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Stillbirth
 

A stillbirth occurs when a fetus, of mid-second trimester to full term gestational age, which has died in the womb or during labour or delivery, exits the maternal body.

Human stillbirth

Causes

A large percentage of human stillbirths are of unknown causes (S.A.D.S. Sudden Antenatal Death Syndrome), even in cases where extensive testing and autopsy have been performed. Some of the causes that have been found are:

Prenatal diagnosis

A decrease or cease of fetal activity may be an indication of fetal distress or death, though it is not entirely uncommon for a healthy fetus to exhibit such changes, particularly near the end of a pregnancy when there is considerably little space in the womb for the fetus to move about. Still, medical examination, including a nonstress test, is recommended in the event of any change in the strength or frequency of fetal movement, especially a complete cease; most midwives and obstetricians recommend the use of a kick chart to assist in detecting any changes. Fetal distress or death can be confirmed or negated via fetoscopy/doptone, ultrasound, and/or electronic fetal monitoring. If the fetus is alive but inactive, extra attention will be given to the placenta and umbilical cord during ultrasound examination to ensure that there is no compromise of oxygen and nutrient delivery.

Prenatal maternal treatment

An in utero fetal death does not present an immediate health risk to the mother and labour will usually begin spontaneously after two weeks, so the mother may choose to wait and deliver the child naturally. After two weeks, the mother is at risk of developing blood clotting problems, and induction is recommended at this point. In many cases, the mother will find the idea of carrying a dead fetus emotionally traumatizing and will elect to be induced. Cesarean delivery is not recommended unless complications develop during vaginal birth.

Impact on family

As with any loss or traumatic event, particularly those involving one's offspring, a grieving period is to be expected; the mother often experiences a heightened sense of grief after a stillbirth, due to her close proximity to the child at the time of death. Grief reactions can range from normal depression, including misplaced guilt and/or blame, to psychosis, such as experiencing phantom fetal movement or newborn crying, inability to face taking down a nursery, "replacement child syndrome" in which the next child is saddled with the expectations of the "ideal" first child, or "vulnerable child syndrome" in which all subsequent children are seen as fragile and prone to harm or illness.

Everyone responds differently to grief and loss: some individuals cope better with their grief if presented with the option of spending personal time with their child, sometimes bathing, dressing, and taking photos of them; and many parents wish to keep memorabilia such as clothing, hospital bracelets, and/or footprints/ultrasound photos. Often, missing these opportunities (due to traumatic stress, illness, or other factor) or being denied them can compound the loss, and it is important that these options be expressly offered or suggested by the health care providers or others involved with the family. Many hospitals provide a "memory box" that contains a blanket and stuffed toy; these are donated to hospitals, primarily by local organizations concerned with stillbirth and child loss.

If the family has other children, developmental psychology generally suggests that: giving them the opportunity to meet their stillborn sibling allows them to experience the child as a real person and helps them understand death; it is natural for children to ask many questions, which should be answered openly and honestly, and they should be encouraged to share their thoughts and feelings, especially if they seem to be withdrawing; children tend to apply literal interpretations to what they are told, so accurate terminology should be used when discussing the stillborn child, death, and similar subjects, so that the child does not become confused or develop phobias (such as developing a sleeping phobia when a stillborn is referred to as "asleep")

Families may require assistance and/or options in regard to:

  • Early hospital arrangements
  • Funeral plans
  • Crisis intervention, grief counselling, and referral to other support serices

Statistics
  • 20% of mothers go through a long period of depression.
  • 30% of mothers report suicidal thoughts

Prevalence

Stillbirth is a relatively common, but often completely random occurrence. Based on statistical data, it has been found that the mean stillbirth rate in the United States is approximately 1 in 115 births, which is roughly 26,000 stillbirths each year, or one every 20 minutes. In developing countries where medical care can be substandard or completely unavailable, this rate is much higher.

In Australia the stillbirth rate is approximately 1 in every 1000 babies.

In England, Wales and Northern Ireland the stillbirth rate is five babies for every 1,000 births (one in 200 babies). In Scotland the stillbirth rate is six babies for every 1,000 births. (From The National Statistical Office and other sources.)

Legal definitions of stillbirth

United Kingdom

In the United Kingdom, stillbirths must be registered by law. The Stillbirth Definition Act (1992) requires that any ‘child’ expelled or issued forth from its mother after the 24th week of pregnancy that did not breathe or show any other signs of life be registered as a stillbirth. This must be done within 42 days and a Stillbirth Certificate is issued to the parent(s).*

Australia

In Australia any stillborn foetus weighing more than 400 grams, or more than 20 weeks in gestation, must have its birth registered. Should the parents of a stillborn child have children later that live, when registering the newer children's birth they must add SB beside the name of the stillborn child.

United States

In the United States, there is no standard definition of the term 'stillbirth'. In fact, each of the 57 unique reporting areas in the United States have slightly different definitions for 'stillbirth'. The most widely accepted definition of 'Stillbirth' (better known as 'Fetal Death') is this:
"Fetal death" means death prior to the complete expulsion or extraction from its mother of a product of human conception, irrespective of the duration of pregnancy and which is not an induced termination of pregnancy. The death is indicated by the fact that after such expulsion or extraction, the fetus does not breathe or show any other evidence of life, such as beating of the heart, pulsation of the umbilical cord, or definite movement of voluntary muscles. Heartbeats are to be distinguished from transient cardiac contractions; respirations are to be distinguished from fleeting respiratory efforts or gasps."
Forty-one areas use a definition very similar to this definition, thirteen areas use a shortened definition of fetal death, and three areas have no formal definition of fetal death.

See also

Childbirth

Footnotes

External links

Obstetrics

Totgeburt | 死産

 

This article is licensed under the GNU Free Documentation License. It uses material from the "Stillbirth".

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