Pregnancy is supposed to be a joyous time in one’s life, filled with anticipation, excitement, and even a little trepidation. While pregnancy is usually most of those things, sometimes the unthinkable happens. Anyone who has experienced the loss of a pregnancy or newborn will know that it is undoubtedly one of life’s most difficult losses.
In today’s blog Eve Health Midwife, Paula Dillon, talks about stillbirth and miscarriage, and coping support for parents and their loved ones.
Stillbirth rates and causes
In Australia stillbirth is defined as the birth of a baby without signs of life after 20 weeks gestation. If the length of pregnancy is unknown, the birth will be considered a stillbirth if the baby weighs 400 grams or more and shows no signs of life at birth.
Although a rare occurrence, stillbirth is more common than one might think – according to the Stillbirth Centre of Research Excellence, in Australia one in 137 women who reach 20 weeks gestation will have a stillborn child, and it affects almost 2,200 families each year. Sadly, in the last 20 years there has been little improvement in overall still birth rates in Australia.
In many cases, the cause of stillbirth is not known, however there are risk factors that are associated with stillbirth including:
- Maternal perception of decreased fetal movements (strength or frequency)
- Fetal growth restriction, where baby does not grow to his/her full potential
- Smoking, drinking, or taking drugs during pregnancy
- Congenital anomalies, where the development of the baby has been affected and are present from conception or early in pregnancy
- Medical conditions of the mother such as high blood pressure , diabetes, kidney disease, heart disease or pre-eclampsia (a condition which can develop in pregnancy, and is typically characterised by a sudden onset of high blood pressure and protein in your urine)
- Birth complications
- Prematurity
- Problems with the umbilical cord or placenta
- Maternal age over 35 (but particularly over 40)
- Overweight or obesity
- Infection
- Sleeping on your back during pregnancy (after 28 weeks it is important to settle to sleep on your side, and either side is fine)
- Pregnancy beyond 41 weeks gestation
- Previous stillbirth
- Family violence during pregnancy
For more about stillbirth and some tips on how mothers can lower their risk visit https://www.pregnancybirthbaby.org.au/what-is-a-stillbirth.
Life after stillbirth
Stillbirth is said to be one of the most distressing things that anyone can go through. It is impossible to fathom one day being blissfully pregnant and awaiting the birth of your baby, and the next moment being told “I’m sorry, there is no heartbeat”. But sadly, for approximately 6 mothers every day in Australia, this is the devastating reality.
After confirmation that a baby’s heart has stopped beating during the pregnancy, parents are faced with the decision on how to birth their baby, knowing their baby will be stillborn. Usually a vaginal birth is recommended as there are less risks of bleeding and infection compared to a caesarean birth. The thought of having an induction and going through labour and birth can be very confronting, therefore it is important that you discuss your birth options with your doctor or midwife. Your midwife will often be your first source of support and information, and will be able to provide you with details about various perinatal loss support services such as . Your health care team is there to help you through the birth process (whether it be a vaginal birth or a caesarean section), and to help you make sense of what has happened. Yours and your partners’ feelings are important. Please do not feel afraid to ask for what you want or need.
In many cases, parents have absolutely no idea what they may want or need, as they are devastated and in shock. Your midwife will be able to help guide you with memory-making, and decisions about autopsy. Many parents hold, bath, dress and take photos of baby once their baby is born, or they might have a special ceremony or blessing to name the baby. Some parents also opt to take their baby home for a day or two. Your midwife can help arrange this.
Your midwife will also offer to collect mementos of your baby, such as a lock of hair, hospital ID bracelet, handprints and footprints. Some parents find it helpful to write a letter to their baby, take down special notes about the features of their baby, or create a memory box. SANDS have some information about making memories on their website.
Adjusting to life without the future you were expecting can take time. Grief can feel like a rollercoaster of emotions which may last months or years, and everyone experience grief differently. There is no right or wrong way to grieve the death of a baby or loss of a pregnancy.
Your midwife is there to support you through the difficult process, including offering advice on how to decrease you breast milk production after a stillbirth, or how you can donate your breastmilk to a milk bank to be given to premature babies if you do not wish for your milk to dry up immediately. Your midwife will also help guide you about support and counselling services available after a stillbirth.
Some useful support links for further information and reading about stillbirth include:
- SANDS Australia: https://www.sands.org.au/
- Pregnancy Loss Australia: https://www.pregnancylossaustralia.org.au/
- Heartfelt: https://www.heartfelt.org.au/
- Red Nose Grief & Loss: https://rednosegriefandloss.org.au/ : Queensland Government: https://www.qld.gov.au/health/support/loss/stillbirth
- Stillbirth Foundation Australia: https://stillbirthfoundation.org.au/
Miscarriage rates and causes
In Australia, about 1 in 5 pregnancies end in a miscarriage, which is the loss of a baby before 20 weeks of pregnancy. Sometimes a woman may miscarry without even having realised she is pregnant. Some women can appear quite accepting and pragmatic about miscarriage, but for others, experiencing a miscarriage can be very upsetting.
Common signs of miscarriage include cramping tummy pain, similar to period pain, and/or vaginal bleeding. Although not considered ‘normal’, vaginal spotting in the first trimester is common and does not always mean a miscarriage is imminent.
Many women wrongly blame themselves for a miscarriage, but in most cases it couldn’t have been prevented. Often a miscarriage happens when the baby fails to develop or there’s a chromosomal abnormality. Sometimes miscarriage is caused by other factors such as:
- Hormonal abnormalities Medical conditions such as diabetes or thyroid conditions
- Immune system and blood clotting problems
- Severe infections
- Problem with the cervix or womb.
If you think that you are having a miscarriage, it is important to contact your doctor or midwife or go to your local emergency department. Most women who experience miscarriage go on to have healthy future pregnancies.
For more about miscarriage and the different types that can happen, here is a useful link: https://www.pregnancybirthbaby.org.au/types-of-miscarriage
Coping with miscarriage
As I mentioned, for some women, miscarriage can be emotionally distressing and painful. One may experience a variety of different emotions, and it’s important to know that there is no right or wrong way to feel. Common emotions include sadness, numbness, guilt, anger, relief, disappointment, and denial.
If you miscarry at home, please contact your doctor, midwife, or hospital emergency department. They will be able to tell you whether you should call an ambulance or make your own way to the hospital. If you miscarry in hospital you might like to see your baby, and this is possible depending on the stage of your pregnancy, when the baby died, and whether you had a dilation and curettage.
While you are not legally required to have a funeral or ceremony for a baby that is under 20 weeks gestation, you may choose to have one. Your hospital may also offer bereavement support.
Some couples find their relationships are strengthened after a miscarriage as their shared grief brings them closer together, while other couple may find their relationship suffers due to the different ways each person copes. Sometimes it is hard for friends and family to understand what you have experienced. Please seek professional counselling services if you feel you need. SANDS have some useful information for friends and family supporting you through miscarriage – https://www.sands.org.au/pages/category/supporting-bereaved-families Also, please seek advice from your GP, obstetrician, or midwife if your emotional health is affecting your day-to-day life.
Some useful support links for further information and reading about miscarriage include:
- The Pink Elephants Support Network: https://miscarriagesupport.org.au/
- SANDS: https://www.sands.org.au/
- Pregnancy Loss Australia: https://www.pregnancylossaustralia.org.au/
Sources and links for further reading about miscarriage or stillbirth:
- Stillbirth Centre of Research Excellence: https://www.stillbirthcre.org.au/resources/stillbirth-facts
- Queensland Health: https://www.health.qld.gov.au/news-events/news/helping-families-through-grief-loss-stillbirth
- Health Direct Pregnancy, Birth & Baby (various links)
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