The term “baby born sleeping” is a gentle, yet heartbreaking, way to describe a stillbirth, which is the loss of a fetus before or during delivery. Stillbirth occurs after the pregnancy has progressed beyond the point of being classified as a miscarriage. This devastating outcome represents a sudden end to a parent’s hopes. Medical professionals seek to understand the circumstances of the loss to provide appropriate care and counseling.
Defining Stillbirth and its Frequency
Stillbirth is medically defined as the death of a fetus after 20 completed weeks of pregnancy. This distinguishes it from a miscarriage, which is the loss of a fetus before the 20th week of gestation. Stillbirths are classified based on timing: early stillbirth occurs between 20 and 27 weeks, and late stillbirth is defined as a loss at 28 weeks or later.
This loss is more common than many realize. In the United States, stillbirth occurs in approximately 1 in every 175 births, accounting for roughly 21,000 cases each year. Globally, about 1.9 million stillbirths occur annually, equating to approximately 1 in 70 total births.
Identifying the Underlying Causes
Stillbirth often results from complex issues involving the placenta, the fetus, or the mother’s health. Placental complications are a common factor, including insufficient blood flow or placental abruption, where the organ prematurely separates from the uterine wall. Placental dysfunction is also frequently linked to fetal growth restriction, where the baby does not grow to its potential size.
The fetus itself may have conditions such as genetic abnormalities or structural birth defects that lead to stillbirth. Issues with the umbilical cord, such as being knotted or compressed, can interrupt the flow of oxygen and nutrients. These cord accidents are more likely to occur later in the pregnancy.
A mother’s pre-existing or pregnancy-related health conditions also contribute to the risk. Known factors include high blood pressure disorders, such as preeclampsia, or uncontrolled diabetes. Infections can sometimes travel to the fetus and cause the loss, including Group B Streptococcus, E. coli, cytomegalovirus (CMV), or toxoplasmosis. Despite thorough investigation, the cause remains unexplained in 25% to 50% of stillbirth cases.
Medical Management and Immediate Next Steps
Confirmation of a stillbirth is typically made through an ultrasound, which shows the absence of fetal cardiac activity. Once the diagnosis is confirmed, medical management focuses on safe delivery of the fetus and supporting the parents’ physical and emotional well-being. Delivery is usually accomplished through induction of labor, using medication to start contractions, though a dilation and evacuation (D&E) procedure may be an option in the second trimester.
A Cesarean section is rarely performed solely for a stillbirth unless a vaginal delivery would threaten the mother’s health. Following the delivery, a comprehensive medical investigation is offered to determine the cause of death. This process involves a detailed examination of the placenta, umbilical cord, and membranes, along with maternal blood tests and genetic analysis.
Parents are offered the option of a fetal autopsy, which provides additional information. Medical teams prioritize compassionate bereavement care, including offering parents the choice to spend time with their baby, hold them, and create memories. Hospitals facilitate memory-making through photographs, handprints, and footprints, and provide referrals to bereavement counselors or support groups.
Reducing Risk and Future Pregnancy Planning
Preventive measures focus on identifying and managing modifiable risk factors. Expectant parents in the third trimester should monitor fetal movement daily, often called “kick counts,” to establish the baby’s normal activity pattern. A noticeable decrease or change in movement is an urgent warning sign requiring immediate medical evaluation.
Managing chronic maternal health conditions like diabetes and hypertension before and during pregnancy is important for risk reduction. Lifestyle adjustments, such as achieving a healthy weight, avoiding smoking, and refraining from alcohol and recreational drug use, also play a part. Research suggests sleeping on the back after 28 weeks may increase risk, prompting recommendations for side sleeping.
For parents who have experienced a stillbirth, a preconception consultation is offered to plan for a subsequent pregnancy. This consultation reviews the investigation findings and creates an individualized management plan to address recurrence risk. While the risk of a second stillbirth is slightly higher, most subsequent pregnancies result in a healthy live birth.