It’s devastating when a baby dies. Here we explain what stillbirth is, causes and risk factors and advice for preventing it.
What is stillbirth?
A stillbirth is the death of a baby after 24 weeks of pregnancy, before or during birth. If a baby dies before 24 weeks have been completed, it’s called a miscarriage (NHS, 2018).
Many mothers who have a late miscarriage also give birth to their baby and, understandably, feel that this should be called a stillbirth. If you, your partner or friend has experienced a miscarriage or stillbirth there is support available.
How common is stillbirth?
In the UK around one in 225 pregnancies end in stillbirth (Tommy’s, 2018). Women with a BMI over 30 have an increased risk of having a stillbirth, at one in 100 pregnancies (Tommy’s, 2018).
What causes stillbirth?
Some stillbirths are linked to complications with the placenta, a birth defect or the mother's health (Tommy’s, 2018). For others, no cause is found. It can often be hard to find out the cause of death when a baby is stillborn (NHS, 2018).
Causes and risk factors of stillbirth in developing countries
In developing countries, the causes can be slightly different from in developed countries. Infections, poor antenatal care, prolonged labour, inadequate medical intervention and the lack of fetal monitoring during labour are their most common causes of stillbirth (Vaishali and Pradeep, 2008; McClure et al, 2009; Ashish et al, 2016). In these countries, identification and treatment of infections and better obstetric care (especially during labour) would drastically reduce the number of stillbirths (McClure et al, 2009).
Causes and risk factors of stillbirth in developed countries
In developed countries, some maternal risk factors have been identified. But these risk factors combined only account for around 20% of the risk of stillbirth. The remaining 80% of the potential causes remain unexplained (Smith, 2015).
Managing complications of pregnancy and intervention during labour are the most effective in preventing stillbirth (Smith, 2015). These complications include: foetal growth restriction, pre-eclampsia, antepartum haemorrhage and reduced foetal movements (Smith, 2015).
The most efficient way of reducing the risk of stillbirth is to deliver the baby. Yet it’s important to remember that extremely preterm babies are more likely to suffer from various health conditions.
Maternal risk factors associated with stillbirth
The following are maternal risk factors associated with stillbirth, with the highest impact risk factors at the top of the list:
- systemic lupus erythematosus (an autoimmune disease, in which the body's immune system mistakenly attacks healthy tissue)
- renal disease
- trombophilia (an abnormality of blood coagulation that increases the risk of blood clots in blood vessels)
- previous low birth-weight infant
- thyroid disorders
- cholestasis of pregnancy (a liver disease that only occurs in pregnancy, pregnancy hormones affecting the normal flow of bile)
- maternal age (>40 years)
- low socio-economic status
- previous stillbirth
- multiple pregnancy.
Between 24 and 27 weeks’ gestation, the most common causes of stillbirth were:
- infection (19%)
- abruption of the placenta (14%)
- lethal anomalies in the fetus (14%)
- unexplained causes (21%).
After 27 weeks’ gestation, the most common category was ‘unexplained’, followed by low fetal weight and placental abruption (Fretts, 2005).
In terms of reducing potentially preventable stillbirths, the failure to adequately diagnose and manage fetal growth restriction was the most common error (Kady and Gardosi, 2004). This was followed by failure to recognise additional maternal medical risk factors (Kady and Gardosi, 2004).
Keep track of your baby’s movements
The number of your baby’s movements will tend to increase up until 32 weeks of pregnancy. After this, it stays about the same, although the type of movement might change towards the due date.
Stating a ‘normal’ specific number of daily movements for unborn babies is not possible. What is important is recognising your baby’s individual pattern of movements and reporting any changes to your midwife or GP immediately. Changes might be a sign that your baby is unwell.
If you think your baby’s movements have slowed down or stopped, contact
your midwife or maternity unit immediately.
Studies suggest an association between pregnant women’s sleeping position and subsequent stillbirth beyond 28 weeks (NHS, 2018). Mothers who have a stillborn baby are more likely to have gone to sleep lying on their backs the night prior to their baby’s death (Heazell et al, 2018). This could be linked to the fact that sleeping on your back can result in compression of the mother’s inferior vena cava, which leads to reduced blood flow to the baby.
It’s recommended that during pregnancy, women sleep on their left side not on their back.
Although a large proportion of stillbirths remain unexplained, it’s thought you could help reduce the risk by:
- Stopping smoking.
- Avoiding alcohol and drugs during pregnancy – these can seriously affect your baby's development and increase the risk of miscarriage and stillbirth.
- Going to sleep on your left side not on your back – don't worry if you wake up on your back, just turn onto your left side before you go back to sleep.
- Protecting yourself against infection.
- Asking your midwife for information about avoiding certain foods (to help avoid potential infections).
- Attending all your antenatal appointments and giving details about any pre-existing medical conditions. This means midwives can monitor the growth and wellbeing of your baby.
- Being aware of your baby's movements towards the end of pregnancy and reporting any changes to your midwife. If you think your baby’s movements have slowed down or stopped, contact your midwife or maternity unit immediately.
(Fretts, 2005; Smith, 2015)
This page was last reviewed in May 2018.
Our support line offers practical and emotional support with feeding your baby and general enquiries for parents, members and volunteers: 0300 330 0700.
If your baby has died or someone close to you has had a stillbirth, there is support available.
The charity Sands (Stillbirth and Neonatal Death charity) offers a helpline for parents and families affected by stillbirth: 0808 164 3332.
The charity Tommy’s offers a helpline run by midwives who have experience in talking about pregnancy loss and have had bereavement training. Call 0800 0147 800. Monday to Friday, 9am – 5pm.
NHS Choices has more information about stillbirth.
Read our article on coping with stillbirth.
NCT has a Shared Experiences support line, where you can get in touch with someone who has gone through a similar experience and is able to offer understanding and a listening ear. Call 0300 330 0700 from Monday – Friday, 9am – 7pm.
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The Lancet. (2016) Ending preventable stillbirths: An executive summary for the Lancet Series. Available from: http://www.thelancet.com/pb/assets/raw/Lancet/stories/series/stillbirths2016-exec-summ.pdf [Accessed 29th May 2018]
Tommy’s. (2018) Stillbirth research. Available from: https://www.tommys.org/our-organisation/our-research/research-stillbirth [Accessed 29th May 2018]
McClure EM, Saleem S, Pasha O, Goldenberg RL. (2009) Stillbirth in developing countries: a review of causes, risk factors and prevention strategies. The journal of maternal-fetal & neonatal medicine. 22(3):183-190. Available from: https://www.ncbi.nlm.nih.gov/pubmed/19089779 [Accessed 29th May 2018]
Ashish KC, Wrammert J, Ewald U, Clark RB, Gautam J, Baral G, Målqvist M. (2016) Incidence of intrapartum stillbirth and associated risk factors in tertiary care setting of Nepal: a case-control study. Reproductive health. 13(1):103. Available from: https://www.ncbi.nlm.nih.gov/pubmed/27581467 [Accessed 29th May 2018]
Smith G. (2015) Prevention of stillbirth. The Obstetrician & Gynaecologist. 17(3):183-187. Available from: https://www.ncbi.nlm.nih.gov/pubmed/27729208 [Accessed 29th May 2018]
Fretts RC. (2005) Etiology and prevention of stillbirth. American Journal of Obstetrics & Gynecology. 193(6):1923-1935. Available from: https://www.ncbi.nlm.nih.gov/pubmed/16325593 [Accessed 29th May 2018]
Kady M, Gardosi J. (2004) Perinatal mortality and fetal growth restriction. Best Pract Res Clin Obstet Gynaecol. 18:397-410. Available from: https://www.ncbi.nlm.nih.gov/pubmed/30196734 [Accessed 29th May 2018]
Heazell AEP, Li M, Budd J, Thompson JMD, Stacey T, Cronin RS, McCowan, LME. (2018) Association between maternal sleep practices and late stillbirth–findings from a stillbirth case‐control study. BJOG: An International Journal of Obstetrics & Gynaecology. 125(2):254-262. Available from: https://www.ncbi.nlm.nih.gov/pubmed/29152887 [Accessed 29th May 2018]
Gordon A, Raynes-Greenow C, McGeechan K, Morris J, Jeffery H. (2012). Stillbirth risk in a second pregnancy. Obstetrics & Gynecology. 119(3):509-517. Available from: https://www.ncbi.nlm.nih.gov/pubmed/22353949 [Accessed 29th May 2018]
Korde-Nayak Vaishali N, Gaikwad Pradeep R. (2008) Causes of stillbirth. The Journal of Obstetrics and Gynecology of India. 58(4):314-318. Available from: [Accessed 29th May 2018]
Royal College of Obstetricians and Gynaecologists: Perinatal Management of Pregnant Women at the Threshold of Infant Viability (The Obstetric Perspective). Scientific Impact Paper No. 41. Available from: https://www.rcog.org.uk/globalassets/documents/guidelines/scientific-impact-papers/sip_41.pdf [Accessed 29th May 2018]
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Surkan, P. J., Stephansson, O., Dickman, P. W., & Cnattingius, S. (2004). Previous preterm and small-for-gestational-age births and the subsequent risk of stillbirth. New England Journal of Medicine, 350(8), 777-785. Available from: https://www.ncbi.nlm.nih.gov/pubmed/14973215 [Accessed 29th May 2018]
NHS Choices. (2018) What happens if your unborn baby dies. Available from: https://www.nhs.uk/conditions/stillbirth/what-happens/ [Accessed 29th May 2018]
Gov.uk. Register a stillbirth. Available from: https://www.gov.uk/register-stillbirth [Accessed 29th May 2018]
Royal College of Obstetricians and Gynecologists. (2018) Your baby’s movements in pregnancy. Available from: https://www.rcog.org.uk/globalassets/documents/patients/patient-information-leaflets/pregnancy/pi-your-babys-movements-in-pregnancy.pdf [Accessed 29th May 2018]
Tommy’s. (2018) Movements matter. Available from: https://www.tommys.org/pregnancy-information/symptom-checker/baby-moving-less/movements-matter-raising-awareness-fetal-movements [Accessed 29th May 2018]
Tommy’s. (2018) Pregnant after stillbirth. Available from: https://www.tommys.org/pregnancy-information/pregnancy-complications/pregnancy-loss/stillbirth/pregnant-after-stillbirth [Accessed 29th May 2018]
Tommy’s. (2018) The Rainbow Clinic. Available from: https://www.tommys.org/our-organisation/our-research/research-cause/stillbirth-research/rainbow-clinic [Accessed 29th May 2018]