posts I also check Up To Date, on online service that summarizes the most recent studies in all topics.
Dr. Rupe,
Thanks for this post. I find it interesting that as you were typing this post, I was undergoing induced labor to deliver a baby that was lost at 16 weeks gestation. As I know this wasn’t considered a still birth, it didn’t quit feel like a miscarriage to me either because I was able to see and hold the baby after delivery. This was my third miscarriage after two live births. However, the other two miscarriages never made it past 6 weeks gestation. At this point, I’m highly confused as to why this is happening. I do have polycystic ovaries which is my only symptom of PCOS. I also had the MaterniT21 test which came back negative. So, who knows what is going on. One day will you write a post about late miscarriages?
Thanks!
I am so very sorry for your loss. Please know that my thoughts and prayers are with you. Yes, I can write more about second trimester losses in the future.
My first granddaughter was stillborn due to an umbilical cord accident (uca) so I am somewhat familiar with the statistics and problems of the umbilical cord and stillbirth. My daughter in law had the hallmarks of a baby in distress and was seen on several occasions by her OB who reassured her all was fine. As they say, hindsight is 20 / 20.
I don’t know if you are familiar with Dr. Jason Collins of The Pregnancy Institute in new Roads, LA, ~ he has been researching the issue of Umbilical Cord Accidents (UCA) for over 20 years. According to research by Dr. Collins and like minded Obstetricians throughout the world, the cord is a definite risk factor contributing to stillbirth and a definite catalyst for stillbirth from 28 weeks onward.
When you think about it, at one time people had a heart attack and died. That was it – no intervention, it wasn’t developed and no one knew the warning signs. Now if you have chest pain and go to the emergency room, the measures taken are incredible. The same is true with a mammogram. Every woman who goes for one knows what the findings may be – but it is better to know why we are going and the importance of the check and deal with the findings – than to be oblivious to the challenge.
All parents to be, as well as, medical personnel should be educated to the possibility and undeniable consequences of an UCA. With 30,000 + stillbirths a year in the USA, and at least 30% of these stillbirths definitely being caused by UCA – it is imperative women are given the facts by their doctors. Once knowledgeable, they can decide their course of action, seek ultrasounds and be proactive for their baby before it is too late. UCAs are not a “rare condition or event” and should be watched for in the last trimester of pregnancy especially. In the words of Dr. Collins, “Why is no one talking about this?”
{paragraph deleted due to containing medically inaccurate information}
Empowering moms to ask simple questions, be proactive and learn how to be their baby’s “guardian“ of the womb is essential. Learning about Group B Strep and CMV ~ and how these potential infections can affect your pregnancy. Just like mammograms and colonoscopies are prevention for the masses, getting to know your baby’s movements can help ensure a happy, healthy and hearty delivery for all. Don’t ever hesitate to call your doctor, midwife or health care team with any questions or concerns you may have. They are there to educate and inform you ~ that’s their job!!! And ~ trust your gut…xo
Connie, I am so very sorry for the loss of your granddaughter.
When I said the risk of cord accident is rare I was referring to the risk being 1/1000… which to me is rare compared to 25% of babies having a nuchal cord (cor around neck). I didn’t mean to marginalize those who had experienced that loss.
I often have patients requesting US to see if ‘the cord is around the neck” near the end of pregnancy. That’s what I was refering to when I said
A stillbirth due to cord accident is very rare, and is usually not due to the cord around the neck. There is not a way on ultrasound to determine if the baby is at risk for cord accident.”
Yes, there are conditions such as monochorionic twins and vasoprevia that are detected at 20 week ultrasound that are predictive of cord event and need further monitoring, but I felt they were beyond the scope of this article.
I agree that kick counts are extremely important and I stress that to all my patients and in the book.
A great resource and a great organization working to fund research that prevents still birth is http://www.starlegacyfoundation.org/
I encourage everyone to check their site out!
Thanks! Great site. BTW We have the same name, I’m “Heather Dawn” as well!
This one’s very informative. I have friends who are having their first babies and I can feel their anxiety towards their pregnancy. Of course, they wouldn’t want their pregnancy to go any wrong. I’d definitely share this article to my friends. Thanks so much for the info!
Wow, thank you for this post. It is such perfect timing. I’m 8 days past my due date and going back to my Dr today to plan an induction. This has been one of my biggest fears lately, and even this morning it was the first thought in my head when I woke up until I felt some reassuring movement. I so appreciate your willingness to take time out of your busy life to share your knowlege and wisdom.