Losing a baby after 20 weeks of pregnancy is called stillbirth. There are things you can do to reduce the risk of stillbirth, but if it has happened, support and resources are available to help you get through this sad and difficult time.
Key points about stillbirth
- A baby is stillborn when they die in the womb after the 20th week of pregnancy or weigh more than 400 grams (where the dates are uncertain).
- Not all the causes of stillbirth are known and it’s not possible to prevent every stillbirth.
- Certain factors may increase the risk of stillbirth and there are things you can do to reduce some of these risks.
- Seek help straight away by calling your midwife or doctor if your baby is not moving as much as usual or you have other signs of concern.
- There is support available to help you through the physical and emotional pain of losing a baby. See our page on things that may help after the loss of a pregnancy.
What causes stillbirth?
There is a lot still unknown about the causes of stillbirth. The following are possible causes:
- Congenital anomalies – problems that affect your baby’s physical development while it is in your uterus (womb). This may involve problems with chromosomes or vital organs such as the brain, kidney or heart.
- Placental problems – the most common of these is placental insufficiency, where the placenta does not provide the necessary nutrients and oxygen to your baby. Sometimes the placenta detaches from the wall of your uterus (called placental abruption) leading to stillbirth.
- Maternal conditions – these include underlying medical conditions such as diabetes, high blood pressure, autoimmune diseases and connective tissue disorders.
- Infection in your baby or placenta.
When should I get help from a midwife or doctor?
If you notice any of the following, get help straight away by calling your midwife or doctor. Do not wait until the next day – contact them now.
- Your baby is not moving as much as usual – a reduction in a baby’s movements can be an important warning sign that a baby is unwell.
- You bleed from your vagina – this could be a sign of a problem with the placenta, cervical changes or an infection.
- You have vaginal discharge that is not normal for you – watery, clear or coloured discharge from your vagina could be your waters breaking or a sign of infection.
- You get blurred vision, severe headache or swelling – these could be signs of pre-eclampsia.
- You have itching, particularly of your hands and feet – this could be a sign of a rare liver condition known as cholestasis of pregnancy.
What happens if my baby dies in my womb?
A baby who has died in your womb (in utero) must still be born. Your doctor will discuss your options with you. Caesarean deliveries are not usually recommended, and as most stillbirth labours need to be induced, many women opt for a vaginal birth using pain relief.
After you have given birth to your stillborn, your doctor will recommend several blood tests and offer a post mortem to try to find a reason for the loss. A consultation may be arranged with an obstetrician about 2 months after the birth to discuss any diagnosis and to make any recommendations for a future pregnancy. You will be offered close monitoring in a future pregnancy.
As well as taking care of these physical aspects, you need to give yourself time to grieve the loss of your baby and the hopes and dreams you had for them. There is no ‘normal’ way to grieve. How ever you are feeling is okay. Read more about things that may help after the loss of a pregnancy and grief and loss.
Funerals and registration
Having a funeral for your baby is a way of recognising their life, however short. A formal goodbye helps you to accept that someone you love has died.
- If your baby dies before 20 weeks of pregnancy (miscarriage) and weighs less than 400 grams, there is no legal requirement to register your baby's birth or to bury them. You are still welcome to hold a funeral.
- If your baby was stillborn after 20 weeks of pregnancy, and/or weighing more than 400 grams (if the dates are uncertain), there is a legal requirement to have their birth registered and to be buried or cremated in an appropriate manner. The death is not registered, but a medical certificate is completed at the hospital. A birth certificate is available to you on request from any Registrar of Births and Deaths.
- If your baby dies after birth up to 28 days of age (neonatal death) you are required to register your baby's birth and your baby must have a burial or cremation. Your baby's death will be registered (usually by a funeral director). A birth and death certificate can be issued on request.
You have to register your baby's birth within 2 months of the birth date.
You can register a birth and apply for a birth certificate online or by sending a form to the Registrar of Births, Deaths and Marriages. Your midwife or nurse will advise you of the steps that need to take place.
If you need support or advice, get in touch with a bereavement service or talk to your midwife or doctor. Support services include:
- Whetūrangitia Information for family and whānau experiencing the death of a baby or child
- Stillbirth and Neonatal Death Support (Sands) Pregnancy, baby and infant loss support
- BabyLoss NZ website and BabyLoss NZ Facebook page for practical advice and information
- Skylight for counselling services
- Grief Centre
- SIDS and Kids
- Miscarriage Support Auckland
- Still Aware
|Dr Alice Miller trained as a GP in the UK and has been working in New Zealand since 2013. She has undertaken extra study in diabetes, sexual and reproductive healthcare, and skin cancer medicine. Alice has a special interest in preventative health and self-care, which she is building on by studying for the Diploma of Public Health with the University of Otago in Wellington.|