Stillbirth (Intrauterine Fetal Demise)

Stillbirth means a baby has died in the womb before being born, from about 20 to 24 weeks of pregnancy onward, depending on local definitions. It is different from an early miscarriage both in timing and in the care that follows. In many cases the first sign is a change or reduction in the baby's movements, which is why we ask every mother to be aware of her baby's normal pattern and to contact us straight away if movements slow or stop — this is never a bother, and prompt assessment matters. Sometimes a stillbirth is discovered at a routine appointment when a heartbeat cannot be found. However it comes to light, you will be met with compassion and clear, honest information at every step.

Stillbirth can happen in pregnancies that seemed entirely healthy, and often no cause is found even after careful investigation. Recognised contributing factors include:

• Placental Problems: The most common identifiable group — the placenta fails to support the baby adequately.
• Fetal Growth Restriction (FGR): A baby not growing as expected is at higher risk, which is why growth surveillance matters.
• Infection: Certain maternal or fetal infections.
• Umbilical Cord Problems: Such as a knot or cord accident, though these are hard to predict.
• Congenital or Genetic Conditions: A structural or chromosomal problem in the baby.
• Maternal Health Conditions: Poorly controlled diabetes, pre-eclampsia, high blood pressure, thyroid disorders, or clotting disorders.
• Other Factors: Advanced maternal age, obesity, smoking, and multiple pregnancy modestly increase risk. Consanguinity may be relevant where a recessive genetic condition is involved.

Even with all our knowledge, a significant proportion of stillbirths remain unexplained, which we understand is deeply frustrating for grieving families.

The diagnosis is confirmed with an ultrasound scan, which allows us to see directly that the baby's heart is no longer beating. Where there is any uncertainty, a second experienced clinician will confirm the finding, because it is essential to be certain. We will explain what we see clearly and gently, and give you time and privacy. This is often first suspected after reduced or absent fetal movements, or occasionally when a heartbeat cannot be detected at a routine check. Once confirmed, we will talk with you — without pressure — about what happens next, and we will also carry out blood tests on you to check your health and to begin looking for a possible cause.

After a diagnosis of stillbirth, in most cases the recommended and safest path is a vaginal birth, as this is generally gentler for the mother's body and recovery than surgery, and allows the best opportunity for investigations. There is usually no immediate rush, and we will discuss timing with you according to your health and your wishes. Labour is typically started with medication to prepare the cervix and induce contractions, and you will have full pain relief, including an epidural if you wish. Throughout, you will be cared for in a private, supported setting. Many parents choose to see and hold their baby, to take photographs, hand and footprints, and other keepsakes — there is no right or wrong choice, and our team will follow your lead and give you time. A caesarean is reserved for specific medical reasons.

After a stillbirth, investigations are offered to try to understand why it happened, both to give you answers and to guide the care of any future pregnancy. These may include a post-mortem (autopsy) examination of the baby, examination of the placenta (placental pathology), genetic testing, and maternal blood tests. A post-mortem is entirely your choice; even a limited examination or placental study alone can be valuable, and we will explain each option sensitively. Grief after stillbirth is profound and lasts far beyond the physical recovery — bereavement support, counselling, and time are all part of healing, and we can connect you with specialist support. When you feel ready to consider another pregnancy, the outlook is genuinely reassuring: the great majority of women who have had a stillbirth go on to have a healthy baby.

During any pregnancy, reduced or absent fetal movements should always prompt you to contact your maternity team the same day — do not wait and do not worry about troubling us. This is the single most important thing you can do. In a pregnancy after a previous stillbirth, we provide a dedicated high-risk pathway with extra growth scans, Doppler assessments of blood flow, closer monitoring, and careful planning of the timing of birth to reduce risk and provide reassurance. At the MFM Unit, Dr. Leanne Bricker and our bereavement-trained team offer compassionate care through loss, thorough investigation for answers, and a closely supported next pregnancy whenever you are ready.