Understanding stillbirth

There is probably no experience in a woman’s life that typifies tragedy to the same degree as a stillbirth. The sheer sense of hopelessness and raw anguish is difficult to articulate. It all boils down to that most innate role of womanhood which no man can ever share; of bringing forth life and nurturing it. Stillbirth means she has failed in that role. At least, that is how she feels. The self-flagellation is, of-course, desperately unfair, but that is not how she will feel. Stillbirth resulting from the mother’s fault is an exception rather than the rule. Mercifully; stillbirth is uncommon.

In the vast majority of cases of stillbirth, it is completely unexpected and therefore unpredictable. This obviously adds to the weight of the tragedy.

Many parents' anguish is not helped by the fact that, even after the event, extensive investigations that are carried out do not yield the important answer: the cause. This is still true in roughly half the cases of stillbirth.

Getting an explanation does at least have the effect of allowing them to try to come to terms with the loss. It also helps the doctors to give credible and informed advice about the future.

So what do we known about causes of stillbirth?

The identifiable causes can be divided into three broad groups. There are

· Maternal illnesses that are usually known before the event; examples include diabetes or pre-eclampsia. There is therefore room to institute measures to prevent this eventuality. Sometimes the measures fail.

· Fetal problems which may include viral or bacterial infections (usually silent and unrecognized) and cord accidents.

· The third group is where the problem is in the placenta (afterbirth).

Any one of the mentioned potential causes of stillbirth is relatively easy to identify after the event. It is therefore possible to give informed advice to the parents.

There are many support groups which parents in this situation find very useful. Medical science has advanced to a stage where any further reduction in the rate of stillbirth is probably an unrealistic prospect. Efforts are therefore appropriately concentrated on trying to ensure that this sad event does not affect the same mother more than once.

Stillbirth and miscarriage

It is estimated that around 3.2 million children are stillborn around the world every year. That is close to 9 thousand babies every single day. It is a cause of profound grief that normally remains private. However, as the figures show, it is an enormous problem.

It may surprise many that the medical fraternity does not appear to agree as to what stage of pregnancy fetal loss becomes technically a stillbirth.

In Britain and most other countries, survival outside the womb is considered realistically possible only after 24 weeks of gestation. There are documented cases of survival at around 23 weeks gestation but these are a rare exception and far from the norm.

If the fetus dies in the womb before 24 weeks and delivery subsequently occurs; this is regarded as a miscarriage, albeit "late" if it was beyond 16 weeks.

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