Stillbirth

What is stillbirth?  

Stillbirth is when a baby dies in the womb after 20 weeks of pregnancy. Most stillbirths happen before labor, but a small number happen during labor and birth. Stillbirth affects about 1 in 175 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.

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 healthcare 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. These include diabetes, high blood pressure, obesity, and substance abuse.

Pregnancy conditions and pregnancy history. This includes, being pregnant with more than one baby (twins, triplets, or more), or being pregnant for the first time, intrahepatic cholestasis of pregnancy (ICP), and complications in a previous pregnancy, including miscarriage or stillbirth.

Other risk factors include being older than 35, high levels stress, and environmental exposures (like pollution or extreme heat). Some people who experience stressors like having low income, lack access to healthcare, or belong to ethnic minority groups, experience higher rates of stillbirth.

Health Disparities. 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.

According to data from the CDC (2021), there are major differences in stillbirth rates among different groups. For Black people, the stillbirth rate is nearly double the rate than most groups. These are rates per 1,000 live births and stillbirths. See the data below:

• Non-Hispanic Black, 9.89
• American Indian/Alaska Native people, 7.48
• Hispanic, 4.82
• Non-Hispanic white, 4.85
• Asian, 3.94
• Native Hawaiian or Other Pacific Islander, 9.87

In many cases, social determinants of health and health disparities are related to racism.  

How do you know if your baby is stillborn?

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 healthcare provider right away or go to the emergency room if you have any of these conditions.

Your provider uses ultrasound to check if your baby’s heart rate and movement.

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.

Your provider may recommend:  

• Dilation and evacuation (also called D&E).
• Inducing labor. Most pregnant people with a stillbirth have their providers induce labor soon after they learn of their baby’s death.
• Cesarean birth (also called c-section).

What tests do you get after a stillbirth?

Your provider checks your baby, the placenta and the umbilical cord, and 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, they may recommend an amnio before you give birth. 
• 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.
• Genetic tests.
• 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.

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?

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. Your healthcare provider can help you find a genetic counselor.

Talk to your healthcare provider about what you can do to help to lower your risk of having a stillbirth in another pregnancy. This may include:

• Get a preconception checkup.
• Get treatment for any medical conditions you have.
• Get to a healthy weight before getting pregnant. 
• 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 get pregnant again, your provider monitors you and your baby closely. Your provider may also ask you to do kick counts to help you keep track of how often your baby moves, and 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 preterm birth or stillbirth. Infections that can cause stillbirth include:

• Cytomegalovirus (also called CMV). 
• 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. 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. 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.

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. 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.
• 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?

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 might want to spend private time with your baby and loved ones. You can name your baby, hold them, and take part in cultural or religious traditions, like a baptism. Some families choose to take photos, make footprints, or save locks of hair. You may also be able to keep items like blankets from the hospital. These keepsakes can be comforting and help you remember your baby. Speak with your healthcare team about ways to be with your baby after the birth.

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 healthcare 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 increase your 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)
• 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)
• Journey Program of Seattle Children’s Hospital (support for families after the death of a child)
• 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, 2024