Medicines for Stillbirth

What it is

A stillbirth is when a baby is born dead after 24 completed weeks of pregnancy (a loss before this point is called a miscarriage). It is a devastating experience for parents and families. Stillbirth can happen for a range of reasons, and in some cases despite the pregnancy having seemed healthy; sometimes a cause is found, and sometimes, despite investigation, no clear cause is identified, which can be particularly hard for parents. Some factors are associated with a higher risk of stillbirth — such as certain health conditions in the mother (for example high blood pressure, diabetes, or others), problems with the placenta, certain infections, problems with the baby’s growth or development, and other factors — but stillbirth can also occur without any identifiable risk factor. A stillbirth may be discovered when a baby’s movements have reduced or stopped and the baby’s heartbeat is not found, or during pregnancy or labour. Because reduced or changed baby movements can sometimes be a warning sign, pregnant women are advised to be aware of their baby’s pattern of movements and to contact their maternity unit promptly if they notice their baby moving less or differently — this is important, as prompt assessment can sometimes identify a problem. When a stillbirth occurs or is diagnosed, parents are cared for by the maternity team with compassion and sensitivity, and are supported through the birth and afterwards; the baby is usually born through labour (which is often induced), and parents are given time, choices, and support around seeing, holding, and creating memories with their baby, according to their wishes. Investigations are usually offered to try to find a cause (which can help understanding and future pregnancies), including examination and tests, and, if the parents agree, a post-mortem examination of the baby. Support for grief and bereavement is a vital part of care, both at the time and afterwards, and specialist bereavement support and organisations are available. The key messages are that stillbirth is the loss of a baby after 24 weeks and is a devastating experience, that compassionate care and support are provided, that being aware of and reporting reduced baby movements is important, and that support and investigation into the cause are available.

How it is treated

The care around a stillbirth focuses on compassionate, sensitive support for the parents and family through the birth and afterwards, investigation to try to find a cause, and bereavement support — with awareness of baby movements being an important preventive message during pregnancy. During pregnancy, an important message is awareness of the baby’s movements: pregnant women are advised to get to know their baby’s usual pattern of movements and to contact their maternity unit promptly (at any time, day or night) if they notice their baby is moving less, has stopped moving, or the pattern has changed, as this can sometimes be a warning sign, and prompt assessment (checking the baby’s wellbeing) can occasionally identify and address a problem. Attending antenatal care, and managing any risk factors or conditions, are also part of supporting a healthy pregnancy. When a stillbirth is diagnosed or occurs, the maternity team provides compassionate, sensitive care: parents are supported through what is happening, given clear information and choices, and the baby is usually born through labour (often induced, with pain relief and support). Parents are given time and support to be with their baby, and to make choices about seeing, holding, and creating memories (such as photographs, hand and footprints, and other mementoes) according to their wishes, and are supported in these deeply personal decisions. Practical support and information are provided, including about registering the birth and arrangements. Investigations are usually offered to try to understand why the stillbirth happened — this may include examination of the baby and placenta, blood and other tests, and, if the parents consent, a post-mortem (post-mortem examination) of the baby; finding a cause can help parents’ understanding and inform the care of future pregnancies, though a cause is not always found. Bereavement and emotional support are a central and ongoing part of care — grief after the loss of a baby is profound, and support is available at the time and in the weeks, months, and beyond, including from the maternity and bereavement team, GP, and specialist bereavement support services and charities that support parents through baby loss. Support for future pregnancies is also provided, including additional care and monitoring, and support for the understandable anxiety that a subsequent pregnancy can bring. The reassuring messages, within a devastating experience, are that parents are cared for with compassion and given support, time, and choices, that investigation is offered to try to find a cause, and that bereavement support is available at the time and afterwards — and that, during pregnancy, being aware of and promptly reporting changes in the baby’s movements is an important step.