Understanding stillbirth

What is stillbirth?

When a baby dies in utero at 20 weeks of pregnancy or later, it's called a stillbirth. (When a pregnancy is lost before 20 weeks, it's called a miscarriage.) About 1 in 160 pregnancies ends in stillbirth in the United States. Most stillbirths happen before labor begins, but a small number occur during labor and delivery.

If you've recently received the heartbreaking news that your baby has died in the womb, your grief may be overwhelming. To find support, see the last section of this article or see our articles on coping with pregnancy loss and honoring a baby who dies in pregnancy.

How is stillbirth diagnosed?

A pregnant woman may notice that her baby is no longer moving and visit her healthcare provider, or she may find out at a regular prenatal visit. The provider listens for the baby's heartbeat using a handheld ultrasound device called a Doppler. If there's no heartbeat, an ultrasound is done to confirm that the heart has stopped beating and the baby has died.

Sometimes the ultrasound provides information that helps explain why the baby died. The practitioner also does blood tests to help determine – or rule out – potential causes. In addition, you may opt to have an amniocentesis to check for chromosomal problems that might have caused or contributed to the stillbirth. (You're likely to get more complete information about your baby's chromosomes from an amnio than from tissue samples after delivery.)

How is a stillborn child delivered?

Some women need to deliver without delay for medical reasons, but others may be allowed to wait a while, to prepare for delivery or give labor a chance to begin on its own. During this time, their provider follows them closely to make sure they're not developing an infection or blood clotting problems.

Most women, though, choose to have labor induced soon after they learn of their baby's death, either through labor and delivery or through a procedure performed under local or general anesthesia.

Labor and delivery

If a woman's cervix has not begun to dilate in preparation for labor, her caregiver may insert medicine into her vagina to start that process. Then she gets an IV infusion of the hormone oxytocin (Pitocin) to stimulate uterine contractions. The vast majority of women are able to deliver vaginally.

Dilation and evacuation (D&E)

If a woman is still in her second trimester and she has access to an experienced practitioner, she may be able to have the baby's body removed in a procedure known as dilation and evacuation (D&E). During the D&E, she's put under general anesthesia or given IV sedation and local anesthesia while the doctor dilates her cervix and removes her baby.

For women who have a choice between these two delivery options, here are a few factors to consider:

The D&E may be a better choice for women who prefer a rapid, more detached procedure. And in experienced hands, women are less likely to have complications from a D&E than from an induction, though the risk of complications is low for both procedures.

Induction may be a better choice for women who want to experience birth as part of their grieving process and who want the option of seeing and holding their child. In addition, an autopsy of the baby after an induction may provide more clues about the cause of the stillbirth than one done after a D&E.