Losing a baby late in your pregnancy is devastating. Understanding why fetal demise sometimes occurs is a complex topic that continues to be studied.
Jade Elliott spoke with Dr. Jessica Page, a maternal fetal medicine specialist with Intermountain Healthcare who cares for patients with high risk pregnancies and has studied stillbirths, to discuss what we do and don’t know about stillbirths.
What is a stillbirth? How is it different from a miscarriage?
Stillbirth is defined as fetal death at or after 20 weeks of gestation. Miscarriages refer to pregnancy at 12 weeks or earlier. Early fetal losses (those between 13 and 19 weeks) are sometimes managed similarly to stillbirths.
How common are stillbirths?
Stillbirths are less common than miscarriage. In the U.S., stillbirths happen in about 6 per 1000 pregnancies. It doesn’t sound like a lot, but each loss is devastating, and it happens more often than it should. In the U.S. we continue to study the issue, learn more and work to improve.
What causes stillbirth?
It’s often hard to know the precise cause, as there can sometimes be more than one potential condition and it can be difficult to assign causality. One of the most common potential causes of stillbirth is placental insufficiency. This refers to situations in which the placenta doesn’t work well to provide the fetus with blood and oxygen. This can be due to maternal medical conditions, disruptions such as placental abruption or umbilical cord occlusion. Sometimes preterm labor prior to fetal viability (about 24 weeks) occurs and leads to stillbirth.
What tests can help determine the cause of the stillbirth and why are they important for women and their families?
Identifying a potential cause of death after a stillbirth can help families achieve emotional closure, and can help providers better manage that woman’s future pregnancies. Additionally, better identification of potential causes of death improves our ability to prevent and better understand stillbirth.
As OB providers it is important for us to deliver compassionate and clear information about what tests are most likely to identify a potential cause of death. Families often need time to consider their options and it is helpful to given them multiple chances to ask questions and process the information.
Types of exams and tests
The most useful tests for identifying a potential cause of death are fetal autopsy and placental pathology. Fetal autopsy is an exam of the baby. This can be a difficult topic for patients emotionally and it is important for providers to explain the options and high yield of this exam. The patient can spend as much time as desired with the baby prior to the exam and following the exam, and the incisions are easily hidden with normal baby clothes. This gives families the option to have funeral services or other memorials as desired. There are also options for less invasive exams which may include an external exam only or imaging with MRI. Autopsy can identify fetal anatomic abnormalities, evidence of infection or other pathologic processes leading to the death.
Placental pathology is a detailed microscopic examination of the placenta and umbilical cord. This is very useful for understanding if placental abnormalities or damage led to the stillbirth.
We also recommend genetic evaluation and testing for antiphospholipid syndrome in cases of stillbirth. If abnormal results are found, this may affect management of future pregnancies.
How do these tests help aid in research and help other women?
Understanding causes of stillbirths enables us to better identify targets for prevention of stillbirth and to characterize those pregnancies at the highest risk.
Why are stillbirths especially difficult emotionally?
Pregnancy loss at any point is difficult, but particularly as pregnancy progresses it can be emotionally devastating. It’s important to take time and space for families to grieve. Creating mementoes are helpful for many families as they navigate this grieving process.
How do labor and delivery nurses, OBs and midwives help provide comfort to mothers who experience a stillbirth?
Labor and delivery staff are experienced in all aspects of childbirth, from the joys in celebrating a new birth to comforting those who experience loss. A lot of it is meeting the patient where she and her partner are at that moment and providing the emotional support they need during their grief process. During a difficult time such as this, it’s common not to internalize all the information and details. Giving patients time and opportunity to ask questions and to acknowledge the loss of their child is especially important.
What are Cuddle Cots and how do they help families spend more time with their baby?
Many Intermountain hospitals have Cuddle Cots available, which are basically a special bassinet that provides some refrigeration for a baby who has passed away, which allows the family to spend more time with the baby they’ve lost, before rigor mortis or stiffness of the body sets in. Often they are donated by another family who has experienced a loss. We give patients as long as they want with the baby. We don’t limit that at all. Having the mementoes and support from other moms is also really helpful.
What else should women know about stillbirths?
While rare, it affects more families than you think. It’s important to recognize the role of that child in that family’s life. Just acknowledging the baby and supporting the family and listening without making judgments or commentary are what are often most helpful.
How might the COVID-19 pandemic magnify some of the feelings experienced after a stillbirth?
We find support in being around others. The pandemic has been very isolating, because we’ve reduced the interaction we have with friends and family to help protect each other from the virus. I tell patients to utilize the resources around them and those in their household. Reach out virtually to friends and family. Take it easy on yourself. Take one step at a time.
You may experience a variety of emotions from denial to anger to sadness, to depression to acceptance. If your feelings of depression and sadness are affecting your ability to function or are long-lasting, talk with your doctor. A referral for counseling or other treatment may help.
During the pandemic the numbers of support people allowed in the hospital may be limited. The hospital staff also provides experienced support. Some families may connect virtually with those not present and staff can assist.
What type of behavioral health resources are available?
Intermountain’s Angel Watch Program offers support for women experiencing pregnancy loss.
Women experiencing stillbirth can reach out to Intermountain’s Angel Watch program that offers support for women experiencing fetal demise. The program is staffed by master’s level social workers, nurses, bereavement specialists and chaplains who are available on-call to provide counseling specific to this type of loss, through in-home or virtual visits. The service is free and available to anyone, not just Intermountain patients. For more information call, 801-698-4486 or visit: https://intermountainhealthcare.org/services/women-newborn/resources/angel-watch/
To listen to the Baby Your Baby Podcast about the Angel Watch Program, click here.
Intermountain Emotional Health Relief Hotline number is 1-833-442-2211.
This free general emotional support hotline was started during the COVID-19 pandemic and can be reached seven days a week from 10 am to 10 pm. It connects callers with a trained care coordinator who can provide appropriate self-care tools, peer support, treatment options, crisis resources, and more.
Intermountain Walk-In Behavioral Health Access Centers
If depression or anxiety persists and you don’t have a mental health provider there are some walk in services available.
Intermountain LDS Hospital in Salt Lake, McKay Dee Hospital in Ogden and Dixie Regional Medical Center in St. George offer walk-in general behavioral health access centers that are open 24 hours. Check with other Intermountain behavioral health locations to see if they have urgent appointments available.
The Baby Your Baby program provides many resources for all pregnant women and new moms in Utah. There is also expert advice from the Utah Department of Health and Intermountain Healthcare that air each week on KUTV 2News.