Stillbirth: the elephant in the room

A supplement published today in BMC Pregnancy and Childbirth on both the causes and psychological aspects of stillbirth, aims to bring together the most current understanding of this most difficult of situations.

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The death of a baby in the late stages of pregnancy (20-24 weeks or later [update: this originally, incorrectly stated “28 weeks”]) is devastating for parents, and the cause often remains largely elusive.  This lack of understanding is surprising, given that stillbirth is ten times as common as Sudden Infant Death Syndrome (SIDS) and four times as prevalent as Downs Syndrome.

Stillbirth occurs in around 1 out of 160 pregnancies in the US, resulting in 26,000 stillbirths per year. Given that this equates to around one stillbirth every 20 minutes, it’s surprising that we don’t talk about it more.

So do we know what causes stillbirth?

There is still much to understand about why stillbirths occur, but research is making progress in this area.

An article by Stacy and colleagues indicates that changes in sleeping habits, specifically, encouraging pregnant women to sleep on their left side rather than on their back, appear to be related to a reduction in late-stage stillbirths. A finding that’s also been replicated in the UK.

Heazell  discusses placental abnormalities as a major risk factor. He compares the placenta to the ‘black-box’ flight recorder, as much can be learned from the pregnancy following placental examination. He theorizes that  better methods of detecting placental function during pregnancy could help us diagnose abnormalities early on, and so reduce the instances of stillbirth.

The pain of loss

Fifty years ago a stillbirth would have been ‘brushed under the carpet’ and parents told to move on and try again. Thankfully, nowadays we recognize the psychological impact a stillbirth has on not only parents, but also future sibling and grandparents.

In order to ease the pain of loss parents are encouraged to spend time with their baby and say goodbye, whereas in the past parents were told ‘it was best not to see’.  O’Leary tells us parents are now encouraged to talk to future siblings about their older brother/sister and let them know it is OK to grieve.  Bennett and Chichester also recognize the role of grandparents, as supporters of their adult children, and also as grievers in their own right.

What’s next?

Around 50% of women who experience a stillbirth start trying for another baby within a year. Mothers who have suffered a stillbirth in the past are often highly stressed during the next pregnancy.

There can be an element of self-blame associated with a stillbirth, which is difficult to tackle when a large portion of stillbirths cannot be explained, or are attributed to maternal factors such as age, diet and anxiety. Mills discusses maternal stress as a risk factor for stillbirth, and suggests that these mothers will require extra support when going through any future pregnancies.

Maternity services in the UK are stretched, however the value of creating a supportive healthcare environment is highlighted by Ilse and Steen. Training doctors, nurses and midwives on how to help in the case of a stillbirth is essential, but we must not forget they are also emotionally affected by the situation and may need support themselves.

Increasing awareness

While many advances in research and support have been made, stillbirth is still a taboo subject. Warland and Glover suggest that increasing awareness of stillbirth may not only reduce the stigma some women encounter, but can also be the first step in reducing its prevalence.

Healthcare campaigns to address risk factors for SIDS have reportedly reduced cases by around 80% in high income countries, so there’s reason to believe that progress can be made for stillbirth too. After all, how can we change things if we don’t talk about it?

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3 Comments

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Nicole

Thanks for addressing stillbirth Jenny – only, I have to mention that the studies on sleeping positions are not conclusive and so that is not currently thought to be a cause. We have to be careful in suggesting causal relationships, because it can be detrimental to mothers who have suffered a stillbirth and to pregnant women.

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Jenny Egar

Hi Nicole, thanks for reading my blog and for your comments. I have tried to use language that would not suggest a causal relationship, and have instead only suggested the variables show a relationship (e.g. correlational). I am sorry if I appear to suggest causation.

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Nicole

I should also mention that stillbirth is delineated after either 20 or 24 weeks of pregnancy (based on which country the mother gives birth in), not 28 weeks. There are legal implications involved with the handling of the fetus so it’s an important distinction from miscarriage or neonatal loss.

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