A stillborn baby is a baby who dies in the womb after 20 weeks of pregnancy but before or during birth. In the United States, pregnancy loss before 20 weeks is classified as a miscarriage, while loss after that point is classified as a stillbirth. About 1 in every 175 pregnancies in the U.S. ends in stillbirth, with the most recent national data showing a rate of 5.73 per 1,000 births.
The World Health Organization uses a different threshold for international reporting, defining stillbirth as a baby who dies after 28 weeks of pregnancy. This difference matters mostly for global statistics, but within the U.S., the 20-week line is the standard used by hospitals, vital records offices, and the CDC.
What Causes Stillbirth
Stillbirth rarely has a single, simple explanation. A large study published in The Lancet Global Health examined nearly 300 cases with complete samples and found four categories of causes that each contributed to roughly one in five stillbirths: maternal medical conditions (primarily high blood pressure disorders like preeclampsia), infections affecting the placenta and fetus, other placental problems, and obstetric complications such as umbilical cord issues or preterm labor.
The placenta plays a central role in many cases. It delivers oxygen and nutrients to the baby, so when it doesn’t function properly, whether from abnormal blood vessel development, blood clots, or infection, the baby’s supply line is compromised. Sometimes the placenta detaches from the uterine wall too early, a condition called placental abruption, which can cut off blood flow suddenly.
In some cases, genetic abnormalities in the baby are the underlying cause. Structural problems with the baby’s heart, brain, or other organs can also be factors. And in roughly one quarter of cases, even after thorough testing, no definitive cause is found.
Risk Factors
Certain conditions raise the likelihood of stillbirth. High blood pressure, diabetes (both pre-existing and gestational), blood clotting disorders, and infections during pregnancy are among the most significant medical risk factors. Pregnancies that extend past 42 weeks also carry increased risk, as placental function tends to decline after the due date.
Being pregnant with multiples, having a previous stillbirth, smoking, and obesity are additional risk factors. Some of these are modifiable, which is why prenatal care focuses heavily on monitoring blood pressure, blood sugar, and fetal growth throughout pregnancy.
Warning Signs to Recognize
The most important warning sign is a noticeable change in your baby’s movement patterns. Most people start feeling fetal movement between weeks 16 and 20, and those movements typically become more consistent and recognizable over time. There is no specific number of movements considered “normal” because every baby has its own pattern. What matters is recognizing when your baby’s movements slow down, stop, or change from what you’ve come to expect.
A reduction in movement doesn’t always mean something is wrong, but it can be the first sign that a baby is in distress. If you notice a change, contact your maternity care provider immediately so the baby’s wellbeing can be assessed, usually through monitoring the heart rate and checking amniotic fluid levels with ultrasound.
How Stillbirth Is Confirmed
When a baby’s movements stop or a heartbeat can’t be detected during a routine visit, an ultrasound is used to check for cardiac activity. This is the definitive way to confirm that a baby has died in the womb. The experience is devastating, and most providers deliver the news in person during the scan.
After confirmation, you won’t necessarily need to deliver right away. Your medical team will discuss timing and options based on how far along the pregnancy is and your own preferences.
What Happens After a Stillbirth
For losses between 14 and 24 weeks, two approaches are equally safe. One is induced labor, where medication prompts contractions so you deliver the baby intact. This takes longer and involves more time in the hospital, but it allows parents to see and hold their baby. The other is a surgical procedure that requires less time and less direct contact with the pregnancy, though it may require follow-up treatment. Complication rates are similar for both, so the choice often comes down to personal and emotional preferences.
For losses later in pregnancy, induced labor is the standard approach. Most people deliver vaginally. The process can take anywhere from several hours to more than a day, depending on how the body responds to the medication.
Many hospitals offer the option to spend time with the baby after delivery. Parents can hold their baby, take photographs, collect handprints or footprints, and involve family members. These moments, while painful, are something many families later describe as important to their grieving process.
Investigating the Cause
After a stillbirth, your medical team may recommend testing to try to determine why it happened. This typically involves examining the placenta under a microscope, blood tests for the mother, and sometimes a full autopsy of the baby. Each step adds diagnostic information. One study found that clinical history and lab work alone identified a cause in 24% of cases. Adding a detailed placental exam raised that number to 61%. When an autopsy was also performed, a probable cause was identified in 74% of cases.
Agreeing to these investigations is entirely your choice. Many parents find that understanding the cause, when one can be found, helps them process the loss and make informed decisions about future pregnancies.
Reducing the Risk
Not all stillbirths are preventable, but some straightforward steps can lower the risk. Attending all prenatal appointments allows your provider to catch problems like preeclampsia or growth restriction early. Routine screenings for blood pressure, blood sugar, and infections exist specifically to identify conditions that could threaten the pregnancy.
Sleep position in late pregnancy is one area where recent research has offered a concrete, actionable recommendation. A pooled analysis of multiple studies found that women who fell asleep on their backs after 28 weeks had roughly 2.6 times the odds of late stillbirth compared to those who fell asleep on their side. Researchers estimated that about 1 in 10 late-pregnancy stillbirths could be prevented if all women settled to sleep on their side during the last three months. If you wake up on your back, there’s no need to panic. Just roll onto your side and go back to sleep. It’s the position you fall asleep in that matters most, since that’s the one you hold longest.
Paying attention to fetal movement remains one of the simplest and most important things you can do. Getting to know your baby’s typical pattern of kicks, rolls, and stretches gives you a baseline. Any significant change from that baseline is worth a phone call to your provider, no matter the time of day.