Stillbirth – when a baby shows no signs of life – is an extremely sad and distressing time for parents and family, as they deal with the shock, grief and pain of losing a baby. Often, the cause of a stillbirth or whether it could have been prevented is unknown. However, there are things you can do to lower the risk of having a stillbirth.

What is a stillbirth?

A stillbirth is the birth of a baby who has died any time from 20 weeks into the pregnancy through to the due date of birth. The baby may have died during the pregnancy or, less commonly, during the birth.

If the length of gestation (pregnancy) is not known, the birth will be considered a stillbirth if the baby weighs 400 grams or more.

A stillbirth is different from a miscarriage, which occurs when a pregnancy ends before 20 weeks of pregnancy.

What can cause or contribute to a stillbirth?

Unfortunately, it’s often not known what causes a stillbirth. Some of the causes include:

• congenital anomalies, which are conditions that affect the baby's structure (how its body is built) or function (how its body works) while it is developing in the womb
• a premature birth, where the baby is too immature to survive
• fetal growth restriction, where the baby doesn't grow to full potential
• a medical condition of the mother, such as diabetes, renal disease, heart disease or pre-eclampsia
• complications during birth
• problems with the umbilical cord or placenta

There are some things that may increase a woman’s risk of having a stillbirth. These include:

• being obese before pregnancy
• infection
• sleeping on your back during pregnancy
• smoking, drinking alcohol or taking drugs during pregnancy
• a knock or trauma to the mother's abdomen (the tummy area)
• family violence during pregnancy

Can I do anything to prevent a stillbirth?

Even though the cause of a stillbirth is often never known, there are several things you can do that may lower the risk of having one.

Staying healthy and taking folic acid before you become pregnant, as well as avoiding smoking, drinking alcohol and taking drugs are all important.

It is also important that you go to all of your antenatal appointments and screenings for any potential health issues as well as having an ultrasound in early pregnancy, which may detect problems.

If you have high blood pressure or diabetes, you should try to ensure these are well controlled before and during your pregnancy.

You should monitor your baby's movements, especially in the third trimester. If you think your baby's movements have changed, speak to your doctor or midwife immediately.

You should sleep on your side as your pregnancy progresses, especially from 28 weeks. Lying on your back puts pressure on major blood vessels. This can reduce the flow of blood to your womb, and restrict your baby’s oxygen supply. Research has shown that sleeping on your side can reduce the risk of stillbirth by half.

It is also important that you take your birth team's advice on inducing or having a caesarean if your pregnancy goes past the due date.

Possible warning signs

Contact your doctor or midwife immediately if:

• you think your baby has stopped moving or is moving differently or less than usual
• you have strong pain or cramping in your abdomen or back
• you receive a hard knock or blow to your abdomen
• you are bleeding or leaking more discharge than normal from your vagina
• you feel dizzy, experience changes to your vision, or have severe or long-lasting headaches
• your face, feet or hands suddenly swell or you have painful swelling in your legs
• you have severe or ongoing nausea and vomiting that affects your eating or drinking
• you have a fever or chills
• you sense that something doesn't feel right

If you can't contact your doctor or midwife go to the nearest GP or maternity hospital. If you think it is an emergency, phone triple zero (000) for an ambulance.

How is a stillbirth diagnosed?

An obstetrician or midwife will let you know if your baby is not showing any signs of life and will support you while they give you this news.

You will need to give birth to your baby and this, along with the news that the baby has died, is an extremely traumatic time for parents. You may be able to go home for a day or 2 before coming back to the hospital to give birth to your baby.

It's normal to feel a range of emotions, from shock and disbelief to deep sadness and grief.

How is the baby usually delivered?

Your midwife or obstetrician will discuss with you the best way for you to give birth. In most cases, they will suggest inducing a vaginal birth rather than a caesarean.

There are reasons why your midwife or doctor will usually recommend this.

• You can spend precious time with your baby once they are born.
• You can get up and move around earlier than you would with a caesarean.
• You are at less risk of an infection.
• You will have more time to process what has happened, since it may take a day or 2 after you are induced for the birth to begin.

Vaginal birth of a stillborn baby may take longer than with a live baby. You will be able to have pain relief as well as the full support of your care team. Your feelings are important as well as your decisions about the birth.

Your care team will also discuss with you some options for after the baby is born.

Other help

You can call Pregnancy, Birth and Baby on 1800 882 436 to speak to a maternal child health nurse about any concerns you have.

If you have experienced a stillbirth you can get support from SANDS Australia by calling 1300 072 637, 24 hours a day.

Still Aware is an Australian stillbirth awareness organisation, providing education and support to parents and health professionals.