Stillbirth

What is stillbirth?  

Stillbirth is when a baby dies in the womb after 20 weeks of pregnancy. Most stillbirths happen before a pregnant person goes into labor, but a small number happen during labor and birth. Stillbirth affects about 1 in 160 pregnancies each year in the United States.

Who is at risk for stillbirth?  

Stillbirth can happen in any family. We don’t always know why stillbirth affects certain families more than others. Researchers are working to learn more about risk factors for stillbirth.

Risk factors are things that make you at risk for (more likely than others to have) a condition. Having a risk factor for stillbirth doesn’t mean for sure that you will have a stillbirth. But knowing about and reducing your risk factors may help prevent a stillbirth from happening to your baby. Some risk factors are things you can’t change, such as having a stillbirth in a previous pregnancy. Other risk factors are things you can do something about, like quitting smoking. Talk to your health care provider about what you can do to help reduce your risk factors for stillbirth.

According to the Centers for Disease Control and Prevention (also called CDC) and other experts, risk factors for stillbirth include:

Medical conditions

• Being obese. If you have an excess amount of body fat and your body mass index (also called BMI) is 30 or higher, you are considered to have obesity. BMI is a measure of body fat based on your height and weight. To find out your BMI, go to www.cdc.gov/bmi.
• Diabetes. Diabetes is a condition in which your body has too much sugar (called glucose) in the blood.
• High blood pressure. Blood pressure is the force of blood that pushes against the walls of your arteries. Arteries are blood vessels that carry blood away from your heart to other parts of the body.
• Substance abuse. Using certain harmful substances increase the risk of having a stillbirth. For example, smoking, drinking alcohol or using street drugs or prescription painkillers, such as opioids.

Pregnancy conditions and pregnancy history

• You’re pregnant with multiples (twins, triplets or more).
• You have intrahepatic cholestasis of pregnancy (also called ICP). This is the most common liver condition that happens during pregnancy.
• You had complications in a previous pregnancy, like preterm birth, preeclampsia or fetal growth restriction. Preterm birth is a birth that happens too early, before 37 weeks of pregnancy. Preeclampsia is a condition that can happen after the 20th week of pregnancy or right after pregnancy. It’s when a pregnant person has high blood pressure and signs that some of her organs, like her kidneys and liver, may not be working properly. Fetal growth restriction is when a baby doesn’t gain enough weight in the womb before birth.
• You’ve never given birth before.
• You had a miscarriage or stillbirth in a previous pregnancy. Miscarriage is when a baby dies in the womb before 20 weeks of pregnancy.
• You’re pregnant after the age of 35. According to the American College of Obstetricians and Gynecologists (ACOG), studies show that a large number of stillbirths that happen among pregnant people 35 or older are related to congenital or chromosomal conditions.
• You have little social support. Many unmarried people have strong social networks of families and friends who help them. However, some studies have reported a higher risk of stillbirth among unmarried people. Researchers think that this may be because they have less social support.

Health Disparities and Racism

We do not know exactly why, but stillbirth happens more often in some groups compared with others. We call this a health disparity (difference). To understand why these groups are at a higher risk of having a stillbirth we need to look at the social factors affecting them, this is what we call social determinants of health. These are the conditions in which you are born, grow, work, live and age. These conditions affect your health throughout your life. In many cases, social determinants of health and health disparities are related to racism.  

Racism refers to the false belief that certain groups of people are born with qualities that make them better than other groups of people.  

Racism isn’t limited to personal attacks such as ethnic slurs, bullying, or physical assault. In a racist culture, one group of people has more power than other groups. People in the dominant racial or ethnic group make important decisions that affects everyone’s lives. For example, they have a lot of control over the way that schools, health care, housing, laws and law enforcement work. This control means that people in the dominant group are more likely to:

• Have better education and job opportunities
• Live in safer environmental conditions
• Be shown in a positive light by media, such as television shows, movies, and news programs.
• Be treated with respect by law enforcement
• Better access to health care

In contrast, people from racial or ethnic minority groups who live in a racist society are more likely to:

• Experience chronic stress
• Live in an unsafe neighborhood
• Live in areas that have higher amounts of environmental toxins, such as air, water, and soil pollution
• Go to a low-performing school
• Have limited access to healthy foods
• Have little or no access to health insurance and quality medical care
• Have less access to well-paying jobs

The Role of Chronic Stress

Studies have shown that the chronic stress caused by living in a racist culture is a factor in many health conditions, including having a preterm or low-birthweight baby. While some studies and statistics mention race as a risk factor for these conditions, we can’t say that race itself the cause. More research is needed to understand the connections between racism, stress, and health problems.

Rates of Stillbirth

According to data from the CDC (2017), there are there are major differences in stillbirth rates among different groups. For Black people, the stillbirth rate is more than double the rate than other groups, except when compared with American Indian/Alaskan Native people. These are rates per 1,000 live births and stillbirths. See the data below:

• Non-Hispanic Black, 10.32
• American Indian/Alaska Native people, 7.22
• Hispanic, 5.01
• Non-Hispanic white, 4.89 
• Asian or Pacific Islander, 4.29

Being a person of color is not a cause for having a stillbirth. However, communities of color are disproportionately affected by racism. Racism and unequal living conditions affect their health and well-being and puts them at higher risk of pregnancy complications, such as stillbirth.

March of Dimes recognizes that racism and its effects are factors in the health disparities in pregnancy outcomes and babies’ health. We must work together to bring fair, just and full access to health care for all moms and babies.

How do you know if your baby is stillborn?

Signs of a condition are things someone else can see or know about you, like you have a rash or you’re coughing. Symptoms are things you feel yourself that others can’t see, like having a sore throat or feeling dizzy.

The most common symptom of stillbirth is when you stop feeling your baby moving and kicking. Others include cramps, pain or bleeding from the vagina. Call your health care provider right away or go to the emergency room if you have any of these conditions.

Your provider uses ultrasound to see if your baby’s heart has stopped beating. An ultrasound uses sound waves and a computer screen to show a picture of your baby in the womb.  

What are your options for giving birth if your baby is stillborn?

If your baby is stillborn, your provider talks with you about options for giving birth. When and how you give birth depends on how far along you are in your pregnancy, your medical condition and what you think is best for you and your family. Some pregnant people need to give birth right away for medical reasons, but it’s often safe to wait until you go into labor on your own. Labor usually starts within 2 weeks after a baby dies in the womb.

Your provider may recommend:  

• Dilation and evacuation (also called D&E). During this surgical procedure, your provider dilates (opens) the cervix to remove tissue from the lining of the uterus. The cervix is the opening to the uterus (womb) that sits at the top of the vagina. Having a D&E may limit the information your provider can get about your baby’s condition. For example, if you have a D&E, your baby’s provider can’t do an autopsy on your baby.
• Inducing labor. This is when your provider gives you medicine or breaks your water (amniotic sac) to make your labor start. Most pregnant people with a stillbirth have their providers induce labor soon after they learn of their baby’s death. If you decide to wait to go into labor on your own and it doesn’t happen by 2 weeks after your baby’s death, your provider may induce labor to help prevent dangerous blood clots from developing.
• Cesarean birth (also called c-section). This is surgery in which your doctor makes a cut in your belly and uterus to deliver your baby.

What tests do you get after a stillbirth?

Your provider checks your baby, the placenta and the umbilical cord to try to find out why your baby died. The placenta grows in your uterus and supplies the baby with food and oxygen through the umbilical cord. Your provider may ask to do certain tests to try and find out what caused the stillbirth. Tests may include:

• Amniocentesis (also called amnio). In this test, your provider takes some amniotic fluid from around your baby in the uterus. If your provider thinks a genetic condition or an infection in your baby may have caused the stillbirth, she may recommend an amnio before you give birth. Genetic conditions are health conditions that are passed from parents to children through genes.
• Autopsy. This is a physical exam of your baby’s body after death. During an autopsy, a provider checks your baby’s organs for signs of birth defects or other conditions. This may help your provider find out what caused your baby’s death and if you may be at risk of having another stillbirth in the future. It’s common for a provider not to find a cause for stillbirth. Birth defects are health conditions that are present at birth. They change the shape or function of one or more parts of the body. Birth defects can cause problems in overall health, how the body develops or how the body works.
• Genetic tests. Genetic tests to check for genetic conditions in your baby
• Tests for infections on your baby or on the placenta

In addition to checking your baby for medical and genetic conditions, your provider reviews your family health history and any problems or illnesses you had during pregnancy. Your family health history is a record of any health conditions you, your partner and members of both your families have had. Your provider may want to test you for infections, genetic conditions and other medical conditions, like lupus or thyroid problems.

Information from tests on you and your baby may help you if you’re thinking about getting pregnant again. Test results may help your provider find out if there’s a chance that you could have another stillbirth. Even if your provider doesn’t find out what caused your stillbirth, having the tests may help you better understand and cope with your baby’s death. If you have questions about the tests, including their cost, talk to your health care provider.

If you’ve had a stillbirth, can you have a healthy baby in another pregnancy?

Yes. For most people, the chances of having another stillbirth are very low. Less than 1 in 100 people (less than 1 percent) who’ve had a stillbirth go on to have another stillbirth.

If you had a stillbirth and are thinking about having another baby, give yourself time to heal physically and emotionally. Your provider may recommend that you have medical tests to try to find out more about what caused your stillbirth. You may need to wait until after you’ve had these tests to try to get pregnant again.

If you had a stillbirth that was caused by a genetic condition, a genetic counselor can help you understand the condition and the chances of you having another stillbirth. A genetic counselor is a person who is trained to help you understand about how genes, birth defects and other medical conditions run in families, and how they can affect your health and your baby’s health. Your health care provider can help you find a genetic counselor.

Here’s what you can do help to lower your risk of having a stillbirth in another pregnancy:

• Get a preconception checkup. This is a medical checkup you get before pregnancy. It helps make sure you’re healthy when you get pregnant.
• Get treatment for any medical conditions you have.
• Get to a healthy weight before getting pregnant. Your provider can recommend ways to get to a weight that’s right for you.
• Don’t smoke, drink alcohol, use marijuana or other drugs that can be harmful to your pregnancy. Tell your provider if you need help to quit.
• If you have any pain or bleeding from the vagina during pregnancy, call your provider right away.

If you get pregnant again, your provider monitors you and your baby closely. At around 32 weeks of pregnancy, she may ask you to do kick counts to help you keep track of how often your baby moves. Your provider also may do medical tests to check your baby’s heart rate and movements.

What causes stillbirth?

We don’t know what causes many stillbirths, but common causes include:

Infections in the mother or baby. Some infections may not cause signs or symptoms and may not be diagnosed until they cause serious complications, like premature birth or stillbirth. Infections that can cause stillbirth include:

• Cytomegalovirus (also called CMV). This is a kind of herpes virus that you can get by coming in contact with body fluid (like saliva, semen, mucus, urine or blood) from a person who carries the virus. It’s a common infection in young children, but if you get it during pregnancy, it can cause serious problems, like stillbirth.
• Fifth disease. This is a common childhood illness that’s caused by a virus called parvovirus B19. It usually spreads through the air from an infected person’s cough or sneeze.
• Genital and urinary tract infections. These infections affect the urinary tract and genitals (also called sex organs), like the vagina or ovaries. The urinary tract is the system of organs (like the kidneys and bladder) that helps your body get rid of waste and extra fluids. Getting infected with genital herpes for the first time during pregnancy can lead to stillbirth. Genital herpes is a sexually transmitted infection (also called STI) you can get from having sex with someone who’s infected.
• Listeriosis. This is a type of food poisoning.
• Syphilis. This is an STI.
• Toxoplasmosis. This is an infection you can get from eating undercooked meat or touching cat poop.

Problems with the placenta or umbilical cord. Placental problems include infections, blood clots, inflammation (redness, pain and swelling), problems with blood vessels and other conditions, like placental abruption. Placental abruption is a serious condition in which the placenta separates from the wall of the uterus before birth. Placental problems cause about 24 in 100 stillbirths (24 percent). Problems with the umbilical cord include having a knot in the cord or the cord being pinched so that your baby doesn’t get enough oxygen. Problems with the umbilical cord may lead to about 10 in 100 stillbirths (10 percent).

Complications during pregnancy, including:

• Being pregnant longer than 42 weeks
• Diabetes, obesity, high blood pressure and preeclampsia
• Health conditions like lupus, thrombophilias and thyroid disorders. Lupus is an autoimmune disorder. Autoimmune disorders are health conditions that happen when antibodies (cells in the body that fight off infections) attack healthy tissue just about anywhere in the body by mistake. Thyroid disorders affect your thyroid, a gland in your neck that makes hormones that help your body store and use energy from food. Thrombophilias increase your chances of making abnormal blood clots.
• Preterm labor and preterm premature rupture of the membranes (also called PPROM). Preterm labor is labor that begins early, before 37 weeks of pregnancy. PPROM is when the sac around the baby breaks early, causing labor to start.
• Fetomaternal hemorrhage. This is when your baby’s blood mixes with your blood during pregnancy or birth.
• Trauma or injuries (like from a car accident)

Conditions in the baby, including:

• Birth defects and genetic conditions. About 14 in 100 stillborn babies (14 percent) have one or more birth defects, including genetic conditions like Down syndrome.
• Fetal growth restriction
• Not getting enough oxygen during labor and birth
• Rh disease. Rh factor is a protein on the surface of red blood cells. Rh disease happens when a person who doesn’t have the protein (called Rh-negative) is pregnant with a baby who does have the protein (called Rh-positive). Rh disease can be prevented.

How can you deal with feelings of grief after a stillbirth?

Grief is all the feelings you have when someone close to you dies. Having a stillborn baby is a painful loss for a family. But there are things you can do to help you grieve, heal and remember your baby.

After birth, do what feels right for you and your family. You may want to spend time alone with your baby and other family members. You can name your baby, hold your baby, bathe and clothe her and take part in cultural or religious traditions, like baptism. Some families take pictures of their baby, make footprints or save locks of hair. You may be able to keep things from the hospital, like blankets, that were used with your baby. Keepsakes like these can help you and your family remember your baby.

Parents who have a stillbirth need time to grieve. You and your partner may cope with grief in different ways, and you may need help dealing with others as you grieve.

After you leave the hospital, certain things, like hearing names you were thinking of for your baby, seeing the baby’s nursery at home or having your breast milk come in can be painful reminders of your loss. You may need help learning how to deal with these situations and the feelings they create. Ask your health care provider to help you find a grief counselor to help you cope with your baby’s death. Or your hospital may have a loss and grief program for families. Getting counseling can be really helpful to you and your family.

Talking about your feelings with other parents who have had a stillbirth may help you deal with your grief. Visit shareyourstory.org, the March of Dimes online community where families who have lost a baby can talk to and support each other. Sharing your story may ease your pain and help you heal.

Having a stillbirth may make you at risk for postpartum depression (also called PPD). PPD is a kind of depression that some women get after having a baby. Tell your provider if you have signs or symptoms of PPD, like feeling depressed most of the day every day, having little interest in things you normally like to do, or having trouble eating or sleeping.

More information

• From hurt to healing (free booklet from the March of Dimes for grieving parents)
• Share Your Story (March of Dimes online community for families to share experiences with prematurity, birth defects or loss)
• Centering Corporation (grief information and resources)
• Compassionate Friends (support for families after the death of a child)
• First Candle (support for families with children who died of SIDS or preventable stillbirth)
• International Stillbirth Alliance
• Journey Program of Seattle Children’s Hospital (support for families after the death of a child)
• Now I Lay Me Down to Sleep (remembrance photography)
• Perinatal Hospice & Palliative Care (resources for parents who find out during pregnancy that their baby has a life-limiting condition)
• Share Pregnancy & Infant Loss Support (resources for families with pregnancy or infant loss)
• Star Legacy Foundation (support for families who have had a stillbirth)

Last reviewed: October, 2020