What is stillbirth?

In Australia, stillbirth is the birth of a baby who has died any time from 20 weeks into the pregnancy. The baby may have died during the pregnancy or, less commonly, during birth.

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

A miscarriage is when a pregnancy ends before 20 weeks of pregnancy.

Every day in Australia, about 6 babies are stillborn.

What can cause stillbirth?

Unfortunately, we often don't know what causes a stillbirth.

Some of the possible causes of stillbirth include the following.

• Congenital abnormalities — such as a genetic condition or heart condition.
• A premature birth — where the baby is too young to survive.
• A medical condition in the mother — such as diabetes, high blood pressure in pregnancy or pre-eclampsia.
• Problems that can cause bleeding during pregnancy— such as placental abruption or placenta praevia.
• Complications during birth.
• Certain infections.
• Problems with the umbilical cord or placenta.
• Major injury or trauma to the mother's abdomen (the tummy area).

You should be checked early in pregnancy for potential problems. This is so that they can be closely monitored.

Your doctor and midwife will talk with you about monitoring and the best timing for the birth of your baby.

Can the risk of a stillbirth be reduced?

In many cases, the cause of stillbirth is not known. But there are some things you can do that can help lower your chance of stillbirth.

Avoid smoking

Avoid smoking while pregnant. Quitting at any time reduces the risk of harm to your baby.

Go to antenatal appointments

Go to your antenatal appointments, where your doctor or midwife can check your baby's growth.

Regular ultrasound scans may be recommended if your baby isn't growing as expected.

Be aware of your baby’s movements

Be aware of your baby's movements, especially in the third trimester.

Get to know the usual pattern of your baby's movements. If you think your baby's movements have changed, speak to your doctor or midwife immediately.

Sleep on your side

Go to 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 blood flow to your uterus (womb) and restrict your baby's oxygen supply.

Research has shown that going to sleep on your side can reduce the risk of stillbirth compared to going to sleep on your back.

Your doctor or midwife will talk with you about the timing of your birth if you have any risk factors.

When should I see my doctor?

Contact your doctor or midwife immediately if you are pregnant and you:

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

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How is a stillbirth diagnosed?

A stillbirth is diagnosed if your baby's heart has stopped beating. During pregnancy, this can be detected with an ultrasound scan.

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

Grieving the loss of a baby is a very traumatic experience. It's normal to feel a range of emotions, including shock, disbelief, deep sadness, anger and emptiness. There’s no right or wrong way to feel and it's okay for you to take as much time as you need.

The care and support you receive during this time should consider your beliefs and practices. Your preferences and values should be respected. Your healthcare team may include a:

• bereavement midwife
• cultural, religious or spiritual advisor
• bereavement counsellor
• Aboriginal and/or Torres Strait Islander health care worker

How is the baby usually delivered?

If you are still pregnant, you will need to give birth to your baby. This is an extremely traumatic time for parents.

Your midwife or obstetrician will discuss with you the best way for you to give birth. They will also talk about the types of pain relief available. You may be able to go home for a day or 2 before giving birth to your baby.

In most cases, they will suggest inducing a vaginal birth rather than a caesarean birth. This is often due to factors such as physical recovery and future pregnancies. Your feelings are important too as well as your preferences about the birth, so they will also be considered and discussed.

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

Will I be able to see my baby?

If you choose to, you can spend time with your baby after the birth. Studies have shown that, for many parents, this can help you through your grief and the difficult times ahead.

If you feel scared or upset about seeing your baby, your healthcare team can help you. They can answer your questions before you decide what you want to do.

You don’t have to decide straight away whether to see your baby. And you can change your mind. If you decide not to see your baby, you may ask for photos to be taken. That way you can see them in the future when you are ready.

You will be able to hold, bathe, dress and take photos and videos of your baby if you want to. If you haven't named your baby, it can help to do this.

Your midwife will be able to help you if you would like to spend a few days with your baby. You may be able to take them home for a while.

You may want to invite family and close friends to see you and your baby. This can make it easier for them to understand. But for some families this is a very private time. You don’t have to speak to others or have visitors if you don’t want to.

Honouring your baby

It's up to you which keepsakes or mementos of your baby you would like to collect during this time. Your hospital healthcare provider may be able to help you with things like:

• a lock of hair
• your baby's cot name card
• the tape measure used to measure your baby
• their identification bracelet
• your baby's handprints and footprints

You may also choose to:

• write a letter to your baby
• write notes about your baby
• keep a diary
• create a memory box

It's OK for you to leave the memory box at the hospital. Or give it to someone else to look after until you are ready to look at it again.

What other decisions will I need to make?

Bereavement rituals

Your healthcare professionals can support you to arrange bereavement rituals that meet your cultural, religious and spiritual needs. These rituals may include blessings, naming services, baptism and burial or cremation.

There is no rush to make decisions about a funeral or other memorial options. Your hospital can help you with information.

Finding out why your baby died

Your healthcare team may recommend some tests to see if they can find out why your baby died. These tests may involve:

• blood tests from the mother
• examining the placenta and umbilical cord
• doing an autopsy or limited autopsy
• scans or photographs of your baby

An autopsy is a thorough examination of your baby. You don't need to say yes to an autopsy or other tests. But it may be helpful for you to know what happened.

Autopsies are always performed respectfully. You can still hold and spend time with your baby after an autopsy. There are some less invasive autopsy approaches that may be more acceptable to some parents.

You may feel overwhelmed about these tests. Your healthcare team will be able to answer any questions you have. You should have time to think about your choices.

There will be a review of the care you received and any tests you have. The findings will be discussed with you. You should be told when to expect any test results and the review findings.

It's important to know that these tests will not always explain why your baby died. This can be very hard for parents to hear.

Other arrangements

You will receive information and support at the hospital about registering your baby’s birth and death. You can also ask about financial support from Centrelink.

Grieving for your baby

There are many ways people grieve following the loss of their baby. There's no 'right' way to do this. It's personal, and your partner's grief process may be different from yours.

Unfortunately, many bereaved parents report feeling isolated in their grief, and that the magnitude of their loss is not well understood.

Support is very important for parents and families who have a stillborn baby. There is an increased risk of parents having mental health problems such as anxiety, depression and post-traumatic stress.

You will receive bereavement support at the hospital as well as information about future support. Parent support groups are helpful for many parents.

Your doctor may recommend a referral for support with a counsellor, social worker or psychologist with specialist experience.

If, at any stage, your feelings are too overwhelming and you sense that you're not coping, it's important to get professional help.

Your body and future pregnancy

Your body will go through normal post-birth changes in the days and weeks following your birth. You may experience breast changes and bleeding from your vagina. This is a very difficult time physically and emotionally, as your body was expecting to care for and feed your baby. It's important to give your body time to heal.

It's also important to let your doctor or midwife know if you experience:

• heavy bleeding that doesn't stop
• a fever
• painful, red, hot areas or lumps on your breasts

After a time, you may think about another pregnancy. This is normal and doesn't mean you have 'moved on' from your baby. The decision to get pregnant can be difficult. How you approach it, and when to make the decision, is up to you.

If you feel it's time to consider having another baby, check with your doctor about whether your body is ready for pregnancy again.

Resources and support

The death of a baby is highly distressing, and grief is a normal response to stillbirth. Support is very important for parents and families who have experienced a stillbirth:

• If you have experienced stillbirth, you can get support from Red Nose Grief and Loss by calling 1300 308 307.
• Still Aware is an Australian stillbirth awareness organisation, providing education and support to parents and health professionals.
• Stillbirth Foundation Australia also has information and support for families and health professionals.
• The Stillbirth Centre of Research Excellence provides support and information for parents.

Information for parents is also available at:

• ‘Guiding conversations’ is a publication designed to support parents as they navigate difficult conversations and decisions around the time of a baby’s death.

Aboriginal and Torres Strait Islanders

Jiba Pepeny (Star Baby) is a resource made by Aboriginal people for Aboriginal people, supporting your journey after losing Bub.

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